To organize a system is not easy especially in a big system like a HEALTH SYSTEM. Like in my previous post, I already mentioned about the main health services provided basically in Indonesia.
Here, are some Key Components of a well functioning health system:
1) Leadership and governance
· Ensuring that the health authorities responsible for directing the health sector as a whole (not just the public service sector), and to meet the challenges of the future (including unexpected events or disasters) as well as current challenges
· Defining, transparently and inclusively the national health policies, strategy and plan that set a clear direction for the health sector by:
- A formulation of the country’s commitment to high level policy goals (health equity, people-centeredness, sound public health polices, effective and accountable governance)
- A strategy for translating these policy goals into its implications for financing, human resources, pharmaceuticals, technology, infrastructure and service delivery, with relevant guidelines, plans and targets
- Mechanisms for accountability and adaptation to evolving needs
- Effective regulation through a combination of guidelines, mandates, and incentives, backed up by legal measures and enforcement mechanisms;
- Effective policy dialogue with other sectors
- Mechanisms and institutional arrangements to channel donor funding and align it to country priorities
Good governance is only possible with good information on health challenges, on the broader environment in which the health system operates, and on the performance of the health system. This specifically includes timely intelligence on:
- Progress in meeting health challenges and social objectives (particularly equity), including but not limited to household surveys, civil registration systems and epidemiological surveillance
- Health financing, including through national health accounts and an analysis of financial catastrophes and of financial and other barriers to health services for the poor and vulnerable
- Trends and needs for HRH; on consumption of and access to pharmaceuticals; on appropriateness and cost of technology; on distribution and adequacy of infrastructure
- Access to care and on the quality of services provided.
3) Health financing
Health financing can be a key policy instrument to improve health and reduce health inequalities if its primary objective is to facilitate universal coverage by removing financial barriers to access and preventing financial hardship and catastrophic expenditure. The following can facilitate these outcomes:
- A system to raise sufficient funds for health fairly
- A system to pool financial resources across population groups to share financial risks
- A financing governance system supported by relevant legislation, financial audit and public expenditure reviews, and clear operational rules to ensure efficient use of funds
4) Human resources for health
The health workforce is central to achieving health. A well performing workforce is one that is responsive to the needs and expectations of people, is fair and efficient to achieve the best outcomes possible given available resources and circumstances. Countries are at different stages of development of their health workforce but common concerns include improving recruitment, education, training and distribution; enhancing productivity and performance; and improving retention. This requires:
- Arrangements for achieving sufficient numbers of the right mix (numbers, diversity and competencies)
- Payment systems that produce the right kind of incentives
- Regulatory mechanisms to ensure system wide deployment and distribution in accordance with needs
- Establishment of job related norms, deployment of support systems and enabling work environments
- Mechanisms to ensure cooperation of all stakeholders ( such as health worker advisory groups, donor coordination groups, private sector, professional associations, communities, client/consumer groups).
5) Essential medical products and technologies
Universal access to health care is heavily dependent on access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality, which are used in a scientifically sound and cost-effective way. Economically, medical products are the second largest component of most health budgets (after salaries) and the largest component of private health expenditure in low and middle income countries. Key components of a functioning system are:
- A medical products regulatory system for marketing authorization and safety monitoring, supported by relevant legislation, enforcement mechanisms, an inspectorate and access to a medical products quality control laboratory
- National lists of essential medical products, national diagnostic and treatment protocols, and standardized equipment per levels of care, to guide procurement, reimbursement and training
- A supply and distribution system to ensure universal access to essential medical products and health technologies through public and private channels, with focus on the poor and disadvantaged
- A national medical products availability and price monitoring system
- A national programme to promote rational prescribing.
6) Service delivery
Health systems are only as effective as the services they provide. These critically depend on:
- Networks of close-to-client primary care, organized as health districts or local area networks with the back-up of specialized and hospital services, responsible for defined populations
- Provision of a package of benefits with a comprehensive and integrated range of clinical and public health interventions, that respond to the full range of health problems of their populations, including those targeted by the Millennium Development Goals
- Standards, norms and guidance to ensure access and essential dimensions of quality: safety, effectiveness, integration, continuity, and people -centeredness
- Mechanisms to hold providers accountable for access and quality and to ensure consumer voice.
To conclude;
Without strong policies and leadership, health systems do not spontaneously provide balanced responses to these challenges, nor do they make the most efficient use of their resources. The leaders of an organization need to be smart in conducting his/her group.
RESOURCES:
1) http://www.who.int/healthsystems/EN_HSSkeycomponents.pdf
2) http://www.who.int/healthsystems/en/
3) http://cpds.fep.um.edu.my/events/2009/workshop/29042009/PPT%20&%20full%20paper/session%202/03%20-%20Components%20of%20a%20Health%20System.pdf
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