1. Health Systems II: Preparing a Health System to overcome challenges in responding to IHR obligations10 18

2. At the end of this session, you will be able to:
Learning objectives
At the end of this session, you will be able to:
describe the main characteristics of a performing health system and its mechanisms
describe health systems capability to meet IHR
describe the challenges and approaches to a performing health system when confronted with a public health event

3. Outline 1. Health System definition 2. Health System capabilites
3. Health System characteristics
3.1 Health System: Key Elements
3.2 Health System: Performance
3.3 Health System: Financing
3.4 Health system: Human resources
4. Health System Strengthening
5. Reminder: Public health emergency management
6. Reminder: IHR aims and obligations
7. Health System capacities needed for IHR
8. Organisational failings
9. Challenges and strategies: surveillance, reporting and responding
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4. 1. Health System Definition
Definition of a Health System (WHO)
A Health system is the sum total of
all the organizations, institutions and resources
whose primary purpose is to improve health.
Components of a Health System
A health system consists of all organizations, people and actions
Objective of a Health System
The primary intent is to promote, restore or maintain health, including efforts to influence determinants of health as well as more direct health-improving activities.

5. 2. Health System capabilities
Health System capability to meet the IHR
All the building blocks must be in place
and perform
Governance  leadership and management for:
Human Resources  different kinds
Facilities  different levels and kinds, laboratory
Supplies  medicines, technologies
Transport and referral  remote areas
Information & communication
Financing  Funds
Accessible
Affordable
Effective, quality care
Cost-efficient
Coordinated
Rapid response

6. 3. Health System characteristics 3.1 Health systems: Key Elements
Characteristics of a Health System
WHO’s building blocks can be seen as a bicycle wheel. If you take out a paddle, the bicycle will not go. Take out the handle, the bicycle will not work. Intersectoral collaboration is required to make the wheel of IHR implemnetation work.

7. 3.2 Health System: Performance
Performance in a Health System
What is Performance in a Health System?
Relations between functions and objectives of the health system:
measuring populations health
goodness and fairness: why it is important?
How do you measure Performance?
Improving key performance functions:
service delivery
creating resources (investment and training)
financing (collecting, pooling and purchasing)
stewardship
‘The best measure of a health system’s performance
is its impact on health outcomes’
(Margareth Chan, WHO, 2007)

8. 3.2 Health System: Performance (continued)
Improving performance in a Health System
As health systems are highly context-specific,
there is no single set of best practices that can be put forward
as a model for improved performance.
Health systems that function well have certain shared characteristics:
systems functioning efficiently to deliver interventions to those in need
sufficient health workers having the right skills and motivation
financing systems that are sustainable, inclusive, and fair
health care costs should not impoverish households even deeper into poverty
In Strengthening Health Systems to improve Health Outcomes: WHO’s Framework for Action
Extract from the Forword of Margareth Chan, WHO (2007)

9. 3.3 Health System: Financing
Resources &
Financing a Health System:
A global challenge
Some poor income countries in africa and some part of Asia will have poor foundation and resources to implement IHR

10. 3.4 Health system: Human resources
Shortage of skills and Health Workers
Over 25% of countries in the world = severe health workforce crisis
Health workers are inequitably distributed throughout the world and within countries (e.g. more in urban than rural area)
Many countries which need to strengthen their health system are weakened by the brain drain of qualified health professionals
Different levels of workers and task shifting
 Without prompt action the shortage will worsen
Action is needed, such as
More direct investment in training is needed
More efficient use of existing health workforce must be implemented
Retention strategies

11. 3.4 Health system: Human resources (continued)
When looking at Africa, 25% of disease burden was tackled with 3% health workforce with very small proportion of health expenditure. Whereas, for America, 10% diseases burden with high health expenditure was euipped with % of health work force.

12. 4. Health Systems Strengthening
Health System Reforms and Strengthening the Health Systems
What could/might help….
Bringing together “program” and “system” expertise
Well functioning health information
Equitable access to medical products, vaccines and technology
Health financing providing protection of patients and incentives to providers and users
Leadership ensuring strategic policy, regulations and accountability
Open policy discussion with stakeholders and users
Transparency and accountability of the adminstration and of staff
A more effective role of WHO at country level :

13. 4. Health systems Strengthening (continued)
The Primary Health Care Reforms ….are necessary to refocus health systems towards « Health for All »
These four pieces need to work togther to revitalise the health systems.
(WHO Report, Primary Health Care – Now More Than Ever, 2008)

14. 5. Reminder: Public health emergency management
Role of the Health System in IHR implementation
and in Emergency Management Preparedness and Response
This diagram depicts the roles of health system at any point for IHR implemnetation. Most important is the response.

15. 6. Reminder: IHR aims and obligations
IHR Aims to prevent, protect against, control and
provide public health responses to
Public Health Events of International Concern (including emerging and re-emerging diseases)
Obligations
1 Surveillance and immediate and ongoing reporting
2 Health service response including points of entry
Performance

16. 6. Health system capacities needed for IHR
Health Systems are closely linked to Core Capacities required under the IHR
1. National Legislation
2. Policy and Co-ordination
3. Surveillance Capacity
4. Preparedness
5. Response
6. Risk Communication
7. Laboratory
8. Human Resource Capacity
Some central challenges of a Health System:
Workforce shortage
Financing
Access (e.g. primary care)
Equity/Solidarity
Stewardship
Need to be systematic and organised
Requires exceptional leadership and management

17. Organizational Failings
8. Challenges
Organizational Failings
Deficient health policies
Difficulties in priority setting
Lack of resources
Lack of coordination between health system components
Partners’ funding and support not aligned with national priorities
Weak implementation capacity and weak country systems (Public financial management, National procurement system and civil sector)
Poor and unsafe delivery

18. 9. Challenges and strategies
Challenges and strategies: surveillance & reporting
Active or passive surveillance – maintaining vigilance
Role of community health workers – not purpose specific
Ability to identify diseases
Prompt reporting – use of mobile communications
Confirmation team ready

19. 9. Challenges and strategies (continued)
Challenges and strategies: response
Properly planned for? Organizational plan? Co-ordination, NGOs, development partners, call centre, response teams, referrals
Visible leadership – public advocacy, staff motivation, problem solving, maintaining human dignity, mobilizing facility and human resources capacity, morale
Trained human resources – which health workers do what
Medicines and vaccines – procurement and supply
Communication – health workers, public
Financing the response
Points of entry and travel

20. Thank you! Eric Buch Professor of Health Policy and Management
Some slides from:
Dr Astrid Stuckelberger with the collaboration of Prof. Philippe Chastonay
Institute of Social and Preventive Medicine Faculty of Medicine of the University of Geneva Switzerland.
In collaboration with
Dr. Paolo Piva,
Department for Health System Governance and Service Delivery
WHO, Geneva, Switzerland
Eric Buch
Professor of Health Policy and Management