1. HSA 171 CAR

2. 1436/ 7/4

3.  The results of activities of an organization or investment over a given period of time.  Organizational Performance: ◦ A measure of how efficiently and effectively managers use available resources to satisfy customers and achieve organizational goals. 3

4. Efficiency Effectiveness Organizational Performance 4

5. A measure of how productively resources are used to achieve a goal. Organizations are efficient when managers minimize the amount of input resources or the amount of time needed to produce a given output of goods or services. 5

6. A measure of the appropriateness of the goals that managers have selected for the organization and of the degree to which the organization achieves those goals. Organizations are effective when managers choose appropriate goals and then achieve them. 6

7.  The accumulated end results of the organization's work processes and activities.  Designing strategies, work processes, and work activities.  Coordinating the work of employees. 7

8.  The term Health System Performance Assessment describes a series of activities including measuring the health system's contribution to socially desirable goals;  Measuring  Measuring the health system and non-health system resources used to achieve these outcomes;  Estimating  Estimating the efficiency with which the resources are used to attain these outcomes;  Evaluating  Evaluating the way the functions of the system influence observed levels of attainment and efficiency;  Designing and implementing  Designing and implementing policies to improve attainment and efficiency and monitoring the effect. 8

9.  Importance:  To enable countries to monitor their own performance and to modify their policies as necessary it is important to be able to measure and compare performance over time. 9

10.  WHO's work aims to support the development of systematic ways to monitor performance in countries, in a way that allows comparison across time within individual systems, across different levels of a system, and between health systems. 10

11. decision makers  To empower decision makers,  by providing them with reliable information for policy and system development. public,  To empower the public,  with information relevant to their well-being. 11

12.  The essential concepts underpinning the health system performance framework are: Health System Functions Health System Goals Health System Efficiency Health System Boundaries 12

13. Health Responsiveness Financial Protection 13

14. The system includes all actors, institutions and resources that undertake health actions.Four key functions determine the way inputs are transformed into outcomes that people value – resource generation, financing, service provision and stewardship.  “Health Action”: Any set of activities whose primary intent is to improve or maintain health  E.g. Seatbelt. 14

15. Health system Functions Financing Resource generation Stewardship Provision of health services 15

16. Stewardship Governance and leadership Generating human and physical resources Inputs 16

17. Service delivery Personal and population -based Financing Collecting, pooling and purchasing 17

18.  Health system financing is: the process by which revenues are collected from primary and secondary sources.  For the purposes of analysis, it is useful to subdivide health system financing into three sub- functions: a)revenue collection, b)fund pooling. c)purchasing. 18

19.  Revenue collection refers to the mobilization of money from primary sources ( individuals, households and firms) and secondary sources (governments and donor agencies).  Funds can be mobilized through 4 basic mechanisms:  out-of-pocket payments,  General taxation,  Statutory health insurance,  Private health insurance. 19

20.  Fund pooling refers to the accumulation of revenues for the common advantage of participants. Indeed, pooling means that financial resources in the pool are no longer tied to a particular contributor. In the language of insurance, pooling means that contributors share financial risk.  Pooling is distinct from revenue collection as some mechanisms of revenue collection such as medical savings accounts do not share financial risks across contributors. 20

21.  Purchasing is the process through which revenues that have been collected and placed in fund pools are allocated to institutional or individual providers in order to deliver a specified or unspecified set of interventions.  Purchasing can range from simple budgeting exercises in highly integrated public systems, where the government collects revenue through general taxation and allocates it to programs and facilities for staff and other costs, to more complicated strategies where specified units of inputs, outputs or outcomes are purchased 21

22.  This function refers to the combination of inputs into a production process that takes place in a particular organizational setting and that leads to the delivery of a series of interventions.  In analyzing provision, it is useful to keep in mind the conventional distinction between personal and non-personal health services.  personal health services: refer to services that are consumed directly by an individual, whether they are preventive, diagnostic, therapeutic, or rehabilitative. 22

23.  non-personal health services: refer to actions that are applied either to collectivities (e.g., mass health education) or to the non-human components of the environment (e.g., basic sanitation). 23

24.  Health systems are not limited to the set of institutions that finance or provide services, but include a diverse group of organizations that produce inputs to those services, particularly human resources, physical resources such as facilities and equipment, and knowledge. This set of organizations encompasses universities and other educational institutions, research centers, construction firms, and the vast array of organizations producing specific technologies such as pharmaceutical products, devices and equipment. 24

25.  A neglected function in most health systems, stewardship goes beyond the conventional notion of regulation. It involves three key aspects: setting, implementing and monitoring the rules of the game for the health system; assuring a level playing field among all actors in the system (particularly purchasers, providers and patients); and defining strategic directions for the health system as a whole. In order to deal with these aspects, stewardship can be subdivided into six sub-functions: overall system design, performance assessment, priority setting, intersectional advocacy, regulation and consumer protection. 25

26.  Health systems with the same level of resources can achieve very different results.  The WHO framework proposes a way of examining how well a health system is doing, given the resources available to it 26