A health system is a complex web of agencies and organizations that aim to improve the health of the nation’s people through delivery of health services and information. Generally, all health systems are led by a Ministry of Health (MOH) and filter information and programs down to various public health institutions (PHI) and non-governmental organizations (NGO). Each country or region may have a different health system structure than neighboring countries depending on the frameworks, as you learned last week.
Due to the vast diversity in health systems globally, it is challenging to make widespread health improvements, even at the local level. Education, government and civil society, and other social programs play a major role in the establishment of health systems. As we take a closer look at global health systems, keep in mind how culture and equity factor in to the development and change of health systems.
The success of health systems is contingent on the structure and involvement of agencies, organizations and local communities. The World Health Organization (WHO) developed a health system framework that provides the foundation to build a successful system. By using the WHO health system model, countries will be able to improve health without compromising culture or equity. Any system will face myriad challenges so it is important to consider how developing countries are able to create a successful health system against adversity. Low income countries are plagued with corruption, lack of order and security, civil injustice and a deficiency of basic fundamental rights. It is not hard to visualize how these factors might inhibit the development of an effective health system.
Rule of Law Index Map (World Justice Project (Links to an external site.))
Many low-income countries do have health systems that provide access to resources and services for the majority of the population and not just the affluent. First we must understand how health services are distributed. There are three types of health systems: national health insurance, national health service and diversified. Countries of all economic status rely on employers and consumers to fund their own health care. However, many have moved, or are moving, to a universal system that requires little economic input from the country’s residents. Alternatively, some of the most developed and decentralized health care systems function primarily on taxes. This is the case in Scandinavian countries. The only country that has a true public sector health system is Cuba. Their health system does not have any private practice hospitals or physicians. While they rank behind many of the high-income countries, their health system exceeds many in the region.
Throughout all health systems, primary care is or is becoming a priority. Health officials and government agencies are beginning to realize that primary and secondary prevention levels save money through better health. As populations improve their overall health, there is decreased use of high cost medical services and equipment.
Building partnerships between the MOH, PHIs and NGOs is essential for improving population health outcomes. Non-governmental organizations are crucial to the delivery of primary health care in developing countries. Many NGOs develop and implement health programs that function as the keystone of prevention. However, NGOs frequently function independently from other organizations and lack the capacity to reach large numbers. By collaborating with the ministry of health or other public health institutions, primary care and prevention programs are more easily able to decrease the burden of disease and improve health outcomes across the population. Ideally, this collaboration would also increase access to local health centers and regional hospitals and improve the quality of primary and secondary care. Quality of care is continually an issue due to the lack of professional knowledge and training.
A Peace Corps volunteer working together with Gambian women and mothers for nutrition and advocacy. (Peace Corps, US government photo on Flickr (Links to an external site.))
Community health workers (CHW) are an effective way to increase access to care for both rural and urban populations without compromising quality, culture or equity. CHWs are residents from local communities that are trained to provide primary care. Because they are familiar with the geographic area and the people that live in the community, the local people trust the community health workers with their health needs.
In rural areas especially, CHWs can make a significant difference in community health. Rural health centers often sit empty most of the year due to cost of upkeep and staffing as well as lack of transportation infrastructure. Rural health centers may be staffed for only for two-three days per quarter to conduct health screenings or provide vaccines, birth control, and pharmaceuticals.
By having a trained CHW in the community, there is always access to basic health care and health education. As with other public health initiatives, the community health worker program has significant challenges too. It is very hard for one CHW to make population level changes.
To improve the health of the population, the entire health system must work together. A partnership between public health entities must have a collective vision and work towards common goals. Health issues change frequently as the world grows and merges. A comprehensive approach to health systems must include public health institutions from the ground up and be able to evolve with health changes.
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