HEALTH SERVICES SYSTEM

MANAGEMENT

DANISH LATIF
 What is a health system

• Health System is all the organizations, institutions and

resources that are devoted to producing health actions
……
• Health actions include all the activities, (whether in
personal health care, public health services or through
intersectoral collaboration initiatives,) whose primary
purpose is to promote, restore or maintain health.
 Primary Boundaries of Health Systems

• Traditional Public Health Activities – health promotion,

disease prevention and other health enhancing
interventions like road and environmental safety
improvements

• Traditional Healers and all use of medications –

prescribed or non-prescribed

• Home care of the sick including Self Medications

Secondary Boundaries of Health Systems

• All those activities whose primary purpose is something other

than Health – education
• For example, even if these activities have a secondary, health
enhancing effect note that general education might be secondary,
but health related education is primary.

• Some actions are intended chiefly to improve health indirectly by

influencing how non-health systems function – eg actions to
increase girls school enrolment or change the curriculum to make
student better future caregivers and consumers of health care
 Who are really the producers of ‘Health’?....

 The primary producers of health - the

individual households especially with
mothers often taking the first key decision
to seek health care for her sick child
Local &
Global
 This decision to seek health care and
which health care is sought depends on Driving
information available to the household Forces
 Communities provide the social cohesions
for families to function in And to facilitate
the uptake of health services by
households,

 it is necessary to provide health

information and education to the
households in a way and manner that is
acceptable and convenient to them.
 Framework….
– leadership and governance for health;
– health service delivery;
– human resources for health;
– health financing;
– health management information systems;
– Health technologies
– community ownership and participation;
– partnerships for health development;
– and research for health.
• For each of these priority areas, the implementation
framework proposes a goal followed by objectives,
interventions, potential actions and stakeholders.
 LONG TERM GOALS

 Conduct policy and programmatic research on the most important policy and management issues in the

health sector.

 Develop successful models of service delivery and management which can be adopted widely by public

sector and NGO health care organizations.

 Train health professionals to effectively manage health services.

 Disseminate latest knowledge and management technology specially in developing countries

 Establish the Institute as a world-class academic institution in the area of health and population

management
 MEDIUM TERM OBJECTIVES

 To improve quality of research and training to match

with the best standards in the world.
 To develop an organizational climate conducive of
initiative, creativity, teamwork and excellence.
 To develop interdisciplinary faculty group with
professional skills in management, public health,
health economics, and behavioral sciences.
 To establish a regular and high quality publication
program.
 To initiate a process for creating an international
market for Institute’s training programmes
Priorities of the Health Care System

Service
Delivery

Research
HRH for
Health

Leadership
Leadership
&
&
Governance
Governance
for
for Partnership
Health Health
Health
s for
Financing Health
development

Community
Health Ownership
Information and
Systems Participatio
n
Leadership and governance
• The interventions proposed for strengthening leadership and
governance for health, include
– institutionalizing intersectoral action for improving health determinants;
– updating national health policy in line with the PHC approach and
regional strategies;
– updating national health policy and aligning the MOH organizational
structure with the PHC approach and regional strategies;
– updating national health strategic plans to ensure integrated management
and provision of comprehensive essential health services;
– updating or enforcing public health acts and laws in line with the PHC
approach; and
– creating or strengthening mechanisms for transparency and accountability
in the health sector.
Health Service Delivery
 proposed interventions for improving effectiveness
of health service delivery include
 consultation and consensus building on the elements
of essential health services, mode of delivery and
costs; and
 service organization and stakeholder incentives to
ensure integration and strengthened efficiency and
equity.
 Human Resources for Health
• The interventions recommended for improving management of human
resources for health (HRH) include
– comprehensive evidence-based health workforce planning;

 building health training institution capacity for scaling up training of relevant

cadres i-e ( small group of people specially trained for a particular purpose)

– building HRH management and leadership capacity for better HRH management;

– developing and implementing retention strategies, including better management of

migration; generating and using HRH evidence for informed decisions at all levels;

 and increasing fiscal(government revenue) space for HRH development.

Health Systems Financing
• In order to improve health system financing, it is proposed
that countries should
– strengthen or develop a comprehensive health financing policy
and a strategic plan;
– institutionalize national health accounts (NHA) and efficiency
monitoring within health management information systems
(HIMS);
– strengthen financial management skills at district/local levels and
financial decentralization; (central to local )
– respect the pledge to allocate at least 15% of the national budget
to health development and allocate enough of that for
implementation of the PHC approach at local level.
Health information systems
 To ensure availability of timely and reliable
information at all levels of the health system,
countries should
 develop and implement a comprehensive national
health information system policy and strategic plan,
taking into account the International Health
Regulations; and
 establish a functional national HMIS in line with the
PHC approach….
 Health technologies….
 In relation to health technologies, countries should
 increase access to quality and safe health technologies;
develop national policies and plans on health technologies;

 develop norms and standards for the selection, use and

management of appropriate health technologies.

 and institute a transparent and reliable system for the

procurement of health technologies.
Community participation
 For effective community participation in health
development, it is proposed that countries should
 create an enabling policy and implementation
framework for community participation;
 build community capacity;
 reorient the health service delivery system; and
 develop and implement health promotion policies and
strategies.
Partnerships for health development

 To improve harmonization and alignment towards

government-led policy and strategic orientations, it
is proposed that countries should institutionalize a
framework for harmonization and alignment of
partner support.
 Research
• In order to improve generation and utilization of research for health
in health development, the proposed interventions include
– review of structures and mechanisms for implementing research for health
and knowledge systems;

– institutionalize a framework for research for health agenda and priority

setting;

– create a critical mass of national researchers for health;

– allocate adequate funding to research for health; and

– create a framework for sharing new knowledge and its applications.

To deliver on the Framework…

 Strengthen our national social health insurance and tax-based

financing of health care
 Strengthen our procurement, supply and distribution processes and
minimize commodity wastage
 Clarify district responsibility in achieving national, international
development goals
 Empower communities (including women, the elderly, children and
other disadvantaged groups) to take appropriate actions for the
promotion of their own health
 Create an enabling environment for devolution of health sector
responsibilities to the districts (especially working closely with the
local Govt structures)
Conclusion
 It is expected that the implementation of this
Framework by countries will contribute to
accelerating the achievement of better health in the
new millennium.
Thank You
