Understanding health systems

As the global community continues to scale up HIV/AIDS, tuberculosis, malaria, and maternal and child health services in low-resource countries, it is giving increased attention to the country health systems that are expected to deliver these services. It is widely acknowledged that a weak health system constrains the expansion and sustainability of health service provision. A thorough understanding of a health system’s institutional and organizational assets and limitations is needed to design appropriate interventions to strengthen it, and to advocate for it with national and international counterparts.

The recently developed Health Systems Assessment Approach: A How-To Manual fills a gap in assessment approaches by providing a tool that examines multiple health system components, synthesizes the data compiled, and guides users in transforming findings into specific strategies that policymakers and program managers can apply to strengthen their country’s health system.

Health Systems Assessment Approach

The Health Systems Assessment Approach: A How-To Manual was inspired by health care practitioners and program managers seeking to strengthen a health system to improve delivery of priority health services, yet with limited resources to carry out a system assessment. The Health Systems Assessment Approach leads a small (3-4 person) team through a rapid and user-friendly yet comprehensive health system assessment: planning the assessment, gathering data, synthesizing findings, orggenerating recommendations, organizing a stakeholder workshop to discuss findings and plan future actions, and preparing the assessment report. Complementing the manual is the recently released Health Systems Database (see box on page 2), which replaces the data provided with the manual.

The Health Systems Assessment Approach is organized around technical modules that guide data collection on:

• Governance
• Financing
• Service delivery
• Human resources
• Pharmaceutical management
• Health information systems

Use of all technical modules produces a comprehensive assessment. Nevertheless, the tool’s approach is flexible – if a country’s needs are more focused, the assessment can comprise only selected modules. A mandatory core module provides background information on the country’s health system.

Each technical module uses an indicator-based approach, and groups its indicators into two components: Component 1 contains indicators for which data are already available from internationally comparable datasets. (These data can be easily accessed using the Health Systems Database.) Component 2 includes quantitative and qualitative indicators gleaned from country-level document review and stakeholder interviews. These indicators allow users to gauge the functioning of that technical area and its contribution to overall health system performance, and to identify specific strengths and weaknesses. The manual provides guidance in using the findings to develop system strengthening interventions.