The essential concepts underpinning the health
system performance framework are set out below.
- Health system boundaries
The
system includes all actors, institutions and resources that undertake
health actions – where a health action is one where the primary intent
is to improve health. Although the defining goal of a health system is to
improve population health, other intrinsic goals are to be responsive to
the population they serve, determined by the way and the environment in
which people are treated, and to ensure that the financial burden of
paying for health is fairly distributed across households. Four key
functions determine the way inputs are transformed into outcomes that
people value – resource generation, financing, service provision and
stewardship.
Health systems should contribute to a number of socially desirable
goals, which they achieve to a greater or lesser extent. Three goals are defined in the
WHO framework:
- improving the health of the population they serve;
- responding to people's non-medical expectations;
- providing financial protection against the costs of ill
health.
Within health and responsiveness, people are concerned with
the level attained and with inequalities, as illustrated below:
| Objectives |
Level |
Distribution |
| health |
x |
x |
| responsiveness |
x |
x |
| financial contribution |
- |
x |
|
Quality |
Equity |
Considerable debate has focused on the appropriateness
of these goals, on how to measure them, and on the question of causal attribution. For
further reading on the debates surrounding the overall framework, click here. For further reading on the debates surrounding
the individual goals, please click below:
- Health system efficiency or 'overall performance'
Health system efficiency or 'overall performance' 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. This is the concept of health system efficiency or overall
performance. The term performance was used interchangeably with efficiency in the World
Health Report. Since then, because in general use the term performance is often defined
more broadly to encompass a range of activities that maximise outcomes, an issue has been
raised about whether WHO should change its terminology to be consistent with the broader
use. Efficiency can be
measured in terms of the system's contribution to health alone, or to a composite
index of goal attainment. In each case outcomes are related to the resources used to
achieve them. Follow this link for further reading on the debates surrounding efficiency
and overall performance. For further reading on the
debates surrounding efficiency, click here.
- Health system functions Variation in efficiency is
related to the way a health system carries out four core functions: provision; financing;
resource generation and stewardship. To understand this relationship, greater
understanding is required about a range of mediating factors and the context in which the
system operates. There has been considerable debate about what these mediating factors are
and how they can be measured. The effective
coverage of a set of critical health interventions is an important one. A major effort to monitor
coverage of critical interventions is now beginning, as well as to define indicators of
the organization and performance of functions and how they effect outcomes. For further reading on the debates surrounding functions and
intermediate goals click
here.
The following schematic illustrates the relationships between
the functions and objectives of health systems. |
