MODULE II.

HEALTH SYSTEMS FRAMEWORK AS A TOOL TO ANALYZE POPULATION HEALTH

Section A: Health Services and Health Workforce
Study Guide Section A of 4 Sections
IMPORTANT REMINDERS
v This module has four (4) sections and will run from November 16, 2013 to December 13, 2013.
You are reading Section A.
v Guide questions are meant to provide you with personal benchmark on your progress. You are
not required to submit your answers. You are however encouraged to raise questions if there are
related matters that you need to clarify.
v There is only one (1) discussion forum for Module II. Discussion Forum 2 will start on November
22, 2013 and will close on December 12, 2013.

ORGANIZING PRINCIPLE
Health services are delivered through an environment called health system. In the previous
module, you learned about the role that health systems play in achieving desired health
outcomes of a population. In order to effectively provide health services, health system
building blocks services, human resource, financing, medical products, vaccines and
technologies, information, and leadership and governance must be aligned to function
towards unified goal and direction.
In this module and onwards, you will take a closer look at the building blocks of health
systems. By understanding the role of each building block and how it interacts with the rest
of the elements, you will gain insights why certain health systems deliver while others
struggle. You can likewise be guided towards identifying actions that could improve the
contribution of each building block in a synergistic manner that in turn results to a
strengthened health system.
This section will start you off on the first two building blocks, health services and human
resources. While you study the building blocks separately for the purpose of this course, be
mindful of the fact that this delineation is not clear cut as these interact and impact each
other in real world experience.
Module II is divided into four (4) sections.
OBJECTIVES OF THE MODULE
At the end of Module II, you are expected to:
1. Acquire understanding and skills to use health systems framework in describing the
state of health of a given population group
2. Utilize findings in health systems analysis in designing recommendations towards
health systems strengthening
UNDERLYING CONCEPTS
The pathway towards organizing a health system that delivers efficient, effective, and
equitable health services differs across nations. Variations can also be observed at subnational levels when comparing across provinces or cities. Further, when considering how
services are channeled in response to disease entities, a countrys health system
organization may differ somewhat when seen through the lens of providing services for TB
eradication, for example, compared to service delivery approaches towards malaria
IH 221 / Module 2 Health Systems Framework as a Tool to Analyze Population Health (Section A) AY, 2013 - 2014

elimination. Analysis of health systems and designing its improvement should regard the
context of the health outcome that it is designed to influence as well as the specific target
population whose needs it should meet.
Framework for Health System Assessment
Nations around the world continue to grapple on how to meet demands for better health
care. No matter what the income levels are, governments face similar thematic concerns in
health care, albeit in varied levels, such as rising cost of health services, achieving target
health outcomes especially those prioritized in the Millennium Development Goals, reducing
inequity to access, and meeting public expectations. Addressing health care concerns take
a different approach since the demand for it is ever increasing, and no matter how financing
is increased, there is a tendency that budgets will not always be enough. The challenge for
governments, health planners and managers therefore is in designing how health systems
can become more effective so that known health interventions are delivered to the target
population consistently at the right time, and a cost that is non-prohibitive.
Designing health service improvement is a continuous process. It often starts with an
analysis of what the current situation is and then benchmarking it to what it is supposed to
achieve. The health systems framework offers a unifying lens that could be used as a tool
for analysis. It is proposed by World Health Organization to be used by governments so that
health system assessments and recommendations can be communicated quickly through
the use of similar concepts and context. The same framework could guide in classifying how
the identified health system gaps are to be bridged.
Note: While the general discussion considers the use of health systems framework in
the context of health systems being managed by governments to improve population
health, it is also a useful tool in examining systems of smaller scale such as those
within a town or a hospital or even a privately-managed healthcare services.
After going through the introduction module, you will now move forward to learning more
about health system building blocks.
Building Block: Health Services
As a building block of health systems, health services refer to approaches, strategies, and
management that ensure the delivery of health interventions to a target population at a time
and place when it is needed, and with the most effective use of resources. In this building
block, health planners attempt to answer the questions - Which services are provided? How
is the service provision organized? and How can the right mix and level of incentive be
ensured?
Read:
The World Health Report (2000). Chapter 3 Health Services: Well Chosen, Well
Organized? IN: Health Systems: Improving Performance, pp 49-50; 52-69
(www.who.int/entity/whr/2000/en/whr00_en.pdf)
Defining the health service package
Health interventions could be clinical and personal in nature. It could also be directed to
populations, known as public health services, targeting population groups exposed to a
given health risk. At the health systems level, decision makers must examine the right mix of
personal and public health services that must be made accessible to target population
groups so that threat to the health of many is minimized.

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For every illness or public health threat, there are options on how to reduce disease burden.
Defining an essential health package is an important feature because it could highlight
which preventive, curative and rehabilitative interventions could produce high impact results.
This could likewise highlight which approaches can give the best results and therefore
should be prioritized.
Read on essential health packages:
World Health Organization (2008). Essential Health Packages: What are they for?
What do they change?, WHO Service Delivery Seminar Series, Draft Technical Brief
No.2. Geneva: WHO.
www.who.int/healthsystems/topics/delivery/technical_brief_ehp.pdf
This decision-making entails looking at which services must be funded according to local
disease priorities such that health goals are effectively achieved. The concept of efficiency
in resource allocation and rationing (e.g., which program gets funded and for how much)
may differ across governments. What is usually constant is that governments tend to aim for
balance between selecting priorities according to evidence and according to peoples
expectations.
Organizing and managing health service delivery models
All of these input human resource, finances, medicines, technology, and services, must be
organized in a particular service delivery configuration so that target recipients receive care.
There is NO universal model prescribed on how to organize inputs and services. What can
work in one setting may totally fail in another because conditions are very different.
However, there are features common to health services that deliver good results.
Health services can be given to health clients at different levels, at home, at the community,
at increasing level of hospital, and even at various settings such as workplaces and schools.
Health service delivery models must be so designed such that the package of interventions
can be delivered as close to the client as possible, with the most efficient use of resources,
and with the least fragmentation possible.
The concept of integration and continuity must be considered. In the heart of this matter
is the health care experience of those receiving it patient-centric care. When a health
client enters a health facility for instance, health professionals must be ready to assess,
consider and provide all that a client will need at that instant. In depth discussion of these
concepts will be dealt with in Module III, when the learner gone through the discussion of all
building blocks.
To illustrate a familiar service delivery model, read on the Philippine profile:
WHO Western Pacific Regional Office (2012). Health Service Delivery Profile:
Philippines, pp 2-5
www.wpro.who.int/entity/health_services/service_delivery_profile_philippines.pdf
In this brief write up, examine how the Department of Health designed the level of
governance. Understand too, where the private sector is situated and how this figures into
the provision of different forms of health services.
Apart from the configuration of service delivery model, the quality of leadership and
management impacts the function of health services. This topic will be discussed further in
the Section on Leadership and Governance.

IH 221 / Module 2 Health Systems Framework as a Tool to Analyze Population Health (Section A) AY, 2013 - 2014

Designing health provider incentives

Health care services are delivered by heath care professionals whose decisions to render
care are influenced by the system of incentives governing the system. The rules
implemented by health care organizations also affects how the reward and punishment
mechanism over health care providers are directed towards achieving the desired level of
health services.
Gauri, Varun. (2001). Are Incentives Everything? Payment Mechanisms for Health
Care Providers in Developing Countries. Policy Research Working Papers. The World
Bank. (http://elibrary.worldbank.org/doi/book/10.1596/1813-9450-2624)
Guide Questions:
1. What constitutes an essential health care package?
2. What are the features of service delivery models?
3. What factors influence the incentives faced by health care providers?
Building Block: Human Resource for Health (HRH)
Human resource for health (HRH) is not limited to the most visible frontline workers in health
facilities and institutions. It also includes managers and support workers, from the lay to the
professional, whose actions contribute primarily to the provision of health services. When
considering HRH as a component of health systems, it should also not focus only on the
public sector. In fact, in most countries, the private sector provides the first access to health
care even for the poorer segment of the population.
Relating to the to topic above, it is well recognized that health workforce density is strongly
correlated with health service coverage, and therefore health outcomes. Having an efficient,
effective, and sustainable pool of HRH is probably one of the most difficult challenges facing
governments today. In fact, WHO recognized the current challenges in ensuring an
adequate number of HRH as the most pressing concern. Even as governments plan,
implement and monitor strategies that will ensure equitable distribution of as responsive
work force, individual health workers make their own decision based on incentive structures
that may be difficult for governments to control. Further, even the most trained HRH will
need other health system input e.g., financing, technology, medicines in order to function
well. Thus there is a great balancing act that government must consider when deciding on
how to invest in HRH in a way that will give the best result out of limited local resources.
Read:
o The World Health Report (2000). Chapter 4 What Resources are Needed? IN:
Health Systems: Improving Performance, pp 77-81; 90-91
(www.who.int/entity/whr/2000/en/whr00_en.pdf)
o Chen, L, et al. (2004). Human resources for health: overcoming the crisis. Lancet,
364:1984-1990. www.thelancet.com
o World Health Organization (2006). World Health Report: Working together for
health. Geneva: WHO. www.who.int/entity/whr/2006/whr06_en.pdf
a.
Overview
b.
Chapter 1
c.
Chapter 2
d.
Chapter 6

IH 221 / Module 2 Health Systems Framework as a Tool to Analyze Population Health (Section A) AY, 2013 - 2014

Guide Questions:
1. What unique features of HRH as a health system input must be considered when
planning for sustainability?
2. What are common HRH issues that must be addressed by health systems?
DISCUSSION FORUM 2
(November 22, 2013 December 12, 2013)
Discussion Question:
World Health Organization recommends the use of health systems approach in describing
population health challenges and designing appropriate solution. Problems are rarely onedimensional and using the health systems framework allows examination from different
possible control knobs so that one could come up with the best composite as possible.
Gleaning from the readings on this topic, what skill sets are needed by health managers so
they could effectively use the health systems framework in such a manner? Cite an example
either from your own workplace or from an event reported by the Ministry of Health where
you are located.
Provide a concise answer not exceeding 250 words. Last day for posting contribution for
marking is on December 12, 2013.
- End of Module II Section A -

IH 221 / Module 2 Health Systems Framework as a Tool to Analyze Population Health (Section A) AY, 2013 - 2014