Following the onset of the COVID-19 pandemic, considerable attention has been given to public health and public health systems. We looked at public health in the previous article. This article will attempt to shed light on what a public health system is, and the types of public health systems.

Background Information:

Health Service: Any service (not limited to medical/ clinical services) aimed at contributing to improved health or to the diagnosis, treatment and rehabilitation of sick people.

Health system boundaries: The outer limits (context, institutions, capacities) within which the health system operates.

What is a Health System?

Several definitions of health systems have been proposed.

The World Health Report 2000 defined health system as including “all the activities whose primary purpose is to promote, restore or maintain health”.

This includes formal health services; actions by traditional healers; and all use of medication, whether prescribed by a provider or not; home care of the sick; health-enhancing interventions like road and environmental safety improvement; health-related education; actions to increase girls’ school enrolment or change the curriculum to make students better future caregivers and consumers of health care.

This way of defining a system does not imply any particular degree of integration, nor that anyone is in overall charge of the activities that compose it. In this sense, every country has a health system, however fragmented it may be among different organizations or however unsystematically it may seem to operate. Integration and oversight do not determine the system, but may greatly influence how well it performs.

In recent years, the definition of “purpose” has been extended to include the prevention of household poverty due to illness.

The World Health Organization Health Systems Strengthening Glossary defines health system as:

1. All the activities whose primary purpose is to promote, restore and/or maintain health (same as World Health Report 2000)
2. The people, institutions and resources, arranged together in accordance with established policies, to improve the health of the population they serve, while responding to people’s legitimate expectations and protecting them against the cost of ill-health through a variety of activities whose primary intent is to improve health.

It defines District Health System as:

1. “A network of primary care health facilities that deliver a comprehensive range of promotive, preventive and curative health care services to a defined population with active participation of the community and under the supervision of a district hospital and district health management team.”
2. “A network of organizations that provides, or makes arrangements to provide, equitable, comprehensive and integrated health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and for the health status of the population that it serves.”

A third definition of health system states that it “comprises all organizations, institutions and resources (elements) that are devoted to producing health actions.”

Health systems are considered open systems because they are open to influence from external factors such as poverty, education, infrastructure, and the broader social and political environment. The various parts of a health system operate at many levels to provide coherence at community or national level.

The World Health Report 2003 distinguishes a Health System (HS) from a Health Care System (HCS). According to that document, “health care system refers to the institutions, people and resources involved in delivering health care to individuals.”

Health System Building Blocks:

This is an analytical framework used by WHO to describe health systems. Six core components have been described:

1. Leadership and governance (stewardship)
2. Service delivery
3. Health workforce
4. Health information system
5. Medical products, vaccines, and technologies
6. Health system financing