Health Systems in Action

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Health Systems in Action

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Introduction

One of the biggest challenges facing health managers and health service providers is how
to turn a demoralized or overworked and stressed staff into a proactive, motivated team
that delivers high-quality health services every day. Weak management systems are major
contributors to the frustration and the sense of futility that countless professionals feel
when they are not able to make sustainable contributions to improved health outcomes.
But any attempt to improve management systems without addressing the needs of the
people who do the work is bound to end in disappointment, more stress, and even lower
morale, reinforcing a vicious circle of ineffectiveness and inefficiency. Addressing this
challenge requires attention at every level to both systems and people.
The medical knowledge exists to reduce illness and death caused by preventable diseases.
Applying knowledge and scaling up evidence-based practices requires strong health
systems with skilled and motivated leader-managers who can support and motivate the
health workforce.
Over the years the authors of this handbook have learned that improving the management
and leadership skills of those who make the health system happen is one of the most
important ways to achieve the ambitious Millennium Development Goals. Even in the
face of poverty, illiteracy, discrimination, and conflict, stronger management systems and
leadership practices can make vital contributions to health services and health outcomes.
This handbook is dedicated to all staff, at any level, in any kind of organization large or
small, private or public who are committed to bringing health services to all who need
them, wherever they live. The ideas, models, and practices presented in the handbook
have been used in Africa, Asia, Europe, and North and South America. They represent the
best thinking of academics and the best doing of practitioners.

Turning frustration into a force for change

Health systems are complex, and trying to change them is a major challenge. Those who
struggle with poorly functioning health systems can use their frustration as a force for
either inaction or action.
Everywhere in the world there are health care managers and providers who have turned
their frustration outward through complaints or aggression against the health system,
which they view as the source of all problems. They say, It s not my fault! or It s not my
problem! At the other end of the spectrum are people who have turned the frustration
inward and become so discouraged and disengaged that they cannot be effective. You will
hear them say, I just can t do anything about it.
Both types of frustrated workers see themselves as victims, with no control over the
dysfunctional systems within which they work. They exist at every level in organizations,
including at the top.

Building functional health systems

The ultimate aim of a health system is to equitably maintain or restore the health of all
the people it serves. An effective health system begins with parents who have learned
the best ways to keep their children healthy. If a child does become sick, the mother can
bring the child to a clinic, be seen without a long wait, and have the health problem correctly
diagnosed and appropriately treated by well-trained and supervised health staff who
have the right medicines available. If the mother is also informed about family planning
and freely chooses an appropriate family planning method so that she will not get pregnant
again right away, the health system is fulfilling its role: attending to people s health
and productivity so that they can contribute to the development and prosperity of all.

A framework for people-centered health systems strengthening

Our first challenge is to clarify our language. The word system can be defined as a set of
interacting or interdependent entities that form an integrated whole. Within this broad
definition, system can refer both to the entire national health system and to the various
management systems that help organize and monitor the use of resources. This duality can
create confusion when we talk about health systems strengthening.
In this handbook, we use the word system to refer to the entire health system. Management
systems refers to the various components of the overall health system, such as
the financial management system, the management information system, or the human
resources management system. And the word subsystems refers to the smaller systems
that are nested within each management system and contribute to its effectiveness.
Using WHO s building blocks as inspiration, Management Sciences for Health has adapted
the WHO framework to create the Framework for People-Centered Health Systems

Proven practices

Recognizing that no system can operate without skilled and motivated staff,
you should always put people first when designing, modifying, or improving
a health management system. Recognize, support, and reward the staff
members who take on the management and leadership roles that make the
health system work every day, at every level.
Rather than depending on outside experts to fix things, arrange for managers
and providers to work side-by-side as partners with technical experts.
This will build the ability and confidence of the people who will operate and
sustain management systems and deliver services when the experts are gone.
Keep management systems as practical as possible: overly complicated management
systems usually cannot be sustained when external support is withdrawn.
Use the Framework for People-Centered Health Systems Strengthening to
help your staff understand how each management system strengthens and
supports others and how all the systems work together to allow your organization
to fulfill its mission.

Glossary of health systems terms

fully functional health system: A point at which the various management systems and
subsystems are connected and integrated so as to provide the best possible health services
to all the intended beneficiaries of those services.
health system: The expertise, structure, and organization that make possible the delivery
of health services nationwide, comprising leadership and governance; human resources
for health; financial management; health information; management of medicines; and
health service delivery.
management systems: The various components of the overall health system that managers
use to plan, organize, and keep track of resources.