10:832:240 Lecture Notes - Lecture 10: Rockefeller Foundation, United Nations Millennium Declaration, Gross Domestic Product
9 May 2018
School
Department
Course
Professor
Lecture #10: An Introduction to Health Systems
I. WHO: What is a Health System?
• A good health system delivers quality services to all people, when and where they need them.
The exact configuration of services varies from country to country, but in all cases requires a
robust financing mechanism; a well-trained and adequately paid workforce; reliable
information on which to base decisions and policies; well maintained facilities and logistics to
deliver quality medicines and technologies.
II. Is the Health System Working?
• Globally, the number of deaths of children under 5 years of age fell from 12.7 million in 1990
to 6.3 million in 2013.
• In developing countries, the percentage of underweight children under 5 years old dropped
from 28% in 1990 to 17% in 2013.
• Globally, new HIV infections declined by 38% between 2001 and 2013.
• Existing cases of tuberculosis are declining, along with deaths among HIV-negative
tuberculosis cases.
• In 2010, the world met the United Nations Millennium Development Goals target on access to
safe drinking-water, as measured by the proxy indicator of access to improved drinking-water
sources, but more needs to be done to achieve the sanitation target.
III. Good Health at Low Cost
• In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some
countries or regions (China, Sri Lanka, Costa Rica, and the state of Kerala) achieve better
health and social outcomes than do others at a similar level of income and to show the role of
political will and socially progressive policies. 25 years on, the Good Health at Low Cost
project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand,
and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in
health or access to services or implemented innovative health policies relative to their
neighbours. A series of comparative case studies (2009–11) looked at how and why each region
accomplished these changes.
• Health systems cost money and, as that money could be spent on other things, it is desirable to
ensure that it is being spent wisely. Poorly functioning health systems place people at risk of
catastrophic health expenditure, with potential macroeconomic consequences if they hoard
money in case of illness rather than spending it. Health expenditure tends to grow as a share of
gross domestic product (GDP) as a result of new drugs and technologies. This is especially true
in countries where absolute expenditure on health is low, and where there is a large amount of
unmet need. There has been a change in the pattern of investment in health systems in low- and
middle-income countries, and a shift from disease-focused financing models to strengthening
health systems (horizontal approaches).
• While we know that health systems can prevent premature death and disability They do so with
very different degrees of success. For example the figure shows that maternal death rates vary
widely between countries, and also between countries with similar levels of resources (e.g.
Page !1
Document Summary
Lecture #10: an introduction to health systems: who: what is a health system, a good health system delivers quality services to all people, when and where they need them. Poorly functioning health systems place people at risk of catastrophic health expenditure, with potential macroeconomic consequences if they hoard money in case of illness rather than spending it. Health expenditure tends to grow as a share of gross domestic product (gdp) as a result of new drugs and technologies. This is especially true in countries where absolute expenditure on health is low, and where there is a large amount of unmet need. For example the figure shows that maternal death rates vary widely between countries, and also between countries with similar levels of resources (e. g. page !1. Brazil, china and south africa are upper-middle-income economies according to the world. Bank classification) (world bank 2011), which is a cause of international attention to health systems.
