Lecture given during the pre-APRM workshop on Social Determinants of Health and Global Health Equity, September 12, 2012, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur

1. The Health System as a
Determinant of Health
Ramon Lorenzo Luis R. Guinto, MD

3. What is a
health system?

5. Health System
“A health system is the sum total of all the
organizations, institutions and resources
whose primary purpose is to improve health."
"A health system needs staff, funds,
information, supplies, transport,
communications and overall guidance and
direction. And it needs to provide services
that are responsive and financially fair, while
treating people decently.”

6. WHO Health Systems
Framework

7. Governance and Leadership
effective oversight, coalition building,
provision of appropriate regulations
and incentives, attention to system-
design, and accountability

8. Information
production, analysis, dissemination and
use of reliable and timely information
on health determinants, health
systems performance and health
status

9. Medicines and Technologies
assured quality, safety, efficacy, cost-
effectiveness, and availability

10. Service Delivery
effective, safe,
quality
personal and
non-personal
health
interventions to
those who
need them

11. Health Workforce
responsive, fair and efficient to achieve the best
health outcomes possible, given available
resources and circumstances

12. Health Financing
raises adequate funds for health, in ways that
ensure people can use needed services, and
are protected from financial catastrophe or
impoverishment associated with having to
pay for them

13. Human Resources
for Health

17. Southeast Asia: International Flows of
Nurses and Doctors RNs and MDs

18. Working lifespan strategies to
build capacity and performance
ENTRY:
Preparing the
workforce
Planning WORKFORCE PERFORMANCE
Education WORKFORCE:
Recruitment Enhancing worker Availability
performance
Competence
Supervision Responsiveness
Compensation Productivity
Systems support
EXIT:
Lifelong learning
Managing attrition
Migration
Career choice
Health and safety
Retirement
Source: WHO (2006). The World Health Report 2006 – Working Together for Health.
Geneva, World Health Organization

19. Health Workforce

20. Health Care Financing

21. Health Financing Functions

22. Health System as a
Relationship

34. Financer-Provider
• Payment systems
o Fee for service
Visits, Bed-days
Diagnostic Related Groups
o Capitation
o Global Budget
• Integrated financer-provider systems

41. Current Challenges

45. Universal Health Coverage

46. From Phua Kai Hong, NUS

47. From Phua Kai Hong, NUS

48. Universal Health Coverage
“access to key promotive, preventive,
curative and rehabilitative health
interventions for all at an affordable
cost”
World Health Assembly, 2005

52. "Universal coverage is the ultimate
expression of fairness."
"Universal coverage is the single most
powerful concept that public health has to
offer."
Dr. Margaret Chan
WHO Director-General
65th World Health Assembly 2012

53. WHY UHC ADVOCACY IS GAINING
MOMENTUM
• UHC is relatively easy to understand
• Compatible with human rights agenda
• UHC is an attainable goal – especially as
countries make transition to MIC status
• UHC is popular and inherently political
• UHC brings politics into health systems
agenda – people receiving services
• Opportunity to celebrate national successes
(perhaps at the expense of others failures)
Yates 2012

57. Public versus Private?

58. Vertical versus Horizontal?

59. Summary
• The health system is a social determinant of
health inequalities.
• All building blocks of the health system must
be enhanced in order to achieve universal
health care.
• Reforms in the health system cannot be
isolated from action on the broader
determinants of health.

60. Thank you!