Introduction

Health care matters. Of course health is determined before and beyond health care but health care still matters. Partly because it deals with pain and loss and worry. Partly because of the opportunities for prevention that arise in health care and the potential role of health practitioners and agencies in promoting and maintaining health.

Health services matter. Affordable and effective services from skilled, knowledgeable and caring practitioners working out of well staffed, stocked and equipped health centres and hospitals. Are such services properly regarded as commodities to be bought and sold; to be accessed according to ability to pay? Or shall we affirm access to health care as a right; guaranteed as part of the social contract? In part it is a question of law (the right to health); in part it is about culture.

Health systems matter: the right services available when they are needed; referral links between agencies and practitioners; research and training instituions to back up the front line agencies; planning, regulatory and funding bodies to ensure access, efficiency and quality. Health systems depend upon resource mobilisation, community ownership and social solidarity but they are also embedded in wider institutional, political and economic relationships and are subject to the forces and pressures which swirl and clash in the wider national and global environments.

Challenges. Sometimes the barriers to health care are specific and local but there are some common patterns: shortfalls in health services; failures in health systems. Some of these reflect similar circumstances prevailing in different places but there are also some common pressures, generated through the same dynamics of globalisation which affect health systems everywhere. Common patterns include:

• multi-tiered service systems with well resourced private sector services for the rich and substandard safety net services for the poor;
• services dependent on user charges for their revenue who set their prices according to what the middle class can pay, excluding poorer people from access;
• lack of resources and services in the rural areas;
• profiteering by transnational supply companies, especially big pharma;
• big power arm twisting to open health care markets for transnational investment.

Learning objectives

This topic has been designed to enable participants to:

• become more familiar with the language of health systems policy: the jargon, the theories, the principles, the cases;
• become more familiar with the main debates in health systems policy globally, including the arguments at the technical level as well as the politics of those debates;
• become more familiar with the links between global debates over health system policies and the politics of the regulation of the contemporary regime of globalisation;
• become more familiar with the principal debates regarding health policy nationally including the technical arguments and the political dynamics;
• be more skilled in policy analysis and policy development at the local, national and global levels.

Contents

There are four topics within this module:

• Comprehensive Primary Health Care
• Health sector reform,
• GATS and health systems.
• Health care financing

See also the library section on countries and regions.

Readings

• Legge (2013) Health system strengthening
• Global Health Watch 3 (2011): 
  • B1 Primary health care
  • B2 Financing health care
  • B3 Health financing models that work
  • B4 Dysfunctional health systems
• Global Health Watch 2 (2008)
  • B1 Health systems advocacy
• Global Health Watch 1 (2005): 
  • B1 Health care systems and approaches to health
• Health Systems Action Network. Useful resource with onlinks. 
• Final report of the Health Systems KN to the WHO Commission on Social Determinants of Health (1.19 mb)
• WHO (2007) Everybody business : strengthening health systems to improve health outcomes : WHO's framework for action
• Paul Hunt (2008). Report on Health Services (by the Special Rapporteur on the Right to Health)