Editing Health system (section)

==Health systems performance==
{{See also| Health services research}}
[[File:Life expectancy vs healthcare spending.jpg|thumb|upright=1.4|Life expectancy vs healthcare spending of rich [[OECD]] countries. [[List of countries by total health expenditure per capita|US average of $10,447 in 2018]].<ref name=life>[https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus Link between health spending and life expectancy: US is an outlier] {{Webarchive|url=https://web.archive.org/web/20220311193123/https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus |date=11 March 2022 }}. May 26, 2017. By [[Max Roser]] at [[Our World in Data]]. Click the sources tab under the chart for info on the countries, healthcare expenditures, and data sources.  See the later version of the chart [https://ourworldindata.org/us-life-expectancy-low here] {{Webarchive|url=https://web.archive.org/web/20220305030958/https://ourworldindata.org/us-life-expectancy-low |date=5 March 2022 }}.</ref>]]

Since 2000, more and more initiatives have been taken at the international and national levels in order to strengthen national health systems as the core components of the [[global health]] system. Having this scope in mind, it is essential to have a clear, and unrestricted, vision of national health systems that might generate further progress in global health. The elaboration and the selection of [[performance indicator]]s are indeed both highly dependent on the [[conceptual framework]] adopted for the [[evaluation]] of the health systems performance.<ref>Handler A, Issel M, Turnock B. A conceptual framework to measure performance of the public health system. ''American Journal of Public Health'', 2001, 91(8): 1235–39.</ref> Like most social systems, health systems are [[complex adaptive system]]s where change does not necessarily follow rigid management models.<ref>{{Cite journal|last1=Wilson|first1=Tim|last2=Plsek|first2=Paul E.|date=2001-09-29|title=Complexity, leadership, and management in healthcare organisations|journal=BMJ|language=en|volume=323|issue=7315|pages=746–749|doi=10.1136/bmj.323.7315.746|issn=0959-8138|pmid=11576986|pmc=1121291}}</ref> In complex systems path dependency, emergent properties and other non-linear patterns are seen,<ref>{{cite journal|last=Paina|first=Ligia|author2=David Peters|title=Understanding pathways for scaling up health services through the lens of complex adaptive systems|journal=Health Policy and Planning|date=5 August 2011|volume=26|issue=5|doi=10.1093/heapol/czr054|pmid=21821667|url=http://www.futurehealthsystems.org/publications/understanding-pathways-for-scaling-up-health-services-throug.html|access-date=18 May 2012|pages=365–373|doi-access=free|archive-date=30 May 2013|archive-url=https://web.archive.org/web/20130530173710/http://www.futurehealthsystems.org/publications/understanding-pathways-for-scaling-up-health-services-throug.html|url-status=dead}}</ref> which can lead to the development of inappropriate guidelines for developing responsive health systems.<ref name="Peters 2012">{{cite journal|last=Peters|first=David|author2=Sara Bennet|title=Better Guidance Is Welcome, but without Blinders|journal=PLOS Med|year=2012|volume=9|issue=3|doi=10.1371/journal.pmed.1001188|pages=e1001188|pmid=22448148|pmc=3308928|doi-access=free}}</ref>

Quality frameworks are essential tools for understanding and improving health systems. They help define, prioritize, and implement health system goals and functions. Among the key frameworks is the World Health Organization's building blocks model, which enhances health quality by focusing on elements like financing, workforce, information, medical products, governance, and service delivery. This model influences global health evaluation and contributes to indicator development and research.<ref>{{Cite book |last=Organization |first=World Health |url=https://iris.who.int/handle/10665/258734 |title=Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies |date=2010 |publisher=World Health Organization |isbn=978-92-4-156405-2 |language=en |access-date=15 May 2024 |archive-date=3 May 2024 |archive-url=https://web.archive.org/web/20240503072926/https://iris.who.int/handle/10665/258734 |url-status=live }}</ref>

The Lancet Global Health Commission's 2018 framework builds upon earlier models by emphasizing system foundations, processes, and outcomes, guided by principles of efficiency, resilience, equity, and people-centeredness. This comprehensive approach addresses challenges associated with chronic and complex conditions and is particularly influential in health services research in developing countries.<ref>{{Cite journal |last1=Kruk |first1=Margaret E. |author-link1=Margaret Elizabeth Kruk |last2=Gage |first2=Anna D. |last3=Arsenault |first3=Catherine |last4=Jordan |first4=Keely |last5=Leslie |first5=Hannah H. |last6=Roder-DeWan |first6=Sanam |last7=Adeyi |first7=Olusoji |last8=Barker |first8=Pierre |last9=Daelmans |first9=Bernadette |last10=Doubova |first10=Svetlana V. |last11=English |first11=Mike |last12=García-Elorrio |first12=Ezequiel |last13=Guanais |first13=Frederico |last14=Gureje |first14=Oye |last15=Hirschhorn |first15=Lisa R. |date=2018 |title=High-quality health systems in the Sustainable Development Goals era: time for a revolution |journal=The Lancet. Global Health |volume=6 |issue=11 |pages=e1196–e1252 |doi=10.1016/S2214-109X(18)30386-3 |issn=2214-109X |pmc=7734391 |pmid=30196093 }}</ref> Importantly, recent developments also highlight the need to integrate environmental sustainability into these frameworks, suggesting its inclusion as a guiding principle to enhance the environmental responsiveness of health systems.<ref>{{Cite journal |last1=Padget |first1=Michael |last2=Peters |first2=Michael A. |last3=Brunn |first3=Matthias |last4=Kringos |first4=Dionne |last5=Kruk |first5=Margaret E. |author-link5=Margaret Elizabeth Kruk |date=2024-04-30 |title=Health systems and environmental sustainability: updating frameworks for a new era |url=https://www.bmj.com/content/385/bmj-2023-076957 |url-status=live |journal=BMJ |language=en |volume=385 |pages=e076957 |doi=10.1136/bmj-2023-076957 |issn=1756-1833 |pmid=38688557 |archive-url=https://web.archive.org/web/20240503072926/https://www.bmj.com/content/385/bmj-2023-076957 |archive-date=3 May 2024 |access-date=15 May 2024}}</ref>

An increasing number of tools and guidelines are being published by international agencies and development partners to assist health system decision-makers to monitor and assess health systems strengthening<ref>World Health Organization. [https://web.archive.org/web/20110101154020/http://www.who.int/healthinfo/systems/monitoring/en/index.html ''Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies''.] Geneva, WHO Press, 2010.</ref> including [[Health human resources|human resources]] development<ref>Dal Poz MR et al. [https://web.archive.org/web/20091014232002/http://www.who.int/hrh/resources/handbook/en/index.html ''Handbook on monitoring and evaluation of human resources for health.''] Geneva, WHO Press, 2009</ref> using standard definitions, indicators and measures. In response to a series of papers published in 2012 by members of the World Health Organization's Task Force on Developing Health Systems Guidance, researchers from the Future Health Systems consortium argue that there is insufficient focus on the 'policy implementation gap'. Recognizing the diversity of stakeholders and complexity of health systems is crucial to ensure that evidence-based guidelines are tested with requisite humility and without a rigid adherence to models dominated by a limited number of disciplines.<ref name="Peters 2012"/><ref>{{cite journal|last=Hyder|first=A|title=Exploring health systems research and its influence on policy processes in low income countries|journal=BMC Public Health|year=2007|volume=7|pages=309|doi=10.1186/1471-2458-7-309|pmid=17974000|pmc=2213669|display-authors=etal|doi-access=free}}</ref> Healthcare services often implement Quality Improvement Initiatives to overcome this policy implementation gap. Although many of these initiatives deliver improved healthcare, a large proportion fail to be sustained. Numerous tools and frameworks have been created to respond to this challenge and increase improvement longevity. One tool highlighted the need for these tools to respond to user preferences and settings to optimize impact.<ref>{{cite journal|last1=Lennox|first1=Laura|last2=Doyle|first2=Cathal|last3=Reed|first3=Julie E.|last4=Bell|first4=Derek|title=What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London|journal=BMJ Open|date=1 September 2017|volume=7|issue=9|pages=e014417|doi=10.1136/bmjopen-2016-014417|pmid=28947436|language=en|issn=2044-6055|pmc=5623390}}</ref>

Health Policy and Systems Research (HPSR) is an emerging multidisciplinary field that challenges 'disciplinary capture' by dominant health research traditions, arguing that these traditions generate premature and inappropriately narrow definitions that impede rather than enhance health systems strengthening.<ref>{{cite journal|last=Sheikh|first=Kabir|author2=Lucy Gilson |author3=Irene Akua Agyepong |author4=Kara Hanson |author5=Freddie Ssengooba |author6=Sara Bennett |title=Building the Field of Health Policy and Systems Research: Framing the Questions|journal=PLOS Medicine|year=2011|volume=8|issue=8|doi=10.1371/journal.pmed.1001073|pages=e1001073|pmid=21857809|pmc=3156683 |doi-access=free }} {{open access}}</ref> HPSR focuses on low- and middle-income countries and draws on the relativist social science paradigm which recognises that all phenomena are constructed through human behaviour and interpretation. In using this approach, HPSR offers insight into health systems by generating a complex understanding of context in order to enhance health policy learning.<ref>{{cite journal|last=Gilson|first=Lucy|author2=Kara Hanson |author3=Kabir Sheikh |author4=Irene Akua Agyepong |author5=Freddie Ssengooba |author6=Sara Bennet |title=Building the Field of Health Policy and Systems Research: Social Science Matters|journal=PLOS Medicine|year=2011|volume=8|issue=8|doi=10.1371/journal.pmed.1001079|pages=e1001079|pmid=21886488|pmc=3160340 |doi-access=free }}  {{open access}}</ref> HPSR calls for greater involvement of local actors, including policy makers, civil society and researchers, in decisions that are made around funding health policy research and health systems strengthening.<ref>{{cite journal|last=Bennet|first=Sara|author2=Irene Akua Agyepong |author3=Kabir Sheikh |author4=Kara Hanson |author5=Freddie Ssengooba |author6=Lucy Gilson |title=Building the Field of Health Policy and Systems Research: An Agenda for Action|journal=PLOS Medicine |year=2011|volume=8|issue=8|doi=10.1371/journal.pmed.1001081|pages=e1001081 |pmid=21918641 |pmc=3168867 |doi-access=free }} {{open access}}</ref>

<div style="display:inline-table; vertical-align:top;">
[[File:Overweight or obese population OECD 2010.png|thumb|none|Percentage of overweight or obese population in 2010. Data source: OECD's iLibrary, http://stats.oecd.org, retrieved 2013-12-12<ref name="OECDOverwObese">{{cite web|url=http://stats.oecd.org//Index.aspx?QueryId=53508|title=OECD.StatExtracts, Health, Non-Medical Determinants of Health, Body weight, Overweight or obese population, self-reported and measured, Total population|publisher=OECD's iLibrary|year=2013|format=Online Statistics|website=stats.oecd.org|access-date=24 April 2014|archive-date=2 April 2019|archive-url=https://web.archive.org/web/20190402154352/https://stats.oecd.org/index.aspx/?QueryId=53508|url-status=live}}</ref>]]
</div>
<div style="display:inline-table; vertical-align:top;">
[[File:Obese population OECD 2010.png|thumb|none|Percentage of obese population in 2010. Data source: OECD's iLibrary, http://stats.oecd.org, retrieved 2013-12-13<ref name="OECDObese">{{cite web|url=http://stats.oecd.org//Index.aspx?QueryId=53527|title=OECD.StatExtracts, Health, Non-Medical Determinants of Health, Body weight, Obese population, self-reported and measured, Total population|publisher=OECD's iLibrary|year=2013|format=Online Statistics|website=stats.oecd.org|access-date=24 April 2014|archive-date=2 April 2019|archive-url=https://web.archive.org/web/20190402163724/https://stats.oecd.org/index.aspx/?QueryId=53527|url-status=live}}</ref>]]
</div>