WHO Building Blocks Research Articles

Health System Strengthening: Adopting WHO Building Blocks- Comparison between India and Indonesia

Background: The objective of this review was to review and compare between Indian and Indonesian health systems. It attempted to understand the health system strengthening activities adopted by both the countries. Subjects and Method: This was a systematic review using qualitative method. The internet-based search strategy extended the traditional approach of using biblio­graphic data­bases, journals, citations to include grey literature, abstracts, web­sites, reports and documents from WHO, World Bank, Ministry of Health Indonesia, and Ministry of Health and Family Welfare India. Results: The concept of designating house­hold meeting requisite health standards as a healthy home is something which can be successfully implemented in India as social recognition plays a vital part in encouraging people to move towards healthier lifestyles. India is in the process of upgrading 150,000 Sub Centres into health and wellness centers. Compre­hensive health care will be provided in these centers, including for mother and child health and noninfectious diseases. Essential drugs and diagnostic services will be provided free of cost at these centers. Another notable feature from India is the concept of ASHA which is an acronym and stands for Accredited Social Health Activist. ASHAs are locally selected and trained women who performed the duties of health promoters and educators in communities. The ASHA is trained to work as an intermediary between the public health system and the community. Medical Insurance coverage for Primary Care and the concept of VVIP Rooms at differential pricing is some­thing which can be tried in Indian context while, the latest Government funded medical insurance for Secondary and Tertiary care and Strategic purchase from Private sector is something Indonesia can emulate. For tackling the rural health care problems : schemes like National Rural Health Mission (NRHM) and mandatory service in rural areas by doctors if they want government job can be looked at by Indonesian Health care professionals. The concept of Posyandu (Maternity Hut) and the registered midwife clinics is a unique concept which can be tried in Indian Context. Conclusion: The Indian and Indonesian health care systems have been compared and contrasted. Keywords: health care system, India, Indonesia Correspondence: Shikha Gill. International Institute of Health Management Research, New Delhi, India. Email: shikhaparttapgill@gmail.com Journal of Health Policy and Management (2018), 3(2): 101-107 https://doi.org/10.26911/thejhpm.2018.03.02.06

Measuring Health System Performance: A Critique, with Proposals for Improving on the WHO “Building Blocks Framework”

Attempts have been made to measure overall national health performance and, more controversially, rank national health systems in terms of their relative performance. The World Health Organization made such an attempt in 2000. The resulting rankings generated criticism and controversy and was not repeated. Any attempt to measure overall national health performance for the purpose of comparison is fraught with challenges and unlikely to be produc- tive. In this critique (opinion piece), I argue that instead of measuring and ranking in terms of relative performance (such as responsiveness of health system and fairness of contribution to the health system), it would be relatively easier and less controversial to change the metrics and focus only on which components of a national health are not meeting specific standards of minimal requirements (i.e. using benchmarks associated with the WHO Blocks Frame- work) and ought to be improved through public policy intervention. The WHO Building Blocks Framework has short- comings and omissions. Some suggestions for its improvement are proposed.

Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework

BackgroundThe WHO health systems Building Blocks framework has become ubiquitous in health systems research. However, it was not developed as a research instrument, but rather to facilitate investments of resources in health systems. In this paper, we reflect on the advantages and limitations of using the framework in applied research, as experienced in three empirical vaccine studies we have undertaken.DiscussionWe argue that while the Building Blocks framework is valuable because of its simplicity and ability to provide a common language for researchers, it is not suitable for analysing dynamic, complex and inter-linked systems impacts. In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole. Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs. Another criticism is not of the framework per se, but rather how it is typically used, with a focus on the six building blocks to the neglect of the dynamic process and outcome aspects of health systems.We believe the framework would be improved by making three amendments: integrating the missing “demand” component; incorporating an overarching, holistic health systems viewpoint and including scope for interactions between components. If researchers choose to use the Building Blocks framework, we recommend that it be adapted to the specific study question and context, with formative research and piloting conducted in order to inform this adaptation.SummaryAs with frameworks in general, the WHO Building Blocks framework is valuable because it creates a common language and shared understanding. However, for applied research, it falls short of what is needed to holistically evaluate the impact of specific interventions on health systems. We propose that if researchers use the framework, it should be adapted and made context-specific.

Recent physician strike in Israel: a health system under stress?

In 2011, a series of physician strikes in Israel followed eight months of unsuccessful negotiations with the government (Ministry of Health and the Ministry of Finance). Strikes by physicians may be a warning that all is not well in a health system and protestors have claimed that they signify a system failure. In contrast, others argue that strikes have been a feature of the Israeli health system from its inception and should not be a cause for alarm. This paper analyses the Israeli health system from the perspective of the strikers' demands using the World Health Organisation’s six health system building blocks as a framework, including: service delivery; health workforce; information; medical products, vaccines and technologies; leadership and governance; and financing. While we recognise that the immediate causes of the 2011 strikes were concerns about salaries and working conditions, we argue that a complex set of interacting factors underlie the strikers' demands, resonating with issues relating to five of the WHO building blocks. We argue that of the five, three are most significant and limit progress with all the others: a disgruntled health workforce, many of whom believe that striking is the only way to be heard; a lack of leadership by the government in understanding and responding to physicians' concerns; and a purported information insufficiency, manifest as a lack of critique and analysis that may have prevented those at the top from making a reliable diagnosis of the system’s problems. This paper argues that there are cracks within the Israeli health system but that these are not irresolvable. The Israeli health system is a relatively new and popular health system, but there are no grounds for complacency.

Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs

BackgroundIntegrated into the work in health systems strengthening (HSS) is a growing focus on the importance of ensuring quality of the services delivered and systems which support them. Understanding how to define and measure quality in the different key World Health Organization building blocks is critical to providing the information needed to address gaps and identify models for replication.Description of approachesWe describe the approaches to defining and improving quality across the five country programs funded through the Doris Duke Charitable Foundation African Health Initiative. While each program has independently developed and implemented country-specific approaches to strengthening health systems, they all included quality of services and systems as a core principle. We describe the differences and similarities across the programs in defining and improving quality as an embedded process essential for HSS to achieve the goal of improved population health. The programs measured quality across most or all of the six WHO building blocks, with specific areas of overlap in improving quality falling into four main categories: 1) defining and measuring quality; 2) ensuring data quality, and building capacity for data use for decision making and response to quality measurements; 3) strengthened supportive supervision and/or mentoring; and 4) operational research to understand the factors associated with observed variation in quality.ConclusionsLearning the value and challenges of these approaches to measuring and improving quality across the key components of HSS as the projects continue their work will help inform similar efforts both now and in the future to ensure quality across the critical components of a health system and the impact on population health.