Introduction

The aim of this website is to share expertise and experience on health care systems with policy makers, managers of health services, health care providers and health system researchers. The website is a product of a network of partners on health systems, which individual members can be found at the bottom of this page. The network is funded by the Belgian government (Directorate-General for Development Co-operation).

A focus on health care systems

Health systems can be defined by their goals (e.g. good health, responsiveness, fairness – World Health Report 2000) and functions (e.g. services, workforce, information, products, financing, leadership – WHO, 2007. Strengthening health systems to improve health outcomes, WHO’s framework for action). Strengthening health systems comprises a vast array of interventions, with an equally wide variation of effects on the final objectives of a health system. Interventions discussed on this website focus on specific elements: on health care systems and on health care delivery. In our view, the objective of strong health care systems is to provide satisfying responses to people’s felt needs by the provision of accessible and acceptable comprehensive care. Such a health care system is expected to foster trust relations between services and community, and to increase chances of success for integrated health promotion and prevention. We focus on critical factors affecting the access to adequate health care. Among others, this is financial access, promotion of quality of care, availability of competent and motivated health personnel, and issues relating to international aid policies, including the interface between disease-specific programmes and health systems.

Health care systems in a changing context

Health care systems are complex systems in a changing context. These dynamics can be described as demographic, epidemiological, technological, economic and socio-political transitions. Many health care systems have not well adjusted to the consequences of the transitions and face serious constraints in essential functions, such as financing, human resources, quality of health care delivery and leadership. Finally this affects the outcome of health systems: it has led in many settings to stagnation in health status, a challenge in equity - unequal access and unfair financial contributions - and a diminished trust in health providers and systems.

The need for healing of health care systems

Health care systems need to be adjusted to the changing context. The general principle of responsiveness of services to patients’ and communities’ expectations remains highly valid. The challenge is to develop policies and strategies to deal with the context transitions and its consequences, in such a way that the objectives of the health system can be met.
The World Health Report 2008, which advocates for a new primary health care movement, puts access to and quality of health care back at the centre of international attention. The observation in the report that inequities in health have risen and that health systems by themselves don’t move towards greater equity, puts pressure on health system leaders to make greater efforts to address these inequities. It is crucial to link politics to action in both directions: values and political choices behind the technical measures on health system strengthening need to be made explicit; and general commitments need translation into concrete strategies. The momentum for reforms in the organisation of health systems, in health care delivery and in health care policies towards greater equity is big. Decision-makers ask advice on which strategies work best in which context. We aim to provide tools for the choice and implementation of strategies towards these objectives in different contexts.