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 Switching International Health Policies and Systems (SWHIPS).The articles are publisher versions or author versions, depending on the archiving policies of the publishers. Of all articles, the copyright remains with the editor or author, respectively. Contact us: healthsystems@itg.be.

More information on the aim of this website.

Selected readings on health systems

‘Selected Readings’ provides a selection of recent health system articles with a review of its relevance and utility, made by the Network Switching International Health Policies & Systems. (http://qa.hepep.sidonia.be/) (http://bit.ly/qniyMS). Contact: healthsystems@itg.be

Health Systems Alerts: online or via RSS feeds

We also produces a weekly newsletter ‘International Health Policies in the News

June 2011

We thank many of you for your reactions to our call for editors. We have considerably enlarged our team with dynamic and emerging voices from all over the globe. This edition, with relatively few articles but extensive reviews, illustrates the development of Selected Readings with more emphasis on the reviews themselves. We will use the summer months to develop the archive function of the Selected Readings. That means that we will not send you a Selected Readings in July/August, but we will give you more news in September. Our aim is to enable you to retrieve the individual reviews per topic. We hope that you continue to provide us the input for this endeavor.

May 2011

The selection of items is small this time, but some of the reviews very elaborate. The editorial team considers the reviews an important aspect of our initiative, because they make our Selected Readings more than a mailing list of articles. Through them, we aim to stimulate reflection and discussion, to remain critical towards publications.

Some reviews turn out to be very thorough analysis which are worth a commentary itself. In this item, the review on the Lancet papers of Brasil and that on stillbirths definitely fall in this category.

We encourage you to join us. Most of you read papers for professional reasons anyhow. By making a review, you can kill two birds with one stone: read the article, formulate your opinion about it and share it with a broader network of colleagues and the outside world. If you want to join our pool of reviewers, send us an email: healthsystems@itg.be.


Feb-April 2011

We are always searching for people who can contribute to the reviewing of articles and stimulating of debate. Being part of the reviewing group means that we might actively approach you to write a short comment on a paper, that you can suggest articles for the selection and that you can join the editing team discussions. The reviews might sometimes lead to publications and discussions outside our immediate network.  Our review on the paper of Swanson et al about the consensus paper on health systems strengthening (HS Sel Readings of December 2010) provoked a reaction from the authors and led to an exchange on the PLoS platform (http://bit.ly/jtVsbf). We are waiting the publication of a letter in Health Affairs reacting to the article of Goroff & Reich (HS Sel Readings Jan 2011). Your voice might thus be heard globally! The people of the clinical science department in ITM accepted to review the article about pharmaceutical interventions in this issue which is first step on the road to collaboration between networks of clinical health and public health. Thank you very much for your input.


January 2011

After a double Christmas edition, we provide you with a lighter version of the Selected Readings this time. The articles selected illustrate the present “wave” of topics that gain attention though. Several articles on chronic diseases, which illustrate the warming up of the international community towards to UN summit in November this year, a thorough review on the impact of e-health on health care, and two articles about research and decision-making. Feel free to comment to us, privately or publicly, about the selection of articles or about the views which we express. In fact, Karen Pesse in her reaction to the article of Prashanth et al, makes an explicit call to all of us to start an international discussion group to address the issue of (universally valid??) standards for health systems research. The floor is yours.


December Special Issue 2010

In the November issue, we promised you to review the 52 World Health Report 2010 background papers – so you could offer the result as a Xmas present and annex to the December Selected Readings in Health Systems. Time has come.

As you will see in the annexed PDF or in the sendspace link, this exercise has not been a systematic review. A consistent logic however (title, authors, number of pages, type of study, level of analysis, key lessons,...) aims at providing easy guidance. My hope is that such will help potential readers to pick up what is of their interest, and to leave the rest untouched. My modest aim is thus to facilitate access in case of need (did I hear that jargon somewhere?)

As you will notice, I complete each review with a short section on relevance for Indian health policy. This is because I offer this work hereby also to Institute of Public Health in Bangalore, as a first in a series of long-awaited IPH working papers. And I trustfully assume that the non-Indian readers will determine the relevance for their particular health policy all by themselves.

Happy end of 2010, and a wonderful 2011!.


December 2010

The last edition of 2010 is a short regular number, with an extensive special edition devoted to the World Health Report 2010.
We wish you all the best for 2011.


November 2010

Again another World Health Report with a focus on health systems, this time on financing universal coverage. Loyal to out intention to provide you not only with publications, but also with a review that puts them in perspective, we have not included the report yet. Instead, we commit ourselves to an in depth discussion of the report and its 52 (!) background papers in the December issue, as an appetiser or desert along your Christmas dinner.

Instead, we offer papers covering a mix of topics. Having just returned from the Global Symposium on Health Systems Research in Montreux, we are inspired to continue our exchange with you in this field, which is increasingly recognised as important yet underdeveloped. Interesting background papers can be found at http://www.hsr-symposium.org/index.php/background-papers.

There was quite some attention for the so-called ‘success stories’ on the road to universal coverage. Although several people mentioned the need also to document failures, in order to better understand the why and how of implementation, this shaming practice is less popular. Another frequently heard remark was the need for more rigour in health systems research. In the next issue we will try to discuss a number of papers that give inspiration for new methodologies in health systems research. The differences in existing terminology in the health systems research discourse are discussed in a number of papers in this selection.

Finally, a lot of discussion, in Montreux but also in earlier editions of our newsletter, concerns the link between research and policy and practice. The new promise seems to be the emergence of national institutes than can link research with policy, adapted to the local contexts. The comment in the Lancet from Frieden en Koplan has also noted their relevance, although they (still) limit themselves to domains that are largely disease-control oriented.

Sept / Oct 2010

The warming up for two major events in the domain of Health Systems research is clearly visible. Many publications about health financing are a forecast to the new World Health Report. The article of Mathauer and Carrin is, according to us, a new key reference, in the scientific literature. The editorials and articles about research and health systems strengthening prepare us for the first symposium on health systems research in Montreux, 16-19 November.

August 2010

Pakistan's Katrina and the floods in south-western Sudan again demonstrate how important it is to have health workforce at the right time in the right place. Hence our back to school edition (in Europe that is) includes some interesting articles on how to get people in rural and remote posts at all.  
September holds a lot of promises now that the war in Iraq is officially declared finished and the Middle East talks have been revamped. We'll keep eyes and ears open for the preludes of the MDGs' summit (20-22 Sept in NY), the ultimate chance to reach the goals of 2015?

July 2010

In press circles, this time of the year is known as silly season – French morte-saison, Dutch komkommertijd, German Sauregurkenzeit – with serpientes de verano popping up for lack of newsworthy stories. Not so in our Selected Readings on Health Systems: you’ll find below some real food for thought. On strengthening health systems of course, supportive tools and community interventions, and so on. A special recommendation goes to Ridde’s article on the per diem epidemic. Another contribution points at the typical very general character of editorials.
Who reads introductions and editorials anyway? Years ago while still in Latin America, I got fed up with the seemingly mandatory use of opening paragraphs expressing the desire that the addressee would be in good health and surrounded by beloved family and so on. In fact I became convinced that nobody ever read them. One day I had to apply to the Minister for a special permission and I replaced some of the nice modifiers by harsh language and balderdash, to see want happened. She willingly granted my request.
So if I’m not mistaken, you skipped this part. Enjoy your reading.

June 2010

Social determinants of health and primary health care are old themes in public health. Even so, in this Selected Readings we present a new report of the Commission on Social Determinants of Health and two articles on primary health care. In the present debates, these classical themes are very much linked to health systems and the article of Kruk on rebuilding health systems, that links the functioning of health systems with the broader society and the state, fits very well in this debate. Health system experts often plea for a broad approach to health systems strengthening that includes multiple components. The book of Guy Carrin seems to deal with financing, but in fact addresses much broader health systems’ issues. There is an increasing recognition of the importance of other than technical elements in health systems strengthening. This automatically draws the attention to the importance of governance. The articles of the Rockefeller Foundation and by Potter could give some useful insights in how to enhance governance. The article of De Brouwere et al discusses well how some of the building blocks link to access to health care delivery.

May 2010

Health System Research is no ivory tower research. It might be conceptual, analytical or operational, but it is always based on problems that are experienced in real-life health systems and inherently aims at strengthening these systems. In the global and national debates on how to strengthen health systems, researchers, decision-makers and implementers can be often found at the same table. The boundaries between think tanks, academia, and international technical, funding or implementing organisations are becoming blurred, many institutions being involved in developing guidelines or norms, providing service delivery and evaluation or research. One would say that the gaps between research, policy and implementation get more narrow, at least potentially. The audience of our Selected Readings mirrors this mixed table. Most of the input to the Selected Readings is still provided by people from the academia. And these people have still another task, being education. May and June are traditionally busy months for students and teachers alike. Theses are written, exams taken and everybody tries his level best to optimize performance. These tasks have taken quite some time of the editorial team this month and has resulted in a somewhat later and slimmer selection than usual. We still owe our readers some key publications, such as a new publication of Commission of Social Determinants of Health on equity and programmes (http://whqlibdoc.who.int/publications/2010/9789241563970_eng.pdf), for which we commit ourselves for the next issue. The May edition contains nevertheless enough body to keep you busy and informed. Enough food for thinkers with a number of articles that propose conceptual frameworks for elements of health systems and performance and some articles with very practical country experiences, for instance on mutual health organisations and chronic diseases.

April 2010

As we all know, one of the biggest challenges for today’s health professionals is not getting information for his/her job, but on choosing the useful and good quality ones from the huge amount of articles that are published each month. We hope this list of commented selected publications can help our readers in this endeavor.

Our purpose is to present a well balanced selection of articles, which includes most of themes that could be of interest for persons working for the strengthening of health services and systems, from local to national and international level. Therefore we try to include issues that are in the public health arena for many decades by now, but are still to be discussed and researched, such as maternal and child health or community participation, as well as up-to –date issues such as the impact of internet on clinical practice. We also try to include different approaches, types of publications, and articles referring to diverse settings. We further aim to stimulate reflection and discussion by providing reviews and comments.

But the search for diversity goes even farther: each month our editorial team is getting not only larger, but also geographically widespread, and next time we hope to have also some of you "on board"!

Information and diversity are very valuable resources and we want to demonstrate this with the selected readings. Our readers will judge, and hopefully give feedback, if we are successful in it or not.

March 2010

In the aftermath of the former World Health Report and in the run up to the next one, there is quite some attention in the health systems’ literature for primary care and for access to care. Even though it might be difficult to prove a strong link between access to care and improved health, as the articles of Rutherford and Frieden discuss, we consider, together with Obama, access to health care as a right. But frameworks for the description and assessment of access are scarce. In fact, access is determined by almost all elements in the health system, and especially the articles on human resources clearly show this.

For this issue, the editorial team was joined by new freelance editors, but also by a team of the ITM short course on health policy. The discussions between so many people of different backgrounds and continents have certainly been enriching. We hope that the richness of these discussions is reflected in the reviews of the articles.

February 2010

Among the papers of this issue, the usual categories are well covered. We present a number of publications that have been written by staff of partner institutes. We asked our reviewers to critically read and review them, and the Department of Public Health Readers Club weighed in with their comments (thanks for that!). We would welcome comments from our newsletter readers, too! For this issue, Fabienne Richard was invited to review the paper by Cross, Bell and Graham, and we take this opportunity to warmly invite anybody interested to join the editorial team on regular or freelance basis.

January 2010

The frameworks for health systems and initiatives for health systems strengthening multiply. It is not easy to retain an overview and to know which framework to use for which purpose. Some are very comprehensive and descriptive; others analyze subsystems or make explicit links with performance. We present a number of articles which illustrate the variability. Frenk criticizes the dominant frameworks, Atun proposes one specifically for the integration of disease-specific health programmes, the European Health Report seems not to add to existing frameworks, and finally Nishtar looks at fund flows and delivery mechanisms.

Maybe an interesting topic for a systematic review? If you want to take up the challenge, then SUPPORT gives you tools, not only how to do it, but also how to use it and to make sure that others use it. Networks might be a way to disseminate your ideas and to stimulate action, but networks themselves are dynamic entities, subject to changes and to interests of people involved.

December 2009

The linkages between practice, research and policy-making are increasingly becoming a topic of debate and analysis itself. The domain of health policy research is not an easy one, though. The existing conceptual models (such as the policy triangle, the streams model and others) still make it difficult to capture the actual process. A health policy researcher is like a rope dancer trying to balance between keeping the necessary distance for observation and coming close enough to understand the content, the context and the processes. This makes it difficult to analyse policy processes beyond the agenda-setting phase. Given the complex nature of decision-making at policy level, it is no surprise that there are different paradigms and subsequently different methods.

At the same time, researchers want to Get their Research being translated Into Policies and Practice (GRIPP). Eldis has dedicated an issue to this art. Ideally, both processes are not linear but circular. Pilot projects, local experiments can provide lessons in do’s and don’ts, which feed national policies. National and international actors can decide to role out a new strategy in a first wave at intermediate scale, in order to draw lessons before a generalized approach. Most of the selected readings in this issue cover this topic from various angles.

We also included a concept note on universal coverage, as a warming up for the discourse around next’s years World Health Report, an article about the health systems strengthening efforts of the Global Fund and a paper on how health systems should be organized in order to deliver quality chronic care.

November 2009

Health system researchers are not idle and respond in various ways to the call of many decision-makers for clearer concepts and strategies on health systems strengthening. The WHO Alliance for health policy and systems research aims at catalysing the conceptual thinking and tries to integrates the concepts of systems thinking and methodologies for complex interventions into the six building blocks model.

An example of the interactions between the six building blocks are the interventions that try to link financing to the performance of health workers in health systems. We selected two publications that give an overview of recent experiences in this field. The first one is a guide on how to best implement the strategy and how to avoid pitfalls, the second one discusses more critically the approach and its risks.

There are no golden bullet interventions to address weak health systems and different actors contribute in their own way. Another report by Cordaid and the Royal Tropical Institute, Amsterdam discusses strategies of the faith-based organizations in sub-Saharan Africa to address the quantitative and qualitative aspects of the human crisis. A Cochrane review discusses the evidence of strategies to contract out health care delivery to private actors.

A good information system on the flows of human and other resource is essential for policy makers and we selected two publications with guidelines on how to set up such a system. There are also two articles about health systems research and its linkages with policy and implementation.

October 2009

This month, we have selected a few publications in the domain of access, equity, participation and on the quality of health care. Exceptionally, we have included an article on human resources already notified in the IHP newsletter, because it is one of the most prominent issues in the debate on health systems strengthening.

Health systems strengthening remains a topic with multiple interpretations, as is shown by the two articles on TB, malaria, HIV and health system strengthening. The growing interest for operational research also in that field is noteworthy. Since HAART has prolonged the life of many AIDS patients, the care for people with AIDS faces the challenges of that of other chronic diseases and the way they are taken care of in general health services.

There are two articles about the link between health policy and research, describing cases from different continents. In the miscellaneous section a report on a typical issue in the area of the newest buzz-word ‘global health’: the threat of infectious outbreaks in cities.

Selected Readings on Health systems, Highlights from Verona

From 6-10 September, the 6th European Congress on Tropical Medicine and International Health was held in Verona, Italy. The topic Health Systems is obviously gaining importance, compared to the two years ago, when the conference was held in Amsterdam. The number of sessions around health systems, the big attendance of many sessions and the questions and discussions after the presentations showed that many people want to hear what is going on. We have selected the highlights of the sessions and news facts for you.
All abstracts of the conference can be found at TM & IH, volume 14 suppl 2 pp 98–247 september 2009