Chapter 7: Health Systems and Policy: Structure, Financing, and Policy Advocacy in Public Health

The health system is the cornerstone of any country’s ability to protect and improve the health of its population. It comprises a complex network of institutions, healthcare providers, resources, and policies that collectively aim to deliver healthcare services. The structure of a health system, how it is financed, and the policies that govern it determine not only the efficiency and accessibility of healthcare but also the quality of care that individuals and populations receive. Effective health systems and sound policy frameworks can lead to better health outcomes, improved equity, and a more resilient healthcare environment.

This chapter explores the key components of health systems, the mechanisms of financing, and the role of policy advocacy in shaping public health. We will examine how these elements work together to address both individual and population health needs while aiming for equity and sustainability in healthcare delivery.

7.1 The Structure of Health Systems

A health system is a network of institutions, organizations, and people whose primary purpose is to improve health. The World Health Organization (WHO) outlines several key components that form the backbone of a health system. These include governance, service delivery, health workforce, financing, health information systems, and the availability of medical products and technologies.

1. Governance and Leadership:

Policy Formulation: The government’s role in establishing health policies is foundational. Health policies help define priorities, set goals, allocate resources, and determine how services will be delivered. Effective leadership ensures that policies are implemented in ways that maximize their impact on health outcomes.

Regulation and Oversight: Health systems require strong regulation to ensure quality standards are met and that health services are accessible to all. This includes monitoring health providers, medical products, and technologies to guarantee safety and effectiveness.

2. Service Delivery:

Primary Healthcare (PHC): Primary healthcare is considered the bedrock of any health system. It involves providing essential health services that are universally accessible to individuals and families in the community. PHC emphasizes disease prevention, health promotion, and basic treatment, which can reduce the burden on secondary and tertiary care facilities.

Secondary and Tertiary Care: Secondary care includes services provided by specialists or in hospitals for more complex health conditions, while tertiary care involves specialized care for advanced or rare health conditions, usually at larger hospitals or research institutions

3. Health Workforce:

Human Resources for Health: The availability of a skilled health workforce is essential for delivering high-quality care. This includes doctors, nurses, midwives, allied health professionals, and support staff. A sufficient and well-trained health workforce is critical in ensuring that care is timely, effective, and safe.

Training and Retention: Proper education, ongoing training, and retention strategies are needed to ensure a stable healthcare workforce. Challenges such as staff shortages or migration of healthcare professionals can undermine the functioning of health systems, especially in low-resource settings.

4. Health Information Systems:

Data and Monitoring: A robust health information system enables effective decision-making by collecting and analyzing health data. Information on disease prevalence, healthcare access, and patient outcomes allows policymakers to allocate resources and design interventions more effectively.

Electronic Health Records (EHR): The use of digital tools, including EHR systems, helps improve the accuracy, speed, and continuity of care, making it easier to track patient histories, streamline diagnostics, and coordinate care.

5. Medical Products, Vaccines, and Technologies:

Availability and Access: Ensuring access to essential medical products, including vaccines, medications, diagnostic tools, and medical technologies, is key to effective healthcare. A functioning supply chain that delivers medicines and technology to health facilities in a timely manner is essential to the performance of any health system.

7.2 Health Financing: Ensuring Sustainability and Equity

Financing healthcare is one of the greatest challenges that governments face. Health financing determines the allocation of resources for healthcare services, which ultimately affects the availability, quality, and affordability of care. For health systems to be sustainable and equitable, they must be funded adequately and efficiently. The objective of health financing is to ensure that everyone has access to the care they need without suffering financial hardship.

1. Financing Models:

Public Financing: Many countries fund their health systems primarily through public sources, such as taxation or social health insurance. Public financing is often viewed as the most equitable approach, as it spreads the cost of healthcare across the entire population, making services available to everyone, regardless of income.

Private Financing: In some countries, private health insurance and out-of-pocket payments play a larger role in financing healthcare. However, this can lead to disparities in access, as those with more resources can afford better care, while low-income individuals may be left behind.

Mixed Financing: Many countries adopt a mixed model, using both public and private financing mechanisms. For example, some health systems use public funds to cover basic services, while private insurance may be used to supplement coverage for more specialized or elective care.

2. Sources of Health Financing:

Taxation: Governments collect revenue through taxes to fund public health systems. Taxes can be general or earmarked for healthcare spending, depending on national policies.

Social Health Insurance: In some countries, health financing is based on a system of social health insurance, where workers and employers contribute to a central fund that finances healthcare services. This system is designed to provide universal coverage by pooling risk across the population.

Private Insurance and Out-of-Pocket Payments: Private health insurance often complements public health systems by covering services not included in national plans or by providing faster access to care. Out-of-pocket payments, however, can create barriers to care, particularly for low-income individuals.

3. Challenges in Health Financing:

Equity in Access: One of the biggest challenges in health financing is ensuring that resources are allocated equitably, so that all individuals have access to the care they need, regardless of their socio-economic status. Without proper financial protection, individuals from low-income households may be excluded from essential services.

Sustainability: As populations grow and age, there is increased pressure on healthcare systems to provide care for more people, which often requires higher levels of funding. Balancing the costs of healthcare with the ability of a country to generate sufficient revenue is a delicate task.

Efficiency: Inefficiencies in the use of health funds, such as wasteful spending, corruption, or poor resource management, can undermine the effectiveness of health financing systems. Maximizing the efficiency of funds is key to improving health outcomes

7.3 Policy Advocacy: Influencing Health Systems and Public Health Outcomes

Health policy plays a pivotal role in shaping how health systems function and in determining the priorities of healthcare delivery. Effective health policy advocacy ensures that public health remains a priority at national and global levels and that resources are allocated appropriately. Advocacy efforts seek to influence policymakers and public opinion, drawing attention to health challenges and proposing solutions.

1. The Role of Health Policy:

Public Health Priorities: Health policies are responsible for identifying and addressing the most pressing health issues facing a population, such as infectious diseases, non-communicable diseases (NCDs), mental health, and maternal and child health.

Equity and Access: Health policy is central to ensuring that healthcare is accessible to all individuals, particularly marginalized groups. Policy interventions are needed to reduce disparities in healthcare access and outcomes, especially for low-income populations, rural communities, and minority groups.

Universal Health Coverage (UHC): One of the key objectives of health policy is to achieve UHC, which aims to provide all individuals with access to quality health services without financial hardship. Advocacy for UHC is critical in countries with large gaps in coverage or where healthcare is primarily paid for out-of-pocket.

2. Policy Advocacy Strategies:

Research and Evidence: Data and research are essential for shaping health policy. Policy advocacy is most effective when it is grounded in strong evidence showing the potential impact of specific interventions. Health organizations, researchers, and think tanks often conduct studies to advocate for policy changes.

Public Engagement: Engaging the public is an important tool for influencing health policy. Public support can be mobilized through campaigns, social media, and public demonstrations. Public advocacy can push policymakers to prioritize certain health issues or make significant changes to health systems.

Coalitions and Partnerships: Policy advocacy is often more powerful when groups work together. Partnerships between government agencies, non-governmental organizations (NGOs), community groups, and private organizations can strengthen advocacy efforts and build a more compelling case for policy reform.

3. Global Health Policy Advocacy:

International Collaboration: Global health policy advocacy is essential for addressing health challenges that transcend borders, such as pandemics, climate change, and the spread of infectious diseases. International organizations like the World Health Organization (WHO), the World Bank, and United Nations (UN) agencies play significant roles in shaping global health policy.

Global Health Frameworks: Health policy advocacy at the global level focuses on frameworks such as the Sustainable Development Goals (SDGs), which emphasize health as a key element of sustainable development. Advocating for stronger international collaboration and funding can help address health challenges in low- and middle-income countries.

7.4 Conclusion

In conclusion, the effectiveness of health systems relies on a harmonious balance between structure, financing, and policy advocacy. A well-organized health system ensures that essential healthcare services are accessible, timely, and of high quality. However, for these systems to function effectively, they must be adequately financed. Whether through public, private, or mixed models, sustainable health financing mechanisms are vital to maintain the quality and reach of healthcare services, particularly in low- and middle-income countries.

Equally important is the role of policy advocacy in shaping the direction of healthcare systems. By influencing policies at local, national, and international levels, advocacy efforts can ensure that health systems prioritize equity, accessibility, and affordability. Policy frameworks must be designed to address the specific health needs of populations while also accounting for global challenges such as pandemics, aging populations, and the rise of non-communicable diseases.

As global health challenges continue to evolve, the need for strong, adaptable, and sustainable health systems has never been greater. Policymakers must work collaboratively with all stakeholders—governments, healthcare providers, civil society, and international organizations—to create systems that are resilient, inclusive, and capable of addressing the diverse health needs of populations worldwide. In the end, a well-structured health system with equitable financing and robust policy advocacy is essential for achieving universal health coverage and improving the overall health and well-being of individuals and communities.