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

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

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Health system gaps in cardiovascular disease prevention and management in Nepal

BMC Health Services Research ◽

10.1186/s12913-021-06681-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Archana Shrestha ◽

Rashmi Maharjan ◽

Biraj Man Karmacharya ◽

Swornim Bajracharya ◽

Niharika Jha ◽

...

Keyword(s):

Human Resources ◽

Health System ◽

Health Systems ◽

National Health ◽

Task Force ◽

Health Spending ◽

Building Blocks ◽

Critical System ◽

Government Organizations ◽

The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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Johne’s disease control programmes

Veterinary Record ◽

10.1136/vr.k3496 ◽

2018 ◽

Vol 183 (7) ◽

pp. 224.1-225 ◽

Cited By ~ 1

Author(s):

Pete Orpin ◽

Dick Sibley

Keyword(s):

Disease Control ◽

Johne's Disease ◽

Johne’S Disease ◽

Control Programmes

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PO649 Tools For Implementing Rheumatic Heart Disease Control Programmes 2nd Edition Update

Global Heart ◽

10.1016/j.gheart.2018.09.504 ◽

2018 ◽

Vol 13 (4) ◽

pp. 520

Author(s):

R. Wyber ◽

T. Johnson ◽

S. Perkins ◽

D. Watkins ◽

S. La Vincente ◽

...

Keyword(s):

Heart Disease ◽

Disease Control ◽

Rheumatic Heart Disease ◽

Control Programmes ◽

Rheumatic Heart

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A code of good practice for the management of disease-control programmes

International Health and Aid Policies ◽

10.1017/cbo9780511902512.025 ◽

2011 ◽

pp. 195-198

Author(s):

Jean-Pierre Unger ◽

Pierre De Paepe ◽

Kasturi Sen ◽

Werner Soors

Keyword(s):

Disease Control ◽

Good Practice ◽

Control Programmes

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Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all

BMJ Global Health ◽

10.1136/bmjgh-2018-001384 ◽

2019 ◽

Vol 3 (Suppl 3) ◽

pp. e001384 ◽

Cited By ~ 9

Author(s):

Emma Sacks ◽

Melanie Morrow ◽

William T Story ◽

Katharine D Shelley ◽

D Shanklin ◽

...

Keyword(s):

Community Health ◽

Health Systems ◽

Health Sector ◽

Building Blocks ◽

Health Systems Strengthening ◽

Health It ◽

The Sustainable Development ◽

Health Goals ◽

Effective Community ◽

Community Roles

Achieving ambitious health goals—from the Every Woman Every Child strategy to the health targets of the sustainable development goals to the renewed promise of Alma-Ata of ‘health for all’—necessitates strong, functional and inclusive health systems. Improving and sustaining community health is integral to overall health systems strengthening efforts. However, while health systems and community health are conceptually and operationally related, the guidance informing health systems policymakers and financiers—particularly the well-known WHO ‘building blocks’ framework—only indirectly addresses the foundational elements necessary for effective community health. Although community-inclusive and community-led strategies may be more difficult, complex, and require more widespread resources than facility-based strategies, their exclusion from health systems frameworks leads to insufficient attention to elements that need ex-ante efforts and investments to set community health effectively within systems. This paper suggests an expansion of the WHO building blocks, starting with the recognition of the essential determinants of the production of health. It presents an expanded framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organising and mobilising social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognises societal partnerships as critical links to the public health sector. This framework makes explicit the oft-neglected investment needs for community health and aims to inform efforts to situate community health within national health systems and global guidance to achieve health for all.

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