The Health System Dynamics Framework: The introduction of an analytical model for health system analysis and its application to two case-studies

J van Olmen, B Criel, U Bhojani, B Marchal, S van Belle, M F Chenge, T Hoerée, M Pirard, W Van Damme, G Kegels

Abstract


Frameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling.

The added value of this framework is: 1) consideration of different levels of a health system and tracing how interventions or events at one level influence other elements and other levels; 2) emphasizes the importance of values; 3) a central axis linking governance, human resources, service delivery and population, and 4) taking into account the key elements of complexity in analysis and strategy development. We urge  the analysis of individual health systems and meta-analysis, for a better understanding of their functioning and strengthening.

 


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References


Alma Ata. Declaration of Alma Ata: International conference on primary health care.

http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf . 6-9-1978. Alma-Ata, USSR, Alma Ata. International Conference on Primary Health Care. 6-9-2008.

Atun, R., de Jongh, T., Secci, F., Ohiri, K., & Adeyi, O. 2009. Integration of targeted health interventions into health systems: a conceptual framework for analysis. Health Policy and Planning, 25, 104-111 available from: PM:19917651

Beaglehole, R. & Yach, D. 2003. Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults. Lancet, 362, (9387) 903-908 available from: ISI:000185329400024

Bennett, S., Agyepong, I., Sheikh, K., Hanson, K., Ssengooba, F., & Gilson, L. 2011. Building the field of health policy and systems research: an agenda for action. PLoS.Med, 8, (8) e1001081 available from: PM:21918641

Berlan, D. & Shiffman, J. 2011. Holding health providers in developing countries accountable to consumers: a synthesis of relevant scholarship. Health Policy Plan. Available from: PM:21551121

Bhojani, U., Thriveni, B., Devadasan, R., Munegowda, M., Anthonyamma, C., Soors, W., Devadasan, N., Criel, B., & Kolsteren, P. 2011. Health system obstacles in the delivery of quality care to people with chronic disease (PWCD): a case study from urban India. Tropical Medicine & International Health, 16, (Supplement I) 346-347

Bloom, G. & Standing, H. Pluralism and marketisation in the health sector: meeting needs in contexts of social change in low- and middle-income countries. [136]. 2001. Brighton, Institute of Development Studies. Working Paper.

Boussery, G., Campos da Silveria, V., & Criel, B. 2011, Harmonisation for Health in Africa. Community of Practive on the Service Delivery Practice Study of High Impact Interventions., Institute of Tropical Medicine Antwerp.

Brinkerhoff, D. Accountability and Health Systems: Overview, Framework, and Strategies. 2003. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc.

Caudron, J., Ford, N., Henkens, M., Mace, C., Kiddle-Monroe,

R., & Pinel, J. 2008. Substandard medicines in resource-poor settings: a problem that can no longer be ignored. Trop.Med Int Health, 13, (8) 1062-1072 available from: PM:18631318

Chenge, F., Van der Vennet, J., Porignon, D., Luboya, N., Kabyla, I., & Criel, B. 2010a. La carte sanitaire de la ville de Lubumbashi, République Démocratique du Congo. Partie I: problématique de la couverture sanitaire en milieu urbain congolais. Global Health Promotion, 17, (3) 63-74

Chenge, F., Van der Vennet, J., van Olmen, J., & Criel, B. Training of Medical Doctors in the DRC. Consequences of uncontrolled creation of medical schools in the province of Katanga. 2010b. Antwerp, Institute of Tropical Medicine. 22-6-2010b.

Evans, R. & Stoddart, G. 1990. Producing health, consuming health care. Social Science & Medicine, 31, (12) 1347-1363 available from: PM:2126895

Freedman, L. 2005. Achieving the MDGs: Health systems as core social institutions. Development, 48, (1) 19-24

Frenk, J. 2010. The global health system: strengthening national health systems as the next step for global progress. Plos Medicine, 7, (1) e1000089 available from: PM:20069038

Gilson, L. 2003. Trust and the development of health care as a social institution. Social Science & Medicine, 56, (7) 1453-1468 available from: PM:12614697

Gilson, L., Hanson, K., Sheikh, K., Agyepong, I., Ssengooba, F., & Bennett, S. 2011. Building the field of health policy and systems research: social science matters. PLoS.Med, 8, (8) e1001079 available from: PM:21886488

Gilson, L., Loewenson, R., Doherty, J., & Francis, V. 2007, Challenging Inequity through Health Systems. Final Report Knowledge Network on Health Systems., WHO Commission on the Social Determinants of Health.

Gilson, L., Palmer, N., & Schneider, H. 2005. Trust and health worker performance: exploring a conceptual framework using South African evidence. Social Science & Medicine, 61, (7) 1418-1429 available from: PM:16005777

Hôpitaux Universitaires de Genève 2010, Geneva Health Forum 2010. Globalisation, Crisis and Health Systems. Confronting Regional perspectives, Geneva.

Howie, J., Heaney, D., Maxwell, M., Walker, J., & Freeman, G. 2000. Developing a 'consultation quality index' (CQI) for use in general practice. Family Practice, 17, (6) 455-461 available from: PM:11120715

Huber, M., Knottnerus, J., Green, L., van der Horst, H., Jadad, A., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M., van der Meer, J., Schnabel, P., Smith, R., van, W.C., & Smid, H. 2011. How should we define health? BMJ, 343, d4163 available from: PM:21791490

Institute of Medicine 2001. Crossing the quality chasm. A new health system for the 21st century. Washington, National Academy Press.

Kalk, A. 2011. The costs of performance-based financing. Bull. World Health Organ, 89, (5) 319 available from: PM:21556295

Keugoung, B., Macq, J., Buve, A., Meli, J., & Criel, B. 2011. The interface between health systems and vertical programmes in Francophone Africa: the managers' perceptions. Trop.Med Int Health, 16, (4) 478-485 available from: PM:21219552

Labonte, R., Mohindra, K., & Lencucha, R. 2011. Framing international trade and chronic disease. Global Health, 7, (1) 21 available from: PM:21726434

Laing, R., Hogerzeil, H., & Ross-Degnan, D. 2001. Ten recommendations to improve use of medicines in developing countries. Health Policy and Planning, 16, (1) 13-20 available from: PM:11238425

Marchal, B., Dedzo, M., & Kegels, G. 2010. A realist evaluation of the management of a well-performing regional hospital in Ghana. Bmc Health Services Research, 10, 24 available from: PM:20100330

Marchal, B. & Kegels, G. 2003. Health workforce imbalances in times of globalization: brain drain or professional mobility? International Journal for Health Planning & Management, 18 Suppl 1, S89-101 available from: PM:14661944

Marchal, B., Van Dormael, M., Pirard, M., Cavalli, A., Kegels, G., & Polman, K. 2011. Neglected Tropical Disease (NTD) control in health systems: the interface between programmes and general health services. Acta Tropica, (in press),

McPake, B., Matthews, Z., Channon, A., Hadi, Y., & Chattoe-Brown, A. 2009, Health Systems Typology, HLSP, Southampton.

Meessen, B., Bigdeli, M., Chheng, K., Decoster, K., Ir, P., Men, C., & Van Damme W. 2011a. Composition of pluralistic health systems: how much can we learn from household surveys? An exploration in Cambodia. Health Policy Plan., 26 Suppl 1, i30-i44 available from: PM:21729915

Meessen, B., Kouanda, S., Musango, L., Richard, F., Ridde, V., & Soucat, A. 2011b. Communities of practice: the missing link for knowledge management on implementation issues in low-income countries? Trop.Med Int Health available from: PM:21564426

Meessen, B., Soucat, A., & Sekabaraga, C. 2011c. Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform? Bull.World Health Organ, 89, (2) 153-156 available from: PM:21346927

Michielsen, J., Meulemans, H., Soors, W., Ndiaye, P., Devadasan, N., De, H.T., Verbist, G., & Criel, B. 2010. Social protection in health: the need for a transformative dimension. Tropical Medicine & International Health available from: PM:20374560

Mills, A. 2011. Health policy and systems research: defining the terrain; identifying the methods. Health Policy and Planning available from: PM:21324972

Mills, A. & Ranson, M. K. 2006, "The design of health systems," In International public health: diseases, programs, systems, and policies, 2nd ed. M. H. Merson, R. E. Black, & A. Mills, eds., Sudbury: Jones and Bartlett Publishers, pp. 513-551.

Narasimhan, V., Brown, H., Pablos-Mendez, A., Adams, O., Dussault, G., Elzinga, G., Nordstrom, A., Habte, D., Jacobs, M., Solimano, G., Sewankambo, N., Wibulpolprasert, S., Evans, T., & Chen, L. 2004. Responding to the global human resources crisis. Lancet, 363, (9419) 1469-1472 available from: ISI:000221130300022

Nishtar, S. 2010. The mixed health systems syndrome. Bull.World Health Organ, 88, (1) 74-75 available from: PM:20428356

Ooms, G. & Hammonds, R. 2009. Scaling up global social health protection: prerequisite reforms to the International Monetary Fund. International Journal of Health Services, 39, (4) 795-801 available from: PM:19927417

Paina, L. & Peters, D. 2011. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan. Available from: PM:21821667

Palmer, N., Mueller, D.H., Gilson, L., Mills, A., & Haines, A. 2004. Health financing to promote access in low income settings-how much do we know? Lancet, 364, (9442) 1365-1370

Paris, V., Devaux, M., & Wei, L. Health Systems Institutional Characteristics: A Survey of 29 OECD Countries. [50]. 2010. Paris, Organization for Economic Co-operation and Development. OECD Health Working Papers.

Parkhurst, J., Weller, I., & Kemp, J. 2010. Getting research into policy, or out of practice, in HIV? Lancet, 375, (9724) 1414-1415 available from: PM:20417842

Perez, D., Lefevre, P., Romero, M.I., Sanchez, L., De Vos, P., & Van der Stuyft, P. 2009. Augmenting frameworks for appraising the practices of community-based health interventions. Health Policy and Planning, 24, (5) 335-341 available from: ISI:000269001700003

Peters, D., El-Saharty, S., Siadat, B., Janovsky, K., & Vujicic, M. Improving Health Service Delivery in Developing Countries. Peters, D., El-Saharty, S., Siadat, B., Janovsky, K., and

Vujicic, M. 2010. Washington, World Bank.

Peters, D. & Muraleedharan, V. 2008. Regulating India's health services: To what end? What future? Social Science & Medicine, 66, (10) 2133-2144 available from: PM:18313189

Potter, C. & Brough, R. 2004. Systemic capacity building: a hierarchy of needs. Health Policy and Planning, 19, (5) 336-345 available from: PM:15310668

Reddy, K., Shah, B., Varghese, C., & Ramadoss, A. 2005. Chronic diseases 3 - Responding to the threat of chronic diseases in India. Lancet, 366, (9498) 1744-1749 available from: ISI:000233206400031;file://C:JOSEFIEN Persoonlijke documenten WERKSTATIONBIBLIOTHEEKChronic DiseasesReddy_responding to threat CD India_Lancete 2005.pdf

Reich, M. 2002. Reshaping the state from above, from within, from below: implications for public health. Social Science & Medicine, 54, (11) 1669-1675 available from: PM:12113448

Reich, M. & Takemi, K. 2009. G8 and strengthening of health systems: follow-up to the Tokayo summit. Lancet, 373, (9662) 508-515

Richard, F., Hercot, D., Ouédraogo, C., Delvaux, T., Samaké, S., van Olmen, J., Conombo, G., Hammonds, R., & Vandemoortele, J. 2011. Sub-Saharan Africa and the Health MDGs: the need to move beyond the 'quick win' model. Reproductive Health Matters, 19, (38) 42-55

Rifkin, S. 2001. Ten best readings on community participation and health. African Health Sciences, 1, (1) 42-45 available from: PM:12789133

Rifkin, S. 2003. A framework linking community empowerment and health equity: it is a matter of CHOICE. J.Health Popul.Nutr., 21, (3) 168-180 available from: PM:14717563

Riley, J. 2008. Low income, social growth, and good health. Berkeley: University of California Press.

Roberts, M., Hsiao, W., Berman, P., & Reich, M. 2004a, "Financing," In Getting Health Reform Right. A Guide to Improving Performance and Equity, New York: Oxford University Press, pp. 153-189.

Roberts, M., Hsiao, W., Berman, P., & Reich, M. 2004b. Getting Health Reform Right. A Guide to Improving Performance and Equity New York, Oxford University Press.

Shakarishvili, G., Atun, R., Berman, P., Hsiao, W., Burgess, C., & Lansang, M. 2010. Converging Health Systems Frameworks: Towards A Concepts-to-Actions Roadmap for Health Systems Strengthening in Low and Middle Income Countries. Global Health Governance, III, (2)

Sheikh, K., Gilson, L., Agyepong, I., Hanson, K., Ssengooba, F., & Bennett, S. 2011. Building the field of health policy and systems research: framing the questions. PLoS.Med, 8, (8) e1001073 available from: PM:21857809

Unger, J. & Criel, B. 1995. Principles of Health Infrastructure Planning in Less-Developed-Countries. International Journal of Health Planning and Management, 10, (2) 113-128 available from: ISI:A1995RJ13700004

Unger, J., De Paepe, P., Buitron, R., & Soors, W. 2008. Costa Rica: Achievements of a heterodox health policy. American Journal of Public Health, 98, (4) 636-643 available from: ISI:000254595500018

Unger, J., De Paepe, P., & Green, A. 2003a. A code of best practice for disease control programmes to avoid damaging health care services in developing countries. International Journal of Health Planning and Management, 18, S27-S39 available from: ISI:000186662200003

Unger, J., Marchal, B., & Green, A. 2003b. Quality standards for health care delivery and management in publicly oriented health services. International Journal of Health Planning and Management, 18, S79-S88 available from: ISI:000186662200007

Van Damme, W., Pirard, M., Assefa, Y., & van Olmen, J. Which Health Systems for Disease Control? How can Disease Control Programs contribute to Health Systems Strengthening in sub-Saharan Africa? [1]. 2011a. Antwerp, Institute of Tropical Medicine. Studies in Health Services Organization and Policy.

Working Papers. Decoster, K., Marchal, B., Soors, W., van Olmen, J., and Van Damme W. 24-6-2011a.

Van Damme, W., Pirard, M., Assefa, Y., & van Olmen, J. Which Health Systems for Disease Control? How can Disease Control Programs contribute to Health Systems Strengthening in sub-Saharan Africa? [1]. 2011b. Antwerp, Institute of Tropical Medicine. Studies in Health Services Organization and Policy. Working Papers. Decoster, K., Marchal, B., Soors, W., van Olmen, J., and Van Damme W. 24-6-2011b.

Ref Type: Serial (Book, Monograph)

van Olmen, J., Criel, B., Devadasan, N., Pariyo, G., De Vos, P., Van Damme, W., Van Dormael, M., Marchal, B., & Kegels, G. 2010a. Primary Health Care in the 21st century: primary care providers and people's empowerment. Tropical Medicine & International Health, 15, (4) 386-390

van Olmen, J., Criel, B., Van Damme, W., Marchal, B., Van Belle, S., Van Dormael, M., Hoeree, T., Pirard, M., & Kegels, G. Analysing Health Systems to Make Them Stronger. [27]. 2010b. Antwerpen, ITG Press.

World Bank 2004a, "Health and Nutrition Services," In World Development Report 2004, S. Devarajan, ed., pp. 133-158.

World Bank. World Development Report 2004. Making services work for poor people. 2004b.

World Health Organization. Constitution of the World Health Organization. 1946.

World Health Organization 2000, The World Health Report 2000. Improving Performance, World Health Organization, Geneva.

World Health Organization 2005, Preparing a Health Care Workforce for the 21st Century: The Challenge of Chronic Conditions, WHO, Geneva.

World Health Organization 2007, Everybody's Business. Strengthening Health Systems to Improve Health Outcomes. WHO's Framework for Action., WHO, Geneva.

World Health Organization The World Health Report 2008. Primary Health Care. Now more than Ever., Geneva: WHO.

World Health Organization. Toolkit on monitoring health systems strengthening. WHO . 2008b. WHO. 17-3-2009b.

World Health Organization 2009, Systems Thinking for Health Systems Strengthening Geneva.

World Health Organization 2010, World Health Report 2010. Health systems financing: the path to universal coverage, World Health Organization, Geneva.

World Health Organization, C. o. S. D. o. H. 2008c, Closing the gap in a generation: Health equity through action on the social determinants of health. Executive summary, World Health Organization, Geneva.

World Health Organization. Regional Office for Africa 2009, First African Medicines Regulatory Authorities Conference. Final Report, World Health Organization. Regional Office for Africa, Brazzaville.




DOI: http://dx.doi.org/10.5195/hcs.2012.71

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