Health Systems: Conceptual Frameworks

Section 2

2. Health System: Conceptual Framework

Several models of the Health System have been developed to illustrate the various
components, functions, goals, and objectives of the health system. Each model
demonstrates different aspects of the system. No model is universally accepted as a
perfect model. Two Health System Models are presented here. The first is based on
the System Approach and shall be discussed in some detail, as it forms the basis
for this Planning Manual. The System approach is an effective analytical framework
for the solution of problems and consists of six essential elements: identification of
the problem, definition of objectives, examination of alternatives, evaluation and
selecting solutions, integration of solutions and implementation, and the use of
feedback through out the process. The second model has relatively recently been
proposed by the World Health Organization, and is the theme of the millennium
World Health Report 2000 on “Health System: Improving
Performance”.5 Whereas, these two models do not contradict each other in any
manner, the latter provides a comprehensive macro-policy framework for evaluation
and comparison of overall functions and objectives, while the former is more apt for
use at the micro-implementation level.

2.1. Health System Model –System Approach

The health system model based on a System Approach illustrates the three important
elements of a district health system6 - the community, the health care delivery
system, and the environment in which the other two are located. The three elements
may be visualized as three concentric circles with the environment forming the
outer circle, the community the inner and the health care delivery system
interspersed between the two (Fig 1).

The three elements are highly interdependent. The environmental ecology, that is,
its socio-cultural, demographic, economic and political surroundings largely
determine health problems and health needs of the community, and exerts a major
influence on the nature, volume and quality of health service availability. The extent
to which the community is involved with health care, influences health problems and
health needs, on the one hand, and the nature and quality of the health services
delivery system on the other. And lastly, the community largely determines the socio-
cultural milieu and exerts a considerable influence on the physical environment.

If the Health Care Delivery System (HCDS) is to optimally serve the community
within the given ecological setting, there must be a close ‘fit’ between these three
elements.

5 World Health Organization (2000) The World Health Report, Health Systems: Improving
Performance, WHO, Geneva.
6 Kielmann A.A; Siddiqi S.; Ngolo R.M. Planning for Health Services at the District. A Manual for

District and First Level Care Facility Managers, GTZ, Health Services Academy, Islamabad, and
University of Nairobi, Kenya (Unpublished document), 1997.

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