Health System and Systemic Thinking

When I was a high school student, things I know about health care consist only doctors, nurses, pharmacists and radiologists. However, as I entered the first year of medical school, I realized that the public health plays an important role in health care. Now, being a fourth year medical student, I am learning even more sophisticated health system that I would like to share with everyone.

Anyway, before I proceed to the definition of health system, I would like to share some interesting lessons learnt in the practical session about systemic thinking. In order to apply the concept of systemic thinking in health, we are first exposed to systemic factors in life. Fortunately, my group gets to observe the sewage system in the university canteen.

To achieve its goals which include maintaining maximal effectiveness in sewage removal and providing cleanliness to our environment, the essential components of the sewage system are water, filter, temporary waste reservoir, waste pipe, and gravel-filled sewage tank. All the essential components are important to keep the system running efficiently and efficaciously. However, to distinguish the essential and accessorial components of the sewage system isn’t easy. I am very proud of my group because everyone shares their opinion to make the discussion effectively.

Now, let’s get back to the definition of health system. The World Health Organization (WHO) defines health systems as “all the organization, institutions, and resources that are devoted to producing health actions”. It encompasses all levels: central, regional, district, community and household. The World Health Report 2000 (WHO 2000) identifies the four key functions of the health system: stewardship/ governance/ oversight, financing, human and physical resources, and organization and management of service delivery.

By applying the concept of systemic thinking in health system, a highly functioning health system need to continually exchange feedback among these four components to ensure that they remain closely aligned and focused on achieving the goal of the system, which is “improving health and health equity in ways that are responsive, financially fair, and make the best, or most efficient, use of available sources”. For example, if the financing in the health system is weakened or misaligned, it will affect the entire system. Thus, the system has to make necessary adjustment to achieve its goal effectively.

In conclusion, a good health system requires integration and cooperation among the stewardship, financing, human and physical resources, and organization and management of services delivery. Without a good inter-relationship, health system can be said to be a pile of sand instead of a system. Nonetheless, there are still a lot to be improved in health care performance. Perhaps by understanding this relationship, we can find some solution to the problems.

References :

1) Lecture Note Block 4.2 - Introduction to Block 4.2 and Health System and Its Outcome (Prof. Laksono)

2) World Health Organization - http://www.who.int/en/

1. 3)WHO: Key Components of a Well Functioning Health System

1. 4)The World Health Report 2000

1. 5)WHO: Health Systems