The Influence of Health Systems and Reforms

HEALTH SYSTEMS AND REFORMS
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Health Systems and Reforms
Health systems and health system reforms influence the delivery of care across nations. Different nations have different health systems and approaches to health system reforms. However, at their most basic level, these systems are meant to promote population health and improve the quality of life. There have been calls to strengthen health systems, and this has been one of the agendas of the World Health Organisation (WHO) (Manyazewal 2017, p.1). Effective health systems should enhance accessibility, cost-effectiveness, and equity in the delivery of quality care. This paper explores health systems, health systems reforms, and their components. It also discusses health equity and equality and how these concepts can be applied in the Nigerian context to promote equitable immunisation against COVID-19.
Health Systems
Health systems play a significant role in the delivery of care. Health systems are defined as the people, institutions, and resources that work together to perform a health action meant to promote and improve the health of consumers (Broerse & Grin 2017, p.1). In a health system, all players are interrelated and organised towards achieving a common goal. Healthcare systems serve one primary purpose; to enhance the delivery of care and promote the health of a population (Sun 2020, p.65). However, it also serves other secondary purposes, some of which are not health-related. For instance, Sun (2020, p.65) indicates that health systems create employment, not only for healthcare professionals, but other support staff working in the healthcare industry. For a health system to be considered effective and efficient, it must address sustainability issues in several key areas: accessibility, affordability, equity, quality, and acceptability (Broerse & Grin 2017, p.15). These areas remain a challenge, even in some of the most developed economies, which is why there have been constant calls for health system reforms.
WHO developed a health systems framework that is formulated around six key building blocks (Manyazewal, 2017; Sacks et al., 2019). These building blocks can also be considered as the components of health systems. Below is a description of the components:
Health workforce- Health systems should have human resources that efficiently respond to the needs of the population in a fair manner (Manyazewal 2017, p.2). It should do so while utilising the existing/available resources and within any given circumstance. Thus, there should be basic efforts aimed at developing and maintaining an effective health workforce. These efforts include facilitating the recruitment of individuals to join the healthcare workforce, improving their education to ensure that competent healthcare professionals are released into the industry, and ensuring that healthcare organisations and ultimately, healthcare systems, retain healthcare professionals. This last part is especially important at a time when there is a global nursing shortage. Sacks et al. (2019, p.4) indicate that to meet the specific needs of populations and respond to them effectively, the healthcare workforce should incorporate both community-based and facility-based health professionals.
1 Health financing- This component addresses equity and access to healthcare services. A good health system should raise enough funds to cover the cost of healthcare while protecting the population from financial risks (Manyazewal 2017, p.2). This means that people should not have to suffer financial hardships as a result of paying for healthcare services. When there is a good health financing system, all the financial barriers that hinder access and promote inequality in the delivery of healthcare services are being eliminated. According to Sacks et al. (2019, p.7), good financing systems should not only focus on the funds that are needed to directly facilitate the delivery of care but also other comprehensive elements that facilitate healthcare delivery. Some successful health systems in high-income countries have been able to reduce financial barriers to healthcare through universal health coverage. However, others are still struggling to make their health systems equitable in this area.
2 Health information- This component shows the importance of health information. A well-functioning health system should facilitate a timely and reliable flow of information to different stakeholders (Sacks et al. 2019, p.8), such as policymakers, healthcare professionals, communities, and other relevant stakeholders. Access to information about the status, management, and performance of healthcare systems is important (Manyazewal 2017, p.2). This is because it can help identify and address the health challenges that a specific population is facing. However, monitoring of progress in healthcare is important for a functional health system to obtain, analyse and disseminate relevant and reliable information.
3 Service delivery- This is a critical component of healthcare systems. It covers safety and quality delivery of care, reliability and timeliness, accessibility, and resource optimisation (Manyazewal 2017, p.2). Effective mechanisms to ensure that providers are not offering substandard quality should be put in place. These mechanisms should protect healthcare consumers. There should also be guidelines and standards that healthcare professionals use to ensure care is safe, accessible, effective, and of high quality.
4 Medical products- This component relates to the issue of accessibility of medical products and technologies. According to Manyazewal (2017, p.2), a performing health system should ensure there is fairness and equality when it comes to accessing medical products and technologies. The products should be cost-effective, safe, efficient, and of high quality.
5 Leadership and governance- This component addresses areas of regulation, health policies, and the role of health authorities in driving the healthcare industry in the right direction, as well as oversight (Manyazewal 2017, p.2). Leadership and governance are country-specific, but all effective health systems are characterised by effective leadership and governance practices. Manyazewal (2017, p.8) posits that these good practices include collaboration between different sectors as well as effective communication across all levels of the government.
The expected outcomes of these components include responsiveness to the health needs of the population, protection from financial risk, improved health in terms of delivery and equity, and improved efficiency in the delivery of healthcare (Manyazewal 2017, p.2). However, most systems are facing challenges, especially after the COVID-19 pandemic hit and overwhelmed healthcare systems around the world. Some countries have made deliberate and fundamental efforts towards ensuring that their health systems are achieving the expected outcomes in alignment with various components. For instance, the United Kingdom (UK) government, in response to the challenge that the health workforce is facing in meeting the needs of the citizen, has introduced a temporary register for the nursing workforce. This register allows trained nurses, including those trained overseas but living in the UK, to join the nursing workforce temporarily and help with the crisis (National Health Service, 2021). This has helped the health system respond to the health needs of those living in the UK.
Health System Reforms
Reforms refer to the changes in the structures and processes of organisations in the public sector to help them improve by becoming more effective and efficient (Usher et al. 2020, p.1). Therefore, health system reforms (HSR) can be defined as the structural and process changes of the healthcare sector to improve efficiency and effectiveness in the delivery of care to the public. Marusic and Rupel (2016, p.226) indicate that the changes in HSR are intentional, sustained, and fundamental. Further, the changes in HSR also describe the people involved in the change, the actions to be taken to bring change, and how the actions should be carried out. Thus, HSR is usually specific to countries because they tend to make changes that meet the healthcare needs of citizens and improve their health outcomes. That being said, HSR should also be flexible, especially during implementation (Marusic & Rupel 2016, p.226). Flexibility allows for modification to be made on the healthcare system as required without putting too much pressure on the foundation. The primary agenda of HSR is to ensure that there is a constant improvement of healthcare outcomes and the changes should go beyond individual healthcare organisations (Briggs & Isouard 2016, p.39). Through HSR, health systems can offer affordable, equitable, and high-quality care (Usher et al. 2020, p.1).
According to Marusic and Rupel (2016, p.226), HSR can either be global or partial. Global reforms target the whole system. They consider the social, demographic, political, economic, cultural and technological changes in the society. Countries usually implement global reforms after a few decades. Partial reforms target just one part of the healthcare system. For instance, demographic changes in developed countries have brought the issue of an ageing population, which has meant that the healthcare system needs to have partial reforms addressing that specific issue. Partial reforms can be implemented after a shorter time than global reforms. Despite HSR being specific to a country, there has been an increase in collaboration and integration beyond the boundaries of one single healthcare system (Briggs & Isouard 2016, p.42). This has resulted in cross-national learning which has allowed governments to learn from their counterparts, although certain modifications have had to be made to accommoda...