Health systems: A review of the concept, global challenges and reforms

Abstract

The study of health systems (HSs) is an important but confusing field. Its unclear boundaries, overlap, and multiple interpretations of terms require conceptual clarification. In light of the available evidence, Firstly, it is very important to realize that the current HSs thinking addresses individual parts rather than the whole HS. Secondly, it fails to recognize that concentrating on the performance of one part of the HS may have damaging effects on the whole HS. Thirdly, current HSs thinking fails to address the views, interests and influence of human resources for health involved in the implementation of reform, and how people and communities are expected to benefit from it. Fourthly, it does not take into account the different meanings, perceptions, cultural values and beliefs that may influence the very different institutions and structures belonging to a HS and working towards the same goals. Fifthly, the structural parts of HSs are designed to work in a stable environment, rather than addressing the ever changing context. Finally, HSs thinking does not provide a structural response to cope with the variety of healthcare stakeholders. The way HSs are currently understood may contribute to their weak performance. The current understanding is fundamentally functionalist, because the practice has focused on the definition of the structure, units and functions at different levels of recursion. The analysis of the literature demonstrates that most existing HSs are underpinned by functionalist approaches.This review provides a conceptual framework for many of the studies that focuses on specific situations and localities and explores what other approaches and methodologies can offer, in order to develop a framework for a given HS, which is more relevant in theory and practice than the other functionalist frameworks that may have been adopted previously. This framework will hopefully also narrow the gap between HSs goals and performance.