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The building blocks of health systems

What makes a resilient and robust health system, and how does this aid our ability to respond to pandemics such as COVID-19?

COVID-19 has laid open the cracks and vulnerabilities of healthcare systems across the world. Even some of the richest countries in the world have been held hostage to the virus and are struggling to respond.

Although we have a robust stockpile of scientific knowledge, unfortunately it is not matched by the power of health systems to deliver them to those with the greatest need, either in a comprehensive way, or at scale. The COVID-19 pandemic has cast the spotlight on the need to identify the essential building blocks of health systems and to foster the factors that contribute both to sustainable development and robust health systems.

According to the World Health Organization, effective healthcare systems are dependent on the following pillars which contribute to ensuring a safe and robust health system:

  • Health service delivery
  • Health workforce
  • Health information systems
  • Access to essential medicines
  • Health systems financing
  • Leadership and governance

A key purpose of the World Health Organisation’s Framework for Action is to promote a common understanding of what a health system is and what constitutes health systems strengthening. This framework also provides a foundation to support countries in scaling up health systems and services to achieve sustainable system-wide effects.

Across the world, countries have a range of health service funding models as well as mechanisms of staffing health care systems. Unfortunately a pandemic, such as COVID-19, can disrupt and disable health care systems that are fragile and where funding is tenuous.

The need for strong and resilient health systems, embedded in just and civil societies, is the essence of the United Nations Sustainable Development Goals. The nursing workforce has a huge role to play in strengthening global health systems. We can do this by taking the following actions that contribute to the robust pillars of health systems:

  • providing excellence in clinical care
  • leading policy initiatives
  • advancing nursing science
  • developing evidence, supporting nursing colleagues and other team members
  • working with and advocating for patients, their families and communities, and
  • collecting data and informing the development of evidence and policy.

JHPIEGO provides excellent resources to identify the building blocks of health systems and monitor changes over time. You can find links to these in the See Also section.

The decisions that you make everyday as a nurse contribute to the efficiency and effectiveness of the health system. The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. And achieving the goals of the United Nations’ Sustainable Development Goals by 2030 depends on nurses leaders exerting their influence in communities and health care systems worldwide. The COVID-19 pandemic exemplifies the importance of considering the broad social, political and economic implications of healthcare.

The 17 Sustainable Development Goals are: 1. No Poverty, 2. Zero hunger, 3. Good health and well-being, 4. Quality education, 5. Gender equality, 6. Clean water and sanitation, 7. Affordable and clean energy, 8. Decent work and economic growth, 9. Industry, innovation and infrastructure, 10. Reduced inequalities, 11. Sustainable cities and communities, 12. Responsible consumption and production, 13. Climate action, 14. Life below water, 15. Life on land, 16. Peace, justice and strong institutions, 17. Partnerships for the goals. The United Nations’ Sustainable Development Goals. (Click to expand)

Data from around the world have identified highly variable approaches to dealing with the COVID-19 pandemic, from intensive case tracing in South Korea through to a less intensive approach in Sweden. Many of the decisions around healthcare strategies are based on an understanding of population size, resilience of the health system and available resources. Understanding the social, political and economic dimensions of health systems is important in formulating healthcare strategies. So, taking the time to understand the health care system in your country and available resources will help you understand strategies.

Some scientists have suggested considering the COVID-19 pandemic as a series of distinct local epidemics. The impact of COVID-19 in different settings has been dependent on the characteristics of health systems and strategies implemented to halt the virus.

Over to you

Read through this additional article on responses to managing the pandemic in six different regions.

6 countries, 6 curves: how nations that moved fast against COVID-19 avoided disaster (The Conversation, April 2020)

Are you from one of these countries or regions? If not, how does your local setting compare to those cited in the study?

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COVID-19: Effective Nursing in Times of Crisis

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