Question

Use the information in this report to respond to the following question, World Health Report: Health Systems (the world health report 2000).

You are the leader of a large international organization. What are the important findings in this report that you can use to improve your organization? (Answer in approx 250 words).

Answer 1

This report sets out to analyse the role of health systems and suggest how to make them more efficient and, most importantly, more accessible and responsive to the hundreds of millions of people presently excluded from benefiting fully from them. The denial of access to basic health care is fundamentally linked to poverty – the greatest blight on humanity’s landscape. For all their achievements and good intentions, health systems have failed globally to narrow the health divide between rich and poor in the last 100 years. In fact, the gap is actually widening. Some such worsening often accompanies economic progress, as the already better-off are the first to benefit from it. But the means exist to accelerate the sharing by the poor in these benefits, and often at relatively low cost.

Greater reliance on such practitioners forms the core of many developed countries’ current reform agendas. Managed care, for example, revolves to a large extent around the strengthening of primary care and the avoidance of unnecessary treatment, especially hospitalization. The approach emphasized in the primary health care movement can be criticized for giving too little attention to people’s demand for health care, which is greatly influenced by perceived quality and responsiveness, and instead concentrating almost exclusively on their presumed needs. Systems fail when these two concepts do not match, because then the supply of services offered cannot possibly align with both. The inadequate attention to demand is reflected in the complete omission of private finance and provision of care from the Alma-Ata Declaration, except insofar as community participation is construed to include small-scale private financing.

first-generation and second-generation reforms have been quite supply-oriented. Concern with demand is more characteristic of changes in the third generation currently under way in many countries, which include such reforms as trying to make “money follow the patient” and shifting away from simply giving providers budgets, which in turn are often determined by supposed needs. If the organizational basis and the quality of primary health care often failed to live up to their potential, much of the technical footing remains sound and has undergone continuous refinement. This development can be sketched as a gradual convergence towards what WHO calls the “new universalism”– high quality delivery of essential care, defined mostly by the criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor.