Health Systems and Models

Health Systems: Basics - System Staples

• Definition: All organizations, people, and actions whose primary intent is to promote, restore, or maintain health.
• Goals:
  • Good health
  • Responsiveness to expectations
  • Fairness in financial contribution
• WHO Health System Framework (Building Blocks):
  • Service delivery
  • Health workforce
  • Health information systems
  • Medical products, vaccines, & technologies
  • Financing
  • Leadership/governance (stewardship)

⭐ The WHO identifies 6 building blocks as essential for a functioning health system. Understanding these is key to analyzing health system performance and guiding reforms for universal health coverage (UHC).

Indian Healthcare Delivery - Bharat's Blueprint

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Indian Health Policies & Committees - Guiding Gazettes

• Bhore Committee (1946): Health Survey & Development; 3-tier system; PHC concept.
• Mudaliar Committee (1962): Health Survey & Planning; strengthened district hospitals; All India Health Services.
• Chadah Committee (1963): Basic Health Worker for malaria vigilance.
• Mukherjee Committee (1965): Delink malaria activities; distinct family planning staff.
• Jungalwalla Committee (1967): Integration of health services.
• Kartar Singh Committee (1973): Multipurpose Health Workers (MPW) under one supervisor.
• Shrivastav Committee (1975): Medical education reforms; ROME scheme.
• National Health Policy (NHP) 1983: 1st NHP; primary healthcare focus.
• National Health Policy (NHP) 2002: 2nd NHP; private sector role; disease surveillance.
• National Health Policy (NHP) 2017: Current; Universal Health Coverage (UHC); ↑ health spend to 2.5% GDP by 2025.

  ⭐ NHP 2017 aims to increase government health expenditure as a percentage of GDP to 2.5% by 2025.

• Ayushman Bharat (2018):
  • PM-JAY: Health insurance for ~10 crore families (approx. 50 crore individuals).
  • HWCs: Comprehensive primary healthcare.

Global Models & Governance - Worldly Ways & Watchdogs

• Key Health System Models:
  • Beveridge (UK): Tax-financed, government-run (NHS). Universal coverage.
  • Bismarck (Germany): Sickness funds, employer-employee contributions.
  • National Health Insurance (Canada): Government-financed (single-payer), private providers.
  • Out-of-Pocket (Many LMICs): Dominant in India; direct patient payment.
• Global Health Governance Bodies:
  • WHO: Sets global health norms, standards; disease surveillance.
  • World Bank: Provides financial & technical assistance for health.
  • UNICEF: Focus on child health, nutrition, and maternal well-being.
  • Global Fund: Mobilizes resources for HIV/AIDS, TB, Malaria.
  • GAVI: Improves access to new & underused vaccines.

⭐ The Alma-Ata Declaration in 1978 by WHO emphasized Primary Health Care as key to "Health for All".

High‑Yield Points - ⚡ Biggest Takeaways

• Beveridge Model: Government-funded healthcare via taxes (UK, Cuba).
• Bismarck Model: Insurance-based via "sickness funds," employer/employee contributions (Germany).
• National Health Insurance: Private providers, government insurance for all citizens (Canada).
• Out-of-Pocket Model: Dominant in many developing countries; care based on ability to pay.
• India's System: Mixed model, high out-of-pocket expenditure; PM-JAY aims for UHC.
• Alma-Ata Declaration (1978): Key for Primary Health Care (PHC) principles.
• WHO's Six Building Blocks: Crucial for Health System Strengthening (HSS).