Factors Hinder Performance Or Health

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FACTORS HINDER PERFORMANCE OR HEALTH

Factors Hinder Performance or Health



Factors Hinder Performance or Health

Introduction

The past decade has witnessed a renaissance of interest in health systems in academic discourse and policy dialogue within the development community. After 20 years of neglect in favor of vertical health programs, community-based small-scale projects, and donor-directed thematic health investments, strong health systems are again seen by policy makers and donors as essential to achieving and sustaining health gains . This has been in part stimulated by the Millennium Development Goals that call for the achievement of several health targets simultaneously by 2015—difficult if not impossible to achieve without functioning health systems.(Daniels,2005)

Discussion

We begin with the WHO definition of health system: “all the activities whose primary purpose is to promote, restore, or maintain health ” but narrow it down to those activities, which are under complete or partial control of governments, as governments are the primary funders and in many cases providers of health services in developing countries. These activities range from direct service provision through public sector clinics and hospitals, to population-level public health activities to funding community-level health education. The private sector in health is not excluded from consideration, however, as governments play an important regulatory role that can influence the performance of private providers.(Mackintosh,2001)

Indicators of health system performance cannot be seen in isolation from their ultimate purpose and from issues of measurement. Governments need tools to monitor and evaluate the functioning of the system on a routine basis and to allow for more informed decisions about health systems funding, organization and policies. Performance indicators are also important to donor countries who want to document effective use of official development assistance for health and to researchers who generate evidence relevant to health system scale-up and reform. While a full discussion of the selection and measurement of indicators is beyond the scope of this paper, metrics need to be locally relevant, reliable and valid as well as feasible to implement. Process indicators should be causally linked to outcomes and sensitive to change in policy. Developed and developing countries may thus adopt very different indicators in measuring the performance of health systems and different indicators may be relevant depending on the unit of analysis (e.g., facility, district, nation). There are now several major initiatives to standardize and harmonize the collection of health metrics globally and to make recommendations on the most useful measures. These include the UN's Interagency Group on Indicators that recommends measures to track progress on the Millennium Development Goals across countries, the WHO-based Health Metrics Network that is helping countries to develop health information systems, and a new research Institute for Health Metrics and Evaluation at the University of Washington, among others.(Daniels,2005)

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