1. Stewardship (overall system oversight) sets the context and policy framework for overall health system. This function is usually (but not always) a governmental responsibility. What are the health priorities to which public resources should be targeted? What is the institutional framework in which the system and its many actors should function? Which activities should be coordinated with other systems outside the realm of health care and hoe (e.g., highway safety, food quality control)? What are the trends in health priorities and resource generation and their implication for the next 10, 20, or 30 years? What information is needed and by whom to ensure effective decidsion making on health matters, including prevention and mitigation of epidemics? These questions are the core of stewardship function. An additional central function of stewardship is generating appropriate data for policy making. These range from public health surveillance data to health system performance and provide the basis for assessing health status, regulating sector, and tracking health system performance, effectiveness and impact.
2. Public and private health service provision is the most visible product of the health care system. The best systems also pro,ote health and try to head off illness through education and preventive measures such as well-child consultations. All these roles and activities mean that the system has to perform a wide range of activities. “Delivering health services is thus an essential part of what the system does—but is not what the system is” (WHO, 2000).
3. Health service inputs (managing resources) is the assembling of essential resources for delivering health services, but these inputs are usually produce at the borders of health system. These inputs include human resources (produced mostly by the education system with some input from the health system), medications, and medical equipment. Producing these resources often takes a long time (e.g., a trained medical doctor, a new vaccine or drug). This function is generally outside the immediate control of health system policy makers who, nevertheless, have to respond to short-term population needs with whatever resources are available.
4. Health system financing includes collecting revenues, pooling financial risk, and allocating revenue (strategic purchasing of services).
· Revenue collection entails collection of money to pay for health services. Revenue collection mechanism are general taxation, Development Assistance for Health (DAH, donor financing), mandatory payroll contributions, mandatory or voluntary risk-rated contributions savings. Traditionally, each method of revenue collection is associated with a specific way of organizing and pooling funds and buying services. For example, public health systems are typically financed through general taxation, and social security organizations are usually financed through mandatory contributions from workers and employers (payroll contributions).
In most countries, health financing is a mix of general taxation, mandatory social insurance contributions, and household out-of-pocket expenditure (OOP). The relative importance of each source of financing varies greatly across countries. While countries in the Organization for Economic Cooperation and Development (OECD) rely heavily on public financing (either fiscal or mandatory payroll tax), the impotance of OOP is larger in middle income countries (MICs), and it is the largest in low-income (LICs), where it often reaches 70 or 80 percent of total health expanditures. DAH is an important source of health financing in a numbers of LICs, mainly in Africa. However, DAH on average contributes only about 7 percent of all health expanditures in LICs, ranging from 3 percent in a few LICs to more than 40 percent in a few.
· Risk pooling refers to the collection and management of financial resources in a way that spreads financial risks from and individual to all pool members (WHO, 2000). Financial risk pooling is the core function of health insurance mechanisms. Participation in effective risk pooling is essential to ensure financial protection. It is also essential to avoid payment at the moment of utilizing the services, which can deter people, especially the poor, from seeking health care when sick or injured. Each society chooses a different way of pooling its people’s financial risk to finanace its health care system.
· Strategic purchasing. Strategic purchasing is the way most risk-pooling organizations (purchasers) use collected and pooled financial resources to finance or buy health care services for their members. In practical, day-to-day interaction between purchasers and providers, the purchaser, within a regulatory framework, plays a key role in defining a substantial part of external incentives for providers to develop appropriate provider-user interaction and health service delivery models.
Wassalam...
Reference:
Healthy Development The World Bank Strategy for HNP Results, Annex L, April 24, 2007
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