Health systems

Health Systems Strengthening Glossary


Data: facts and figures as raw material, not analysed.

Decentralization: political reform designed to promote local autonomy, decentralization entails changes in authority and financial responsibility for health services. Hence, decentralization can have a large impact on health service performance. There are several forms of decentralization affecting the health sector in different ways: (i) deconcentration, which transfers authority and responsibility from the central level of the Ministry of Health to its field offices; (ii) delegation, which transfers authority and responsibility from the central level of the Ministry of Health to organizations not directly under its control; (iii) devolution, which transfers authority and responsibility from the central level of the Ministry of Health to lower level autonomous units of government; (iv) privatization, which involves the transfer of ownership and government functions from public to private bodies, which may consist of voluntary organizations and for-profit and not-for-profit private organizations, with varying degree of government regulation. 1

Deflation: removal of the effect of price inflation from expenditure amounts by dividing the expenditure amount by a price index or deflator. 2

Deflator: a price index used to distinguish between those changes in money value which result from a change in prices and those which result from a change in physical output. 3

Demand (for health services): (i) the health care expectations expressed by individuals or communities; (ii) the willingness and/or ability to seek, use and, in some settings, pay for services. May be subdivided into expressed demand (equated with use) and potential demand. May be subdivided into rational demand (demand that corresponds to need) and irrational demand (demand that does not correspond to need). 4

Depreciation:the reduction in value of a capital asset through wear and tear. 5

Direct cost: (i) internal cost of an activity or decision including cost of labour, other goods and services, capital (usually considered as a rental value) and consumables. Direct cost excludes external costs, productivity costs, uncompensated forgone earnings and elements of cost that may be undervalued by market prices. 6

(ii) all the goods, services and other resources that are consumed in the provision of a particular service or area (e.g. hospital supplies), including medical costs (e.g. payments to providers, material) and non-medical costs (e.g. transportation to hospital). 7

Disbursement:"the release of funds to - or the purchase of goods or services for - a recipient; by extension, the amount thus spent. Disbursements record the actual international transfer of financial resources, or of goods or services valued at the cost to the donor. In the case of activities carried out in donor countries, such as training, administration or public awareness programmes, disbursement is taken to have occurred when the funds have been transferred to the service provider or the recipient. They may be recorded gross (the total amount disbursed over a given accounting period) or net (the gross amount less any repayments of LOAN principal or recoveries on GRANTS received during the same period)." 8

Discounting: adjusting for people time preference, i.e. the fact that people generally want to have benefits today and defer costs to tomorrow; also, but not only, to reflect that $1 today is worth more than $1 in the future. Discounting is necessary because for many health interventions, benefits occur some time after costs are incurred. A discount rate is, therefore, necessary to adjust future costs and benefits into present-day values. The discount rate usually incorporates inflation.

Disease Management:coordinated information and intervention system for populations that suffer from diseases that share the value of self-care in their treatment and control. They focus on patients with specific diagnoses; they target diseases that are highly prevalent, that require intensive or high-cost care, or that represent high drug costs; and they focus on interventions whose results can be measured and for which significant variations in clinical practice have been described. 9

District health system: (i) a network of primary care health facilities that deliver a comprehensive range of promotive, preventive and curative health care services to a defined population with active participation of the community and under the supervision of a district hospital and district health management team. (ii) A network of organizations that provides, or makes arrangements to provide, equitable, comprehensive and integrated health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and for the health status of the population that it serves. 10See integrated service delivery network.

District planning: the process of strategic and / or operational planning of health services at the district level, ideally aligned with the national health strategy/plan of which it is the local expression.


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