Health systems

Health Systems Strengthening Glossary



Economies of Scale: the decline in average cost of each unit produced as output increases, due to the distribution of production costs and other fixed costs across a higher number of units. 1

Effectiveness: the extent to which a specific intervention, procedure, regimen or service, when deployed in the field in routine circumstances, does what it is intended to do for a specified population. 2

Efficacy: the extent to which a specific intervention, procedure, regimen or service, produces the intended result under ideal conditions. 3

Efficiency: the capacity to produce the maximum output for a given input. 4

Endorsement (of a national Policy/Strategy/Plan): approval and signing off on the National Policy/Strategy/Plan by relevant authorities (parliament, ministry of health, others).

Equity in Health: (i) the absence of systematic or potentially remediable differences in health status, access to healthcare and health-enhancing environments, and treatment in one or more aspects of health across populations or population groups defined socially, economically, demographically or geographically within and across countries.. 5 (ii) a measure of the degree to which health policies are able to distribute well-being fairly. 6

Essential Public Health Functions: the health authority’s functions with regard to: (i) monitoring, evaluation and analysis of health status; (ii) surveillance, research and control of the risks and threats to public health; (iii) health promotion; (iv) social participation in health; (v) development of policies and institutional capacity for public health planning and management; (vi) strengthening of public health regulation and enforcement capacity; (vii) evaluation and promotion of equitable access to necessary health services; (viii) human resources development and training in public health; (ix) quality assurance in personal and population-based health services; (x) research in public health; and (xi) reduction of the impact of emergencies and disasters on health. 7

Evaluation:the systematic and objective assessment of the relevance, adequacy, progress, efficiency, effectiveness and impact of a course of actions, in relation to objectives and taking into account the resources and facilities that have been deployed. 8

Evidence: "any form of knowledge, including, but not confined to research, of sufficient quality to inform decisions." 9


Facilitation: (i) the effort to help a process move forward towards attaining a particular end or result. (ii) the process undertaken to enable the different stakeholders involved in policy dialogue to achieve a high degree of consensus around a specific policy concern and to ensure that negotiations run well.

Fiduciary risk: "the risk that funds are not used for the intended purpose, do not achieve value for money, or are not properly accounted for." 10

First Level of Care: the entry point into the health care system, at the interface between services and community. Where the first level of care satisfies a number of quality criteria it is called primary care. See: primary care

Fiscal space: " ..the capacity of government to provide additional budgetary resources for a desired purpose without any prejudice to the sustainability of its financial position." 11

Fragile states: "states that lack either the capacity, or the will (or both), to deliver core state functions for the majority of the people, including the poor. The most important functions of the state for poverty reduction are territorial control, safety and security, capacity to manage public resources, delivery of basic services, and the ability to protect and support the ways in which the poorest people sustain themselves".12

Fragmentation (of health services): (i) coexistence of units, facilities or programmes that are not integrated into the health network13; (ii) services that do not cover the entire range of promotion, prevention, diagnosis, treatment, rehabilitation and palliative care services; (iii) services at different levels of care that are not coordinated among themselves; (iv) services that do not continue over time; (v) services that do not meet people’s needs.

Functional Integration: the extent to which key support functions and activities such as financing, human resources, strategic planning, information management, marketing and quality assurance/improvement are coordinated across all system’s units. 14

Fungibility: the exchangeability of funds across competing expenditures. The presence of fungible funds limits the effectiveness of earmarking certain financing lines to specific purposes. For example, the generous support provided by donors to social sectors may permit the reduction of state funding to them, to benefit other sectors, like the army. Proponents of general budget support as the main form of aid see the fungibility of donor funds as a cornerstone of their argument. Fairly effective public expenditure management systems must be in place to make donor contributions fully fungible.


  • The Economist [online glossary]
  • WHO Terminology Information System [online glossary]
  • Health Systems Observatory. Glossary for Health System. World Health Organization, Eastern Mediterranean Regional Office.
  • WHO Terminology Information System [online glossary]
  • Starfield B. Equity in Health. Journal of Epidemiology and Community Health 2002; 56: 483-484; and Whitehead M, Dahlgren G. Leveling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health. In: Studies on Social and Economic Determinants of Population Health No.2. Copenhagen: WHO Regional Office for Europe. 2006.
  • Commission for Social Determinant for Health (2008); and La renovación de la atención primaria de salud en las Américas: documento de posición de la OPS/OMS. Washington, D.C., La Organización Panamericana de la Salud, 2007.
  • La salud pública en las Américas: nuevos conceptos, análisis del desempeño y bases para la acción. Publicación científica y técnica No. 589. Washington, D.C., La Organización Panamericana de la Salud, 2002.
  • A glossary of technical terms on the economics and finance of heath services. Copenhagen, World Health Organization Regional Office for Europe, 1998. Available at:
  • Buse K, Mays B, Walt G. Making health policy. Open University Press, 2005.
  • Managing fiduciary risk when providing poverty reduction budget support. London, UK Department for International Development, 2004.
  • Heller PS. The prospects of creating ‘fiscal space’ for the health sector. Health Policy and Planning; 2006, 21, 2:75-79.
  • Leader N, Colenso P. Aid instruments in fragile states. London, DFID (PRDE Working Paper 5), 2005.
  • Salud en las Américas. Vol. I, p. 319. Washington, DC: Organización Panamericana de la Salud; 2007
  • Shortell SM; Anderson DA; Gillies RR; Mitchell JB; Morgan KL. Building integrated systems: the holographic organization. Healthcare Forum Journal 1993; 36(2):20-6.