Health systems

Health Systems Strengthening Glossary



Gatekeeper: a health care provider at the first contact level who has responsibilities for the provision of primary care as well as for the coordination of specialized care and referral. 1

Global Burden of disease: a comprehensive demographic and epidemiological framework to estimate health gaps for an extensive set of disease and injury causes, and for major risk factors, using all available mortality and health data and methods to ensure internal consistency and comparability of estimates.2 See burden of disease.

Governance: (i) the exercise of political, economic and administrative authority in the management of a country's affairs at all levels, comprising the complex mechanisms, processes, relationships and institutions through which citizens and groups articulate their interests, exercise their rights and obligations and mediate their differences.3 (ii) the traditions and institutions by which authority in a country is exercised for the common good, including the processes by which those in authority are selected, monitored and replaced; the capacity of the government to effectively manage its resources and implement sound policies; and the respect of citizens and the state for the institutions that govern economic and social interactions among them4; (iii) the process of creating an organizational vision and mission - what it will be and what it will do - in addition to defining the goals and objectives that should be met to achieve the vision and mission; of articulating the organization, its owners and the policies that derive from these values - policies concerning the options that its members should have in order to achieve the desired outcomes; and adopting the management necessary for achieving those results and a performance evaluation of the managers and the organization as a whole. 5 See stewardship.


Harmonization: the coordination of donors contributions and activities, the transparent sharing of information and the attempt to be collectively effective and avoid duplication. See Paris Declaration.

Health in all policies: a policy or reform designed to secure healthier communities, by integrating public health actions with primary care and by pursuing healthy public policies across sectors. 6

Health insurance: "a contract between the insured and the insurer to the effect that in the event of specified events (determined in the insurance contract) occurring the insurer will pay compensation either to the insured person or to the health service provider. There are two major forms of health insurance. One is private health insurance, with premiums based on individual or group risks. The other is social security, whereby in principle society’s risks are pooled, with contributions by individuals usually dependent on their capacity to pay." 7

Health needs: objectively determined deficiencies in health that require health care, from promotion to palliation. Perceived health needs: the need for health services as experienced by the individual and which he/she is prepared to acknowledge; perceived need may or may not coincide with professionally defined or scientifically confirmed need. Professionally defined health needs: the need for health services as recognized by health professionals from the point of view of the benefit obtainable from advice, preventive measures, management or specific therapy; Professionally defined need may or may not coincide with perceived or scientifically confirmed need. Scientifically confirmed health needs: the need confirmed by objective measures of biological, anthropometric or psychological factors, expert opinion or the passage of time; it is generally considered to correspond to those conditions that can be classified in accordance with the International Classification of Diseases. 8

Health planning: (i) the orderly process of defining health problems, identifying unmet needs and surveying the resources to meet them, establishing priority goals that are realistic and feasible, and projecting administrative action, concerned not only with the adequacy, efficacy and efficiency of health services but also with those factors of ecology and of social and individual behaviour that affect the health of the individual and the community".9 (ii) the process of organizing decisions and actions to achieve particular ends, set within a policy. 10 (iii) a code word for public decision making towards the future 11often used interchangeably with policy formation or developing strategies and programmes 12


Health policy: (i) a set of decisions or commitments to pursue courses of action aimed at achieving defined goals for improving health, stating or inferring the values that underpin these decisions; the health policy may or may not specify the source of funding that can be applied to the action, the planning and management arrangements to be adopted for implementation of the policy, and the relevant institutions to be involved. 13 (ii) a general statement of understanding [to] guide decision making 14that results from an agreement or consensus among relevant partners on the issues to be addressed and on the approaches or strategies to deal with them. 15

Health Sector Reform: (i) " a movement aimed at reconfiguring health services, dominant in the 90s in the framework of the New Public Management, typically including the following components: separating the roles of financing and provision and the possible introduction of a managed market; developing alternative financing mechanisms, particularly user charges and health insurance; decentralization; limiting the public sector and encouraging a greater role for the private sector; prioritizing the use of cost-effectiveness techniques". 16 (ii) changing the rules of the game and the balance of power within the health sector.

Health service: any service (i.e. not limited to medical or clinical services) aimed at contributing to improved health or to the diagnosis, treatment and rehabilitation of sick people. 17

Health system boundaries: the outer limits (context, institutions, capacities) within which the health system operates.

Health system building blocks: an analytical framework used by WHO to describe health systems, disaggregating them into 6 core components: leadership and governance (stewardship), service delivery, health workforce, health information system, medical products, vaccines and technologies, and health system financing. 18

Health system functions: an analytical framework describing four key work packages health systems have to perform: providing services; generating the human and physical resources that make service delivery possible; raising and pooling the resources used to pay for health care; and, the function of stewardship - setting and enforcing the rules of the game and providing strategic direction for all the different actors involved. These functions are performed in the pursuit of three goals: health, responsiveness and fair financing. 19

Health system performance: (i) the level of achievement of the health system relative to resources. 20 (ii) the degree to which a health system carries out its functions - (service provision, resource generation, financing and stewardship) to achieve its goals. 21

Health systems strengthening: (i) the process of identifying and implementing the changes in policy and practice in a country’s health system, so that the country can respond better to its health and health system challenges22; (ii) any array of initiatives and strategies that improves one or more of the functions of the health system and that leads to better health through improvements in access, coverage, quality, or efficiency. 23

Health system: (i) all the activities whose primary purpose is to promote, restore and/or maintain health24; (ii) the people, institutions and resources, arranged together in accordance with established policies, to improve the health of the population they serve, while responding to people’s legitimate expectations and protecting them against the cost of ill-health through a variety of activities whose primary intent is to improve health. 25

Health: the state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. 26

Horizontal Integration: coordination of the functions, activities or operating units that are at the same stage of the service production process. Examples of this type of integration are consolidations, mergers and shared services within a single level of care. 27


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