Health systems

Health Systems Strengthening Glossary



Marginal cost: the change in total cost that results from a unit increase in output. 1

Market failure: the failure of market to achieve an efficient allocation of resources or to reach social goals, providing the economic case for regulation and intervention of the state. 2

Medium-term plan and expenditure framework (MTEF): (i) a tool for linking policy, planning and budgeting over a medium-term (3 years) across the whole of government and at a sectoral level. It consists of a top-down resource envelope, a bottom-up estimation of the current and medium-term costs of existing policy and, ultimately, the matching of these costs with available resources in the context of the annual budget process. 3(ii) a rolling plan, typically for 3 years, which focuses on translating the national strategic plan into organization of work, allocation of resources and division of tasks for implementation, and links the national strategic plan with the operational plans. MTEF often have two dimensions: identification of national investment priorities, updating the M&E framework, defining the overall resource envelope; and allocation of resources to objectives and projection of future resource needs and availability.4

Monitoring: the continuous oversight of an activity to assist in its supervision and to see that it proceeds according to plan. Monitoring involves the specification of methods to measure activity, use of resources, and response to services against agreed criteria. 5

Mutual accountability: situation where governments, donors and involved stakeholders are all accountable to each other for development results. See: Paris Declaration. 6


National disease/programme strategy or national disease/programme strategic plan: strategic plan to guide the control of a particular disease or health problem at national level, with the intended actions to achieve the goals of a given programme. Ideally aligned to the national health strategic plan.

National health strategy, also known as a national health strategic plan or national health plan: a process of organizing decisions and actions to achieve particular ends, set within a policy7, providing "a model of an intended future situation and a programme of action predetermined to achieve the intended situation" 8 . Refers to the broad, long term lines of action to achieve the policy vision and goals for the health sector, incorporating "the identification of suitable points for intervention, the ways of ensuring the involvement of other sectors, the range of political, social, economic and technical factors, as well as constraints and ways of dealing with them".9

Network of Services: set of provider units that: are functionally coordinated; are hierarchically organized according to level of complexity; have a common geographic point of reference; are commanded by a single operator; share operating standards, information systems and other logistical resources; and share a common purpose. 10

New Public Management: an approach to managing the public sector characterized by deregulation of line management; conversion of civil service departments into free-standing agencies or enterprises; performance-based accountability contracts; competition, privatisation and downsizing." 11


Objective: a statement of a desired future state, condition, or purpose, which an institution, a project, a service or a programme seeks to achieve. 12

On-/Off-budget funding: the capture (or lack of it) of funds (internal, such as user charges or fines, or external) by the budget process of the recipient government.

Operational plan: operational plans focus on effective management of resources with a short time framework, converting objectives into targets and activities, and arrangements for monitoring implementation and resource usage. Specific meanings include: (i) translation of the national strategic plan within a one-year time frame; (ii) translation of the national strategic plan into a sub-national plan, e.g. a district plan, usually with a shorter time frame than the national strategic plan; (iii) a subset of a national strategic plan, limited to a particular programme.

Opportunity cost: "the value of the next best alternative forgone as a result of the decision made”. 13

Outcome: those aspects of health that result from the interventions provided by the health system, the facilities and personnel that recommend them and the actions of those who are the targets of the interventions. 14

Out-of-pocket payments (OOP): payments for goods or services that include: (i) direct payments: payments for goods or services that are not covered by any form of insurance; (ii) cost sharing: a provision of health insurance or third-party payment that requires the individual who is covered to pay part of the cost of health care received; and (iii) informal payments: unofficial payments for goods and services that should be fully funded from pooled revenue. 15

Output: the quantity and quality of activities carried out by a programme.

Ownership: the effective leadership and coordination by countries of their development policies, strategies and development actions. See: Paris Declaration.


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  • See also jointly agreed IHP+ principles
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