Health systems

Health Systems Strengthening Glossary



Realism (as a feature of national health plans): the extent to which a national plan is feasible, given the existing capacity and resources and is therefore more likely to be implemented. 1

Recurrent expenditures - costs: costs that refer to inputs which last less than one year and are regularly purchased for continuing an activity, such as salaries, drugs and supplies, repair maintenance, and others. 2

Regulation: the imposition of external constraints upon the behaviour of an individual or an organization to force a change from preferred or spontaneous behaviour. 3

Resilience: "the ability of a system, community or society exposed to hazards to resist, absorb, accommodate to and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions." 4

Resource planning: the estimation of resource inputs (human resources, medical devices, medical equipment, pharmaceuticals and facilities) necessary to provide expected services.

Resource: the inputs required to make health systems work (human and financial resources, drugs, supplies and equipments, and infrastructure).


Segmentation (of health systems): the coexistence of subsystems with different modalities of financing, affiliation and health care delivery, each of them ‘specializing’ in different strata of the population according to their type of employment, income level, ability to pay, and social status. This kind of institutional arrangement consolidates and deepens inequity in access to health care services across different population groups. In organizational terms, segmentation is the coexistence of one or more public entities (depending on the degree of decentralization or deconcentration), social security (represented by one or more entities), different financers/insurers, and private providers (depending on the extent of market and business management mechanisms introduced during sectoral reforms). 5

Shadow alignment: "shadow alignment is a state-avoiding approach but one that is 'future-proof'. It does not give an authority or government control over resources, but does use structures, institutions or systems which are parallel but compatible with existing or potential organization of the state. It aims to avoid creating a diversionary institutional legacy that can undermine or impede the development of a more accountable and legitimate future relationship between the people and their governments." 6

Shadow prices: "prices that have been adjusted for various reasons, including donations, distorted exchange rates, subsidies, to yield an economic cost that better reflects the value of a given good." 7

Situation analysis: analysis of the current status and expected trends in a country's health and health system. Ideally includes: (i) assessment of current and future health needs and determinants of health; (ii) assessment of expectations and demand of services; (iii) assessment of the health system performance, health sector capacity and health system resources, and the gaps in responding to current and future needs and expectations; and analysis of stakeholder positions. 8

Stakeholder: an individual, group or an organization that has an interest in the organization and delivery of health care.

Standard: an established, accepted and evidence-based technical specification or basis for comparison. 9

Stewardship: "the very essence of good government..the careful and responsible management of the well-being of the population." Includes: health policy formulation (defining the vision and direction of health system), regulation (setting fair rules of the game with a level playing field) and intelligence (assessing performance and sharing information). 10 See: governance

Strategy: a series of broad lines of action intended to achieve a set of goals and targets set out within a policy or programme. 11

Structural adjustment: set of policies adopted by the International Monetary Fund (IMF) and the World Bank since the 1980s with the aim of enhancing the external viability of the adjusting countries’ economies and the stability of the international financial system, consistent with the overarching liberal ideology that drives globalization processes in the financial and trade sectors; these policies involve devaluation, public spending reduction, tax increases, and tighter monetary policy, and a reduction of the role of the state. 12

Sustainability: the potential for sustaining beneficial outcomes for an agreed period at an acceptable level of resource commitment within acceptable organizational and community contingencies. 13


Target: an intermediate result towards an objective that a programme seeks to achieve, within a specified time frame, a target is more specific than an objective and lends itself more readily to being expressed in quantitative terms. 14

Transaction costs: "any use of resources required to negotiate and enforce agreements, including the cost of information needed to facilitate a bargaining strategy, the time spent haggling, and the costs of preventing cheating by the parties to the bargain." 15


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