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| WHO Health Systems Framework | |
|---|---|
| Name | WHO Health Systems Framework |
| Established | 2007 |
| Jurisdiction | World Health Organization |
| Parent agency | United Nations |
WHO Health Systems Framework
The WHO Health Systems Framework is a policy tool developed by the World Health Organization to describe and strengthen national health systems through six interrelated components. First promulgated in a 2007 report produced by the World Health Organization's World Health Assembly and technical divisions, the framework has informed strategies adopted by ministries such as the Ministry of Health (Brazil), National Health Service (England), and Ministry of Health and Family Welfare (India). It is referenced in global programs led by organizations including the World Bank, United Nations Children's Fund, and Global Fund to Fight AIDS, Tuberculosis and Malaria.
The framework frames a health system as comprising six components intended to improve outcomes like population health, responsiveness, and financial protection, aligning with goals articulated in the Alma-Ata Declaration, the Millennium Development Goals, and the Sustainable Development Goals. It was elaborated alongside WHO policy instruments such as the World Health Report 2000, the International Health Regulations (2005), and the WHO Framework Convention on Tobacco Control, and has been applied to reforms in countries from Rwanda to Canada. The framework has been used by institutions including the European Commission, African Union, Pan American Health Organization, and Gavi, the Vaccine Alliance.
The framework identifies six "building blocks" that mirror priorities found in documents like the Oslo Ministerial Declaration and initiatives from the Bill & Melinda Gates Foundation. Each block is linked to examples and actors:
- Service Delivery: Emphasis on accessible, quality care as pursued by the National Health Service (Scotland), Clínica Alemana, and community models tied to the Declaration of Alma-Ata. - Health Workforce: Human resources strategies echoing workforce plans from the World Health Assembly and national cadres such as the Indian Public Health Service and NHS England workforce pilots. - Health Information Systems: Monitoring and surveillance approaches comparable to systems used by the Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, and national registries in Sweden. - Access to Essential Medicines: Policies influenced by the TRIPS Agreement, the Doha Declaration on the TRIPS Agreement and Public Health, procurement mechanisms like those of the Global Fund, and pooled purchasing practised by the Pan American Health Organization. - Financing: Financial protection models related to reforms in Thailand, the Affordable Care Act debates in the United States, and social insurance arrangements in Germany. - Leadership/Governance: Stewardship and regulation practices resonant with roles of the Ministry of Health (Chile), the Food and Drug Administration (United States), and governance dialogues at the World Health Assembly.
Implementation has involved adaptation by actors including ministries such as the Ministry of Health (South Africa), development banks like the Asian Development Bank, and technical partners like Médecins Sans Frontières and PATH (organization). Tools derived from the framework include national health sector strategic plans used in Uganda, performance-based financing piloted in Burundi, and health financing reviews supported by the International Monetary Fund and the World Bank. Implementation often engages multilateral partnerships such as those formed at UN General Assembly health summits and donor coordination platforms linked to the Organization for Economic Co-operation and Development.
Scholars and institutions including researchers at Harvard University, London School of Hygiene & Tropical Medicine, and Johns Hopkins Bloomberg School of Public Health have critiqued the framework for being descriptive rather than prescriptive, echoing debates from the World Health Report 2000 and discussions at the Global Symposium on Health Systems Research. Critics argue it underemphasizes social determinants foregrounded in reports by Commission on Social Determinants of Health and actors like Oxfam International, and may insufficiently account for political economy concerns highlighted in analyses of reforms in Greece and Argentina. Others note challenges in measurement similar to those encountered in the Global Burden of Disease Study and governance assessments by Transparency International.
The framework has informed reforms in diverse settings: Rwanda's health system performance efforts linked to programs supported by the Clinton Foundation and Global Fund to Fight AIDS, Tuberculosis and Malaria; Thailand's universal coverage scheme influenced by WHO guidance and comparisons with models from Japan and Germany; and integrated care pilots in Canada discussed at forums such as the Commonwealth Heads of Government Meeting. Evaluations by institutions like the World Bank and academic teams from University of Oxford and Yale University document mixed results, with documented improvements in indicators in Ethiopia and challenges in fragmented systems in Nigeria.
Since 2007, the framework has evolved alongside complementary approaches such as the People-Centred and Integrated Health Services framework, the Health Systems Dynamics Framework used by the Joint Learning Network for Universal Health Coverage, and the Lancet Commission on Global Surgery recommendations. It intersects with normative instruments including the Universal Health Coverage agenda advanced at the United Nations General Assembly (2012) and technical guidance from the World Health Organization and Pan American Health Organization. Continual debates engage stakeholders from the Bill & Melinda Gates Foundation to the World Bank Group about integrating equity-focused analyses like those promoted by the Commission on Investing in Health.