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Health Systems Frameworks

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Global Health Essentials

Part of the book series: Sustainable Development Goals Series ((SDGS))

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Health systems frameworks help to describe and analyze health systems, as well as frame interventions to strengthen health systems, while reflecting the agendas and biases of their authors. This chapter summarizes the uses and limitations of some widely used health systems frameworks, arguing that the choice of a framework should be fit-for-purpose. A comprehensive description of a health system framework is presented to fill some gaps by incorporating previously overlooked social and structural determinants of health, and as well incorporating broader population health services and health emergency and disaster risk management. We discuss how frameworks can support a systems thinking approach when they prompt how key stakeholders, functions, and outcomes are specifically related to each other and health system objectives, and outline considerations to help in selecting an appropriate framework.

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  1. World Health Organization. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: World Health Organization; 2007.

    Google Scholar 

  2. World Health Organization. The World Health Report 2000. Health systems: improving performance. Geneva: World Health Organization; 2000.

    Google Scholar 

  3. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social determinants of health discussion paper 2 (policy and practice). Geneva: World Health Organization; 2010.

    Google Scholar 

  4. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sheikh K, Abimbola S. Learning health systems: pathways to progress: a flagship report from the Alliance for Health Policy and Systems Research. Geneva: World Health Organization; 2021. Accessed 15 June 2022

    Google Scholar 

  6. Hoffman S, Røttingen J-A, Bennett S, Lavis JN, Edge JS, Frenk J. A review of conceptual barriers and opportunities facing health systems research to inform a strategy from the World Health Organization. Geneva: Alliance for Health Policy and Systems Research; 2012. Accessed 15 June 2022

    Google Scholar 

  7. Tanahashi T. Health service coverage and its evaluation. Bull World Health Organ. 1978;56(2):295–303.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Strifler L, Cardoso R, McGowan J, Cogo E, Nincic V, Khan PA, Scott A, Ghassemi M, MacDonald H, Lai Y, Treister V, Tricco AC, Straus SE. Scoping review identifies significant number of knowledge translation theories, models, and frameworks with limited use. J Clin Epidemiol. 2018;2018(100):92–102.

    Article  Google Scholar 

  9. Roemer MI. National Health Systems of the world. New York: Oxford University Press; 1991.

    Google Scholar 

  10. Kielmann AA, Neuvians D, Kipp W, et al. Quality, quantity and utilization of basic health services. In: Evaluation of the impact of health interventions. Belgium: Derouaux Ordina Editions; 1995.

    Google Scholar 

  11. Roberts MJ, Hsiao W, Berman P, Reich MR. Getting health reform right. A guide to improving performance and equity. New York: Oxford University Press; 2008.

    Book  Google Scholar 

  12. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–252.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Baeza C, Packard TG. Beyond survival: protecting households from health shocks in Latin America. Washington DC/Stanford: World Bank/Stanford University Press; 2006.

    Book  Google Scholar 

  14. Peters DH, El-Saharty S, Siadat B, Janovsky K, Vujicic M. Improving health services in developing countries: from evidence to action. Washington, DC: World Bank; 2009.

    Book  Google Scholar 

  15. Siddiqi S, Peters DH, Mataria A. Introduction to health systems: setting the scene. In: Siddiqi S, Mataria A, Rouleau KD, Iqbal M, editors. Making health systems work. Cambridge: Cambridge University Press; 2023.

    Google Scholar 

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Correspondence to David H. Peters .

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Peters, D.H. (2023). Health Systems Frameworks. In: Raviglione, M.C.B., Tediosi, F., Villa, S., Casamitjana, N., Plasència, A. (eds) Global Health Essentials. Sustainable Development Goals Series. Springer, Cham.

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-33850-2

  • Online ISBN: 978-3-031-33851-9

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