Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities

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Abstract

Background

Acknowledging the health system strengthening agenda, the World Health Organization (WHO) has formulated a health systems framework that describes health systems in terms of six building blocks. This study aimed to determine the current status of the six WHO health system building blocks in public healthcare facilities in Ethiopia.

Methods

A quantitative, cross-sectional study was conducted in five public hospitals in central Ethiopia which were in a post-reform period. A self-administered, structured questionnaire which covered the WHO’s six health system building blocks was used to collect data on healthcare professionals who consented. Data was analyzed using IBM SPSS version 20.

Results

The overall performance of the public hospitals was 60% when weighed against the WHO building blocks which, in this procedure, needed a minimum of 80% score. For each building block, performance scores were: information 53%, health workforce 55%, medical products and technologies 58%, leadership and governance 61%, healthcare financing 62%, and service delivery 69%. There existed a significant difference in performance among the hospitals ( p < .001).

Conclusion

The study proved that the WHO’s health system building blocks are useful for assessing the process of strengthening health systems in Ethiopia. The six blocks allow identifying different improvement opportunities in each one of the hospitals. There was no contradiction between the indicators of the WHO building blocks and the health sustainable development goal (SDG) objectives. However, such SDG objectives should not be a substitute for strategies to strengthen health systems.

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Most cited references 30

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The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress

Julio J Frenk (2010)

In the second in a series of articles on the changing nature of global health institutions, Julio Frenk offers a framework to better understand national health systems and their role in global health.

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The emergence of global attention to health systems strengthening.

Jeremy Shiffman, Tamara Hafner (2012)

After a period of proliferation of disease-specific initiatives, over the past decade and especially since 2005 many organizations involved in global health have come to direct attention and resources to the issue of health systems strengthening. We explore how and why such attention emerged. A qualitative methodology, process-tracing, was used to construct a case history and analyse the factors shaping and inhibiting global political attention for health systems strengthening. We find that the critical factors behind the recent burst of attention include fears among global health actors that health systems problems threaten the achievement of the health-related Millennium Development Goals, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. While a variety of actors now embrace health systems strengthening, they do not constitute a cohesive policy community. Moreover, the concept of health systems strengthening remains vague and there is a weak evidence base for informing policies and programmes for strengthening health systems. There are several reasons to question the sustainability of the agenda. Among these are the global financial crisis, the history of pendulum swings in global health and the instrumental embrace of the issue by some actors.

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Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework

Sandra Mounier-Jack, Ulla K Griffiths, Svea Closser … (2014)

Background The WHO health systems Building Blocks framework has become ubiquitous in health systems research. However, it was not developed as a research instrument, but rather to facilitate investments of resources in health systems. In this paper, we reflect on the advantages and limitations of using the framework in applied research, as experienced in three empirical vaccine studies we have undertaken. Discussion We argue that while the Building Blocks framework is valuable because of its simplicity and ability to provide a common language for researchers, it is not suitable for analysing dynamic, complex and inter-linked systems impacts. In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole. Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs. Another criticism is not of the framework per se, but rather how it is typically used, with a focus on the six building blocks to the neglect of the dynamic process and outcome aspects of health systems. We believe the framework would be improved by making three amendments: integrating the missing “demand” component; incorporating an overarching, holistic health systems viewpoint and including scope for interactions between components. If researchers choose to use the Building Blocks framework, we recommend that it be adapted to the specific study question and context, with formative research and piloting conducted in order to inform this adaptation. Summary As with frameworks in general, the WHO Building Blocks framework is valuable because it creates a common language and shared understanding. However, for applied research, it falls short of what is needed to holistically evaluate the impact of specific interventions on health systems. We propose that if researchers use the framework, it should be adapted and made context-specific.

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Author and article information

Contributors

Tsegahun Manyazewal:

ORCID: http://orcid.org/0000-0002-8360-7574

+251 11 416 6041 , 012 429 6770 , tsegahunm@gmail.com

Journal

Journal ID (nlm-ta): Arch Public Health

Journal ID (iso-abbrev): Arch Public Health

Title: Archives of Public Health

Publisher: BioMed Central (London )

ISSN (Print): 0778-7367

ISSN (Electronic): 2049-3258

Publication date (Electronic): 31 August 2017

Publication date PMC-release: 31 August 2017

Publication date Collection: 2017

Volume: 75

Electronic Location Identifier: 50

Affiliations

ISNI 0000 0004 0610 3238, GRID grid.412801.e, Department of Health Studies, , College of Human Science, University of South Africa, ; Pretoria, P.O. BOX 392 South Africa

Author information

Tsegahun Manyazewal http://orcid.org/0000-0002-8360-7574

Article

Publisher ID: 221

DOI: 10.1186/s13690-017-0221-9

PMC ID: 5651704

PubMed ID: 29075485

SO-VID: fa6cbb7e-cd7e-4801-805d-741820b5b8fa

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 24 March 2017

Date accepted : 12 July 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100008227, University of South Africa;

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ScienceOpen disciplines: Public health

Keywords: world health organization,health system,health system strengthening,health development goals,ethiopia

Data availability:

ScienceOpen disciplines: Public health

Keywords: world health organization, health system, health system strengthening, health development goals, ethiopia

Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities

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Background

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Conclusion

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UN Sustainable Development Goals

Most cited references 30

The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress

The emergence of global attention to health systems strengthening.

Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework

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