A new era for the WHO health system building blocks?

A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health.a There is mounting evidence that health systems that can deliver services equitably and efficiently are critical for achieving improved health status.

While increased attention to health systems strengthening is welcome, it requires a sound monitoring strategy that enables decision-makers to accurately track system performance and health progress, evaluate impact, and ensure accountability. Accordingly, in 2007 the World Health Organization (WHO) proposed a frameworkb describing health systems in terms of six core components or “building blocks”: (i) service delivery; (ii) health workforce; (iii) health information systems; (iv) access to essential medicines; (v) financing; and (vi) leadership/governance (Figure 1). The subsequent WHO monitoring framework recognized that “sound and reliable information is the foundation of decision-making across all health system building blocks.”c

WHO health systems frameworkThe nature of information-sharing and communication systems has changed dramatically since the WHO health systems framework was introduced. Similarly, knowledge and thinking about “patient engagement” in health care has greatly evolved. People who are actively involved in their own health care tend to have demonstrably better outcomes.d

While it would be impossible to integrate all multidimensional aspects of the information age and of patient engagement directly into the WHO building blocks model, the changes do warrant a revision of the framework to include some acknowledgement of these two broad dimensions as part of health systems monitoring.

With this in mind, we propose a modification of the framework, highlighting general points of influence of communication and patient engagement (Figure 2).

Proposed modified WHO health system frameworkAs we prepare the accompanying narrative description of these additions along with a discussion of their implications, we would appreciate initial feedback from interested readers. As far as possible, we will integrate your input into an amended version of the framework diagram and narrative description by mid-October 2014.

With grateful thanks in anticipation of your thoughts.

Jeffrey V. Lazarus – Secretariat Director and co-founder, Health Systems Global

Tim France – Managing Director, Inis Communication

Blog originally posted by Health Systems Global on 22 August 2014. Reposted with permission.


a. World Health Organization

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

c. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: World Health Organization; 2010

d. The latest evidence will be published in a supplement to Health Policy and Planning to be launched at the Third Global Symposium on Health Systems Research (Cape Town, Sept 2014).

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