Health systems frameworks studied in master of public health
Health systems and health system frameworks are an important part of any work done in the field of public health. If you are looking to study a master of public health, then you will learn about them in great detail. Should you opt to study UJ’s online Master of Public Health, you will encounter health systems in three of the nine compulsory modules.
The Principles and Practice of Environmental Health module looks at the relative strengths and weaknesses of various occupational and environmental health systems. This module allows learners to gain a contextual framework of public health.
The Africa Health Systems, Health and Environmental Politics and Management module looks at the impact that existing health systems have on Africa’s demographics while also looking at the influence of both the political and natural physical environment and how they influence each other.
The Health Systems, Funding Model and Health Economics module looks at best practices around the world for health systems in both developed and developing economies. This module looks at the different ways that health systems can be funded, which we also cover in more detail in our FAQs below where we explain the four main funding models for public health systems.
WHO framework for health systems performance assessment
In recognition of the importance or performance assessment in developing public health policy, the World Health Organisation (WHO) has produced a detailed guideline for countries to follow. The 246-page Health Systems Performance Assessment Framework for Universal Health Coverage document outlines best practice for gathering and analysing health system data and measuring this against the health goals.
The WHO places a particular emphasis on looking at both the performance and the final end goals of a public health system. The guide aims to assist health policy decision makers in both identifying areas where performance is poor and in identifying the causes for that poor performance.
The World Bank’s control knobs framework
As part of its global strategy for health, the World Bank states that it actively supports countries in their efforts to provide universal high quality health coverage to their citizens, regardless of their ability to pay.
The World Bank uses an approach to grouping policy interventions on health systems that it calls the control knobs framework. The aim of this framework is to assess the performance of a health system and to provide guidance on efforts to improve the system’s performance.
You can read more about the control knobs framework in our FAQs section below.
WHO building blocks framework
The WHO is another large global organisation that is heavily involved in health frameworks and assisting in developing and improving health systems around the world. The WHO makes use of an analytical framework to assess health systems that involves breaking the overall system into six distinct building blocks.
The six building blocks that the WHO uses in this approach are:
- Leadership and governance
- Service delivery
- Health system financing
- Health workforce
- Medical products, vaccines and technologies
- Health information systems
Health information systems core indicators to know for an MPH
Core indicators provide the basis for a health information system and are used in both planning of the health system and in monitoring its performance. These core indicators can be roughly split into health system inputs, outputs, outcomes and health status. Knowledge of these indicators and how to apply them is something that you will gain from studying a master of public health (MPH).
The WHO has compiled a list of 100 core health indicators that it describes as a “standard set of core indicators prioritised by the global community to provide concise information on the health situation and trends, including responses at national and global levels”.
Health Information System Performance Index (Hispix)
One of the measures by which the WHO assesses the overall performance of a health information system is the Health Information System Performance Index (Hispix).
This measure makes use of publicly available data and ranks the data against various standardised indicators to provide a numerical score. This score is intended to provide an objective and comparable assessment that can be used for any country’s health system.
The WHO describes Hispix in far greater detail in Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies.
Health surveys
Measures such as Hispix require reliable data that is publicly available. While much of this data is provided through existing health information systems that record and report on patient data, this is only able to capture data on people who have made use of public health facilities such as clinics and hospitals. Health surveys are used to gather data on the health of a population that includes those who have not sought care at a public health facility.
Here in South Africa these and other surveys are carried out by Statistics South Africa, otherwise shortened to Stats SA. Examples of many health surveys carried out by Stats SA include the South African Demographic and Health Survey, Trends in selected health indicators regarding children under 5 years in South Africa and The Status of Women’s Health in South Africa: Evidence from selected indicators.
Birth and death registration
Similarly to how health surveys provide crucial data for the monitoring and assessment of health systems, so too does a reliable record of all the births and deaths within a population. Accurate registration of births and deaths allows for a reliable record of a country’s population at any given time.
In South Africa this is controlled by the Births and Deaths Registration Act of 1992, which requires that all births within the country are registered within 30 days. This also applies to South African citizens living abroad, requiring the registration to be done at the nearest South African diplomatic or consular mission.
Registration of deaths are somewhat more complicated if there is a suspicion that it was not due to natural causes, but the law requires that all deaths are registered as soon as is practical. The recording of details on the cause of death also provides important data for assessing a public health system.
Civil registration
Civil registration refers to the registration of births and deaths as covered in the above section as well as the registration of marriages. While the registration of marriages does not have as direct a relation to public health as for births and deaths, it is nonetheless of great importance.
The African Union celebrates Africa Civil Registration and Vital Statistics Day on 10 August every year. It aims to raise public awareness on the importance of a well-functioning civil registration system to allow for the the timely registration of vital events.
Civil registration in Africa differs somewhat from Western countries as it also recognises traditional cultural marriages as well as polygamy. This is important for spouses to obtain legal recognition and protection for things such as inheritance, pensions and death and disability payments.
Censuses
Stats SA conducts a national census every 10 years to provide an even more detailed snapshot of the country’s entire population that can be gleaned from the registration of births and deaths. As well as providing a count of all the people living within the country, a census also gathers information on socio-economic factors, such as people’s living conditions, their access to basic services and their income, among others.
Census data is used by the government for planning, policy formulation and for deciding on final budget allocations across local, provincial and national government.
The latest South African census was carried out in 2022 but at the time of writing the results had not yet been made available.
Health facility reporting
While surveys are useful for gathering general information on the health status of a population, health facilities are able to provide far more detailed data. When health facility reporting is done accurately, and within a well-structured health framework, the health reports of health facilities provide public health managers and other policy makers with crucial empirical data.
This requires that health facilities report in a uniform fashion, while also ensuring accuracy of the information.
Health system resource tracking
One of the roles of a health information system is to ensure that all of the health system’s resources are tracked. This includes human resources and staffing, property management and maintenance, as well as up-to-date tracking of all medical equipment and supplies.
South Africa’s health information systems sources to use for your masters dissertation
South Africa’s public health system comprises a complex network of organisations, people and facilities. Policy makers as well as students and researchers have access to many different sources of information on the functioning of the country’s health systems and the health of the population.
Below are some of the health information systems and organisations that are crucial to South Africa’s public health system.
District Health Information System (DHIS)
District Health Information System (DHIS) is the name of an open-source software platform that is used by many countries to provide a national health management information system.
Although most commonly used for health data, the DHIS2 software can be used for any data collection and management and is used in many other industries. DHIS2 is based in Norway, but the project had its roots in South Africa in 1994.
EDRweb – Electronic Drug-Resistant TB Register
The Electronic Drug-Resistant TB Register (EDRweb) is a project run by the South African Department of Health, with the support of several organisations, for the surveillance and management of drug-resistant tuberculosis (TB).
Authorised users can either input new data for drug-resistant TB units or access the central database and pull out data reports. The data provided by EDRweb helps to speed up decision making and to determine where interventions are needed.
South African Medical Research Council
The South African Medical Research Council (SAMRC) is an important contributor towards public health in South Africa and the country’s overall public health system. The SAMRC carries out medical research with the aim of improving the country’s overall health.
The SAMRC is a public entity that falls under South Africa’s national government. It is South Africa’s largest single local funder of health research as well as medical diagnostics, medical devices and therapeutics.
The council also keeps close tabs on the country’s largest causes of death and it focuses on what it describes as South Africa’s “quadruple burden of disease”. This quadruple burden includes maternal, new-born and child health, HIV/Aids and TB, non-communicable diseases and interpersonal violence.
Although it carries out research in many medical fields, the bulk of its work is directed at the leading health threats to the country. These are tuberculosis, HIV/Aids, cardiovascular and non-communicable diseases, alcohol and other drug abuse as well as issues related to gender and health.
You can read a bit more about the SAMRC in our FAQ below.
Stats SA – mortality and causes of death in South Africa
Statistics South Africa (Stats SA) plays a crucial role in public health in South Africa. It does this by providing accurate data for the country’s public health administrators. Stats SA provides many different quarterly and annual reports relating to the functioning of the country.
Stats SA produces many health-related reports and reports relating to causes of death in South Africa. One of the more comprehensive of these reports is Mortality and causes of death in South Africa: Findings from death notification. This report provides detailed information on causes of death across the country as well as giving a breakdown by province. Unfortunately these reports take Stats SA quite a long time to compile and the release of information trails behind the dates that are reported on.
At the time of writing, the most recently available mortality report was released in mid 2021 to cover the year 2018. The previous report, released in 2020, gave the leading causes of death and mortality breakdown for 2017.
You can see some more detail of what is contained in these reports in our FAQs on South Africa’s mortality rate and on the diseases causing the most deaths in South Africa.
National Treasury health expenditure data
The National Treasury is responsible for allocating the government’s budget each year and a large part of this allocation is made up of expenditure on public health. Health expenditure receives the second-highest budget allocation, beaten only by what is spent on education.
You can read more about what South Africa spends on health care each year in our FAQ below.
South African Community Epidemiology Network on Drug Use (Sacendu)
The South African Community Epidemiology Network on Drug Use (Sacendu) is a public entity that monitors alcohol, tobacco and other drug use in the country. It falls under the umbrella of the SAMRC and its goal is to reduce the impact of substance abuse on individuals and their communities by identifying the most effective forms of intervention and support.
The members of Sacendu meet every six months and they produce two reports per year that monitor the trends of alcohol, tobacco and other drug use. At the time of writing, the most recent such report was this alcohol, tobacco and other drug use report for January to June of 2021.
Council for Medical Schemes annual report
The Council for Medical Schemes was set up by parliament to act as an independent regulatory body for the country’s medical schemes. It ensures transparency and fairness and works towards affordable and accessible healthcare cover for the South African public.
Each year it provides an annual report on its strategic, operational and financial performance. The latest annual report, which came out in October 2022, covered 72 medical schemes.
Tips to successfully complete a distance learning masters programme
Distance learning or online learning offers students far more flexibility than traditional contact courses. However, this flexibility also comes with additional responsibility and online learners will need to rely on their own discipline and motivation to put in the work that is required.
Fortunately online or distance learners are not entirely alone. Online programmes such as those offered by UJ provide abundant support for online students. Lecturers are accessible and interaction with other students in the course is strongly encouraged.
There are also many resources available to help online students, such as our previous post on study skills for online learning as well as this guide to online learning protocols or “netiquette”.
Health systems FAQs
Here are some common questions and answers related to health systems.
