Monitoring the Building Blocks of Health Systems

When working with countries to measure and compare health systems functioning, it is important to strike a good balance between avoiding blueprints that do not allow for country contexts and specificities while also encouraging a degree of standardization that enables comparisons within and between countries as well as over time. Standardized indicators allow comparisons between countries and can help mutual learning, including the identification of bottlenecks and the sharing of lessons learned.

This handbook does not attempt to cover all components of the health system or deal with the various monitoring and evaluation frameworks. Instead, it is structured around the WHO framework that describes health systems in terms of six core components or "building blocks": service delivery, health workforce, health information systems, medical products, vaccines and technologies, financing and leadership/governance. The selection of indicators was guided by the need to detect change and show progress in health systems strengthening. Indicators relate to both the level and distribution of inputs and outputs. While the focus is on low- and middle-income countries, experiences from high-income countries are also used to guide the development of measurement systems.

Each section has proposed core indicators that all countries are encouraged to collect, plus a wider set of indicators that users can choose or modify as needed. It is anticipated that the core indicators will enable the production of country "dashboards" that contain the instruments by which health systems trends can be regularly monitored and compared. Countries should integrate new indicators with existing indicators of their health sector and statistical strategies and plans. Health systems monitoring should also be seen in the context of the indicators' impact on access to priority health services and their contribution to reaching the Millennium Development Goals (MDGs).

The handbook is divided into six sections, each of which covers one health system component or building block and is set out along the following lines:

-introduction to the component and related indicators;

-description of possible sources of information and available measurement strategies;

-proposed "core indicators", supplemented, where necessary, by additional indicators that may be used depending on the country health system attributes and needs.