A health system is defined as the collection of organizations, individuals, and actions whose primary purpose is to promote, restore, or maintain the health of a population. Recognizing the need for a standardized approach to analyze and strengthen these structures globally, the World Health Organization (WHO) developed a comprehensive framework. This framework helps countries assess their health system performance and identify specific areas that require investment or reform to improve overall health outcomes.
The Six Building Blocks Framework
The WHO framework, introduced in 2007, provides a holistic view for assessing a health system’s performance and identifying operational constraints. Its purpose is to guide a common conceptual understanding. The six components, or “building blocks,” are interconnected and must function together to achieve the system’s goals of improved health, responsiveness, and financial protection.
The six specific blocks are Service Delivery, Health Workforce, Health Information Systems, Medical Products, Vaccines, and Technologies, Financing, and Leadership/Governance. These blocks represent the minimum requirements for a system to operate effectively and efficiently. The framework is often used as a practical checklist to ensure all foundational components are addressed during system strengthening initiatives.
Resources Required for Operation
Health Workforce
The Health Workforce block focuses on ensuring there is a sufficient number of trained, skilled, and motivated personnel available to provide care. This includes doctors, nurses, community health workers, and administrators, all needing the right skills in the right place at the right time. Productivity, competency, and responsiveness are dimensions of a well-managed health workforce, which directly impacts the quality and reach of services.
Medical Products, Vaccines, and Technologies
This block ensures equitable access to essential commodities that are assured of quality, safety, and efficacy. This involves the entire supply chain, from procurement and quality assurance to efficient distribution of pharmaceuticals, vaccines, and medical equipment. A sound system guarantees that patients and health workers have the correct tools, from basic medicines to complex diagnostic equipment, when and where they need them. Failures in this area, such as inadequate supplies, can severely undermine service delivery.
Financing
The Financing block addresses how funds are raised, pooled, and spent to ensure that all people can use needed health services without suffering financial hardship. The goal is to ensure people are protected from financial catastrophe, often achieved through pooling funds and prepayment mechanisms. The way care is financed is often considered more important than the amount of money spent, with equity and access being primary concerns. This block influences resource allocation across the entire system, determining who gets what care and under what terms.
Delivering and Tracking Care
Service Delivery
The Service Delivery block represents the most visible component of the health system, encompassing the provision of personal and non-personal health interventions. This includes everything from preventative services like vaccinations to complex hospital procedures, delivered in a way that is effective, safe, and of high quality. Quality service delivery is characterized by being comprehensive, integrated, and accessible to those who need it. Its functions cover the entire spectrum of care, including prevention, diagnosis, treatment, and rehabilitation.
Health Information Systems
The Health Information Systems block details the necessity of reliable data for monitoring performance and informing policy. This block involves four primary functions: data generation, compilation, analysis and synthesis, and communication and use. Reliable, timely information is the foundation for evidence-based healthcare, strategic planning, and resource allocation across all other building blocks. Monitoring health determinants, system performance, and health status allows decision-makers to track diseases, evaluate impact, and ensure accountability. A robust information system is fundamental for making informed decisions and measuring progress toward national health goals.
Guiding the System
The Leadership and Governance block, also referred to as Stewardship, functions as the oversight mechanism for the entire health system. Its role is to ensure a strategic policy framework exists, combined with effective oversight, coalition building, and regulation. This block sets the overall direction and manages the interactions between the other five components.
The core functions of governance include setting policy direction, monitoring performance, and ensuring accountability to the population. It involves managing the relationships between public and private actors and providing the incentives needed to drive the system toward national health goals. Effective stewardship is responsible for maintaining system design and ensuring that all resources are used efficiently and equitably.