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What is a Health System?

One way to analyze a health system, try to understand where the roadblocks exist to improving health outcomes, and formulate strategies for system strengthening is using the ‘Control Knobs ’ framework outlined in Getting Health Reform Right: A Guide to Improving Performance and Equity. This framework is currently used by the World Bank Institute as the basis for its Flagship Program on Health Sector Reform and Sustainable Financing. The control knobs and other key health system components are explained below.

Health System Components / Health System Control Knobs

Financing  Where does funding for the Health System come from? How are the funds pooled? How are they allocated and spent?
Payment  How are providers (hospitals, clinics, managers, physicians, nurses, etc.) paid?
Organization and Service Delivery  Who delivers health care and in what settings? How are those facilities organized? Where do people go for care and why?
Regulation  How are different actors in the health system -- insurers, producers of inputs, providers, and facilities regulated?
Persuasion How does personal behavior of providers and patients influence both individual interaction with the health system and individual health?
Politics  How can health system reformers mobilize the political support need to bring about positive change?
Ethics and Values How do national health systems reflect the country's and community's values?

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