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Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework.

Mounier-Jack S, Griffiths UK, Closser S, Burchett H, Marchal B - BMC Public Health (2014)

Bottom Line: In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole.Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs.We propose that if researchers use the framework, it should be adapted and made context-specific.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. sandra.mounier-jack@lshtm.ac.uk.

ABSTRACT

Background: The WHO health systems Building Blocks framework has become ubiquitous in health systems research. However, it was not developed as a research instrument, but rather to facilitate investments of resources in health systems. In this paper, we reflect on the advantages and limitations of using the framework in applied research, as experienced in three empirical vaccine studies we have undertaken.

Discussion: We argue that while the Building Blocks framework is valuable because of its simplicity and ability to provide a common language for researchers, it is not suitable for analysing dynamic, complex and inter-linked systems impacts. In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole. Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs. Another criticism is not of the framework per se, but rather how it is typically used, with a focus on the six building blocks to the neglect of the dynamic process and outcome aspects of health systems.We believe the framework would be improved by making three amendments: integrating the missing "demand" component; incorporating an overarching, holistic health systems viewpoint and including scope for interactions between components. If researchers choose to use the Building Blocks framework, we recommend that it be adapted to the specific study question and context, with formative research and piloting conducted in order to inform this adaptation.

Summary: As with frameworks in general, the WHO Building Blocks framework is valuable because it creates a common language and shared understanding. However, for applied research, it falls short of what is needed to holistically evaluate the impact of specific interventions on health systems. We propose that if researchers use the framework, it should be adapted and made context-specific.

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The WHO health system building blocks framework. Source: WHO 2007[1].
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Figure 1: The WHO health system building blocks framework. Source: WHO 2007[1].

Mentions: In 2007, the WHO published a health systems Building Blocks framework with the aim of promoting a common understanding of what a health system is and what constitutes health systems strengthening[1]. In the framework, a health system is conceptualized as consisting of six building blocks: (i) service delivery; (ii) health workforce; (iii) information; (iv) medical products, vaccines and technologies; (v) financing; and (vi) leadership and governance, as well as process elements (access, coverage, quality and safety) and outcomes (improved health and health equity, responsiveness, social and financial risk protection and improved efficiency) (FigureĀ 1)[1].


Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework.

Mounier-Jack S, Griffiths UK, Closser S, Burchett H, Marchal B - BMC Public Health (2014)

The WHO health system building blocks framework. Source: WHO 2007[1].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3974593&req=5

Figure 1: The WHO health system building blocks framework. Source: WHO 2007[1].
Mentions: In 2007, the WHO published a health systems Building Blocks framework with the aim of promoting a common understanding of what a health system is and what constitutes health systems strengthening[1]. In the framework, a health system is conceptualized as consisting of six building blocks: (i) service delivery; (ii) health workforce; (iii) information; (iv) medical products, vaccines and technologies; (v) financing; and (vi) leadership and governance, as well as process elements (access, coverage, quality and safety) and outcomes (improved health and health equity, responsiveness, social and financial risk protection and improved efficiency) (FigureĀ 1)[1].

Bottom Line: In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole.Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs.We propose that if researchers use the framework, it should be adapted and made context-specific.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. sandra.mounier-jack@lshtm.ac.uk.

ABSTRACT

Background: The WHO health systems Building Blocks framework has become ubiquitous in health systems research. However, it was not developed as a research instrument, but rather to facilitate investments of resources in health systems. In this paper, we reflect on the advantages and limitations of using the framework in applied research, as experienced in three empirical vaccine studies we have undertaken.

Discussion: We argue that while the Building Blocks framework is valuable because of its simplicity and ability to provide a common language for researchers, it is not suitable for analysing dynamic, complex and inter-linked systems impacts. In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole. Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs. Another criticism is not of the framework per se, but rather how it is typically used, with a focus on the six building blocks to the neglect of the dynamic process and outcome aspects of health systems.We believe the framework would be improved by making three amendments: integrating the missing "demand" component; incorporating an overarching, holistic health systems viewpoint and including scope for interactions between components. If researchers choose to use the Building Blocks framework, we recommend that it be adapted to the specific study question and context, with formative research and piloting conducted in order to inform this adaptation.

Summary: As with frameworks in general, the WHO Building Blocks framework is valuable because it creates a common language and shared understanding. However, for applied research, it falls short of what is needed to holistically evaluate the impact of specific interventions on health systems. We propose that if researchers use the framework, it should be adapted and made context-specific.

Show MeSH