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The Health System

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Health systems are defined as comprising all the organizations, institutions and resources that are devoted to producing health actions. A health action is defined as any effort, whether in personal health care, public health services or through intersectoral initiatives, whose primary purpose is to improve health. But while improving health is clearly the main objective of a health system, it is not the only one. The objective of good health itself is really twofold: the best attainable average level – goodness – and the smallest feasible differences among individuals and groups – fairness. Goodness means a health system responding well to what people expect of it; fairness means it responds equally well to everyone, without discrimination

National health systems have three overall goals:
1. good health,
2. responsiveness to the expectations of the population, and 3. fairness of financial contribution.

WHO describes health systems as having six building blocks: service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership and governance (stewardship). The 2008 Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focuses on nine major priority areas, namely Leadership and Governance for Health; Health Services Delivery; Human Resources for Health; Health Financing; Health Information Systems; Health Technologies; Community Ownership and Participation; Partnerships for Health Development; and Research for Health.

This section of the analytical profile is structured along the lines of the WHO Framework and the priorities described by the 2008 Ouagadougou Declaration.

3 The Health System
3.1 Health system outcomes
3.2 Leadership and governance
3.3 Community ownership and participation
3.4 Partnerships for health development
3.5 Health information, evidence and knowledge
3.6 Research
3.7 Health financing system
3.8 Service delivery
3.9 Health workforce
3.10 Medical products, vaccines, infrastructures and equipment
3.11 General country health policies
3.12 Universal coverage


The country's health care system consists of the formal and the informal sector. The informal sector consists of traditional health practitioners and other unregulated service providers. In the formal health sector there are both public and private health service providers including NGOs, mission, industry and private practitioners. Service delivery is organized in a five tier system, namely - national referral hospitals; regional hospitals; primary health care facilities including health centres, public health units, rural clinics and outreach sites; and lastly community based care where care and support is provided by rural health motivators, faith-based healthcare providers, traditional birth attendants and other volunteers.

Of the total health facilities in the country 45 per cent belong to the public sector, 12 per cent are owned by industries, 15 per cent by mission, 5 per cent by NGOs, 20 per cent by private practitioners and 3 per cent by private nurses.

Health care services are by and large free especially at the PHC levels. However patients do pay a minimal fee for services in particular at outpatient facilities. This fact was reported as hindering access to STI services by youth during the interviews. It may also be a factor considering the proportion of people living under less than $ 1 per day in the country.