A functioning health system is crucial ucial for maternal health programmes to achieve their goals of improving maternal and perinatal health. The six essential building blocks of a health system are service delivery, health workforce, information, equipment and supplies, financing and leadership and governance. Health systems are complex and interconnected social and political organizations. Although some of their core elements are tangible (infrastructure, equipment, supplies, vehicles and people), many are intangible or conceptual in nature, such as health sector reforms and governance. Maternity services are the means through which the health system provides care for mothers and their babies. Maternity services are usually organized in at least three levels - primary, secondary and tertiary. Acute problems exist in the recruitment, retention, deployment and distribution of people working in the health system. The problems are not restricted to doctors, nurses and midwives, but extend to paramedical and ancillary staff (such as laboratory technicians, radiographers) and professional managers. Health sector reforms are changes in policy and institutional arrangements of the health system and are required for a health system to be responsive to a range of external factors and ultimately to provide equitable and efficient health services. Some major reforms pertinent to maternity care in India are discussed in this chapter, including examples of public-private partnerships, financing health care and aid harmonization.
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