Health system modelling research: towards a whole-health-system perspective for identifying good value for money investments in health system strengthening

Abstract

Global health research has typically focused on single diseases, and most economic evaluation research to date has analysed technical health interventions to identify ‘best buys’. New approaches in the conduct of economic evaluations are needed to help policymakers in choosing what may be good value (ie, greater health, distribution of health, or financial risk protection) for money (ie, per budget expenditure) investments for health system strengthening (HSS) that tend to be programmatic. We posit that these economic evaluations of HSS interventions will require developing new analytic models of health systems which recognise the dynamic connections between the different components of the health system, characterise the type and interlinks of the system’s delivery platforms; and acknowledge the multiple constraints both within and outside the health sector which limit the system’s capacity to efficiently attain its objectives. We describe priority health system modelling research areas to conduct economic evaluation of HSS interventions and ultimately identify good value for money investments in HSS.

Toward health system strengthening in low- and middle-income countries: insights from mathematical modeling of drug supply chains

“…However, national policymakers and international agencies (e.g. Gavi, the Vaccine Alliance; the Global Fund To Fight AIDS, TB, and Malaria) are paying increasing attention to strengthening health systems and to improving their efficiency [18]. In addition to solely investigating disease-focused interventions, for example, analysts need to examine system-wide delivery platforms such as health facilities, and operational elements such as supply chains.…”

“…Studying health system strengthening (HSS) interventions rather than single technical interventions is needed to help policymakers choose what may be good value for money investments for health systems [18]. HSS interventions importantly include pharmaceutical procurement and supply chain management.…”

We shouldn’t count chickens before they hatch: results-based financing and the challenges of cost-effectiveness analysis

“…Unlike targeted interventions, RBF is a systemwide intervention that is subject to system constraints, which will have dynamic impacts on various components of the health system. Because of this many scholars have argued the need to develop new analytic models to comprehend such system effects (Vassall, Bozzani, & Hanson, 2019;Verguet et al, 2019) as well as better modelling to understand impacts from other contextual moderators of RBF delivery (Borghi, Singh, Brown, Anselmi, & Kristensen, 2018).…”

Health priority-setting for official development assistance in low-income and middle-income countries: a Best Fit Framework Synthesis study with primary data from Ethiopia, Nigeria and Tanzania

“…We view this process to be more aligned with that of a complex open system, and thus can be better explained by the use of system theory. Although system theory did not originate from health system analysis [ 30 , 31 ], many scholars have attempted to apply it to this area [ 32 ]. This study was designed with the same line of thought that decision making for priority setting in the health sector has the same characteristic as a complex system, that it is comprised of a set of interconnected elements, it is more than a simple additive of functions of the components, the process is non-linear and the results are often unpredictable and can be counterintuitive [ 33 – 35 ].…”