[MUSIC] You've just heard about two analytical health system performance frameworks. The WHO framework published in 2000 and the Commonwealth Fund framework published in 2006. Now let's move on to the last analytical framework, the WHO building blocks framework, and the deterministic framework, the control knobs framework. In 2007, the WHO published its framework for action with the aim of clarifying and strengthening WHO's role in health systems in a changing world. In this publication, the 2000 framework was modified to incorporate some of the feedback received after its publication. As part of this role, the 2007 framework begins by seeking to establish a common understanding of what constitutes a health system. What its defining goals are and what activities are included in health system strengthening. There's a stronger emphasis on the functions or instrumental goals than in the 2000 framework. And these have been renamed and regrouped into the six building blocks of the health system, which was covered earlier in the course. While there are six distinct building blocks, the interaction between these blocks are essential for the health system to achieve its overarching goals. Changes in one area will have repercussions in another. And so the distinct parts of the system must function together in order to be effective. To remind you, the building blocks are service delivery, which ensures the delivery of effective, safe, quality personal and non personal health interventions to those who need them. When and where they need them with minimum waste of resources. Health workforce, which works in a responsive, fair and efficient way to achieve the best health outcomes possible, given available resources and circumstances. Information, which ensures the production, analysis, dissemination, and use of reliable and timely information on health determinants, health system performance and health status. Medical products, vaccines and technologies, which ensures equitable access to essential medical products, vaccines. Technologies of a short quality, safety, efficiency and cost-effectiveness and they're scientifically sound and cost-effective use. Financing, which relates to raising adequate funds for health in ways that ensure people can use the needed services. And are protected from financial catastrophe or impoverishment associated with having to pay for them. And finally, leadership in governance, which ensures strategic policy frameworks exist and are combined with effective oversight. Coalition building, the provision of appropriate regulation and incentives, attention to system design and accountability. On to the deterministic framework now, the control knobs framework, which was published in 2008. This framework was introduced by Roberts et al., in their book Getting Health Reform Right. This framework is based on practical experience of designing, implementing and evaluating reforms. It conceptualizes the health system as a set of relationships where the structural components or means. And their interactions are associated and connected to the goals the health system desires to achieve or the ends. This framework describes the health system control knobs that policy makers can use to achieve health system goals. It also establishes a continuum between the interventions or the control knobs, the outcomes or the intermediate performance measures, and objectives. Which are the performance goals that allow policy makers to consider whole system interactions. The control knobs framework is constructed in terms of five control knobs. Financing, which refers to all mechanisms for raising the money that pays for activities in the health sector. Including the design of institutions that collect the money and the allocation of resources to different priorities. Payment, which refers to the methods for transferring money to health care providers and any cases where patients are paid directly. Organization, which refers to the mechanisms reformers use to affect the mix of providers in health markets, the roles and functions and how the providers operate internally. Regulation, which refers to the use of coercion by the state to alter the behavior of actors in the health system. And behavior, which refers to efforts to influence how individuals act in relation to health and healthcare, including both patients and providers. Now you've heard about four different frameworks use to assess the performance of health systems. To summarize, many health system performance assessment frameworks exist. Each with a particular aim or purpose in mind with a slightly different conceptualization of the health system. All frameworks go about achieving their ends by attempting to provide conceptual clarity in analytical, technical, and operational thinking for the different stakeholders involved. And finally, there isn't a single best framework you can use, but rather a best fit for the purpose you intend to use it for. Now let's move on to an exercise will you get a chance to apply what you've just learned. [MUSIC]