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. 2014 Mar 25:14:278.
doi: 10.1186/1471-2458-14-278.

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

Sandra Mounier-Jack  1 , Ulla K Griffiths, Svea Closser, Helen Burchett, Bruno Marchal
Affiliations

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

Sandra Mounier-Jack et al. BMC Public Health. .

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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Figures

Figure 1
Figure 1
The WHO health system building blocks framework. Source: WHO 2007 [1].
See this image and copyright information in PMC

References

    1. World Health Organization. Everybody’s business: strengthening health systems to improve health outcomes. WHO’s Framework for Action. Geneva: World Health Organization; 2007. http://wwwwhoint/healthsystems/strategy/everybodys_businesspdf.
    1. Hoffman SJ, Røttingen JA, Bennett S, Lavis JN, Edge JS, Frenk J. Background paper on conceptual issues related to health systems research to inform a WHO Global strategy on health systems research. Health Systems Alliance. 2012. http://www.who.int/alliance-hpsr/alliancehpsr_backgroundpaperhsrstrat1.pdf.
    1. World Health Organization Maximizing Positive Synergies Collaborative Group. An assessment of interactions between global health initiatives and country health systems. Lancet. 2009;373:2137–2169. - PubMed
    1. Car J, Paljarvi T, Car M, Kazeem A, Majeed A, Atun R. Negative health system effects of Global Fund’s investments in AIDS, tuberculosis and malaria from 2002 to 2009: systematic review. JRSM Short Reports. 2012;3(10):70. doi: 10.1258/shorts.2012.012062. - DOI - PMC - PubMed
    1. Unger JP, De Paepe P, Green A. A code of best practice for disease control programmes to avoid damaging health care services in developing countries. Int J Health Plann Manage. 2003;18(Suppl 1):S27–S39. Epub 2003/12/10. - PubMed