Table 1 Health system building block and function matrix adapted from USAID manual of health system assessment
From: Health system gaps in cardiovascular disease prevention and management in Nepal
Building Block | Equity | Access | Efficiency | Quality (including safety) | Sustainability |
|---|---|---|---|---|---|
Governance | Health policy ensuring equity | Information on quality of care is available to the population | Role of civil society including professional organizations to oversee health services and follow protocols, standards, and code of conduct | Regulations (protocols, standards, code of conduct, and certification) are known and enforced | Organized and financed in a way that offer incentive to public, NGOs and private providers |
Financing | Government and out of pocket expenditure as % of total health expenditure Budget allocation for CVD Health insurance mechanism User fee policy | Per capita total expenditure in health Health insurance coverage Service covered by health insurance | Local-level spending authority and institutional capacity | Provider payment mechanism for health insurance | External resources as percent of total health expenditure Sustainability of health insurance Provider payment mechanism |
Service Delivery |  | Availability of CVD services Time to reach nearest health facility | – | Existence of clinical standards into a practical form that can be used at local level | – |
Human Resource | Ratio of health personnel per 1000 Ratio of healthcare workers distribution by cadre, geography and sector | – | Existence of costed HRH strategic plan; evidence that the plan is being implemented | Enabling environment exists for health professionals (job description, tools, supplies, supportive supervision) | Active stakeholder participation in human resource policy and processes |
Medical products | Out of pocket expenditure on medicine | Percent of household within 30 min reach to public facilities that dispense essential medicine | Percent of procurement according to plan | System of collecting data regarding efficacy, quality, and safety of marketed products | System to recover pharmaceuticals dispensed in public facilities |
Information system |  | – | Use of data for planning, budgeting or fund raising | Presence of procedure to verify the quality of data | Availability of financial and/or physical resources to support information system |