( By J.-J. Guilbert )

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Chapter 1: Priority health problems and educational objectives - System?


The word “system” is used frequently in the Handbook. Let us take a few minutes to explore its different meanings.

A system is often defined as a set of interacting components or elements aimed at a common goal.

Support system

A support system refers here to an institution, organization, administrative structure, or other community structure that facilitates the effective implementation of a health care activity (e.g. the education system).

Health system1

1 Glossary of terms used in the “Health for All” Series No. 1-8. Geneva, World Health Organization, 1984 (“Health for All” Series No. 9).

A health system is the complex of interrelated elements that contribute to health in homes, educational institutions, workplaces, public places and communities, as well as in the physical and psychosocial environment, and the health and related sectors. A health system is usually organized at various levels, starting at the most peripheral level, also known as the community level or the primary level of health care, and proceeding through the intermediate (district, regional or provincial) to the central level.

Educational institutions - one of the support systems for health care activities


Taking these definitions and the objectives of your institution as an element in society, you should regard your institution as one of the support systems for health care activities.

Any programme of action intended to improve the health situation in a society (at the national, district, local, family or individual level) must be able to draw support from different sectors. Various fields of action may be delineated or left open by overall national policy. The political system will therefore have a crucial role to play if general policy decisions are needed for programmes of action to be implemented.

The authorities and administrative structures, with the powers of decision that are delegated to them, often have a strong influence on health care at various levels, for although they can facilitate initiative and action, they can also hamper them and be a source of constraint.

For the right decisions to be taken, both in terms of policy and administration, it is essential to have a database designed in the light of the information requirements of the users, that is, of the general public. This database is also important for the formulation of training programmes or for more limited educational activities. The circulation of information among different users often leaves much to be desired. A proper system of communication between the different sectors is essential for the information needed for decision-making to be circulated and for the various sectors to be able to keep each other informed of their activities. This will prevent unnecessary overlap, duplication and errors, thus making for better use of resources. This is often the weakest link in a support system.

In many countries the infrastructure is inadequate. This weakness is evident in transport, communications, water supply, waste disposal, etc., which are clearly vital sectors and which have varying degrees of influence on the health situation.

There are many other sectors that might be mentioned, but we shall confine our attention to the support system which is the subject of this Handbook, namely, the education system. This system is responsible for education and training from the primary level to the university and beyond. It is important that it should function well, as it must supply human resources with the skills needed by the other support systems. It is fair to say that the existence of an efficient education system is a prerequisite for any action to improve the health situation in a country. Here we shall deal only with the part of the system that is concerned with education for the health professions.

Figure 1 (p. 1.14) represents the support systems for the health system:

- the political system;
- the structures and authorities of the administrative system;
- the general system (or general infrastructure);
- the education system.

Unfortunately, it all too often happens that most of these systems act as a constraint rather than a support to health care activities. However, by regarding them as support systems, we will force ourselves to see their positive side and the ways in which they can provide support.

Figure 1. Position of the educational system in relation to all the elements that have an influence on the system which must respond to the health needs of the population.