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Health systems strengthening, universal health coverage, health

security and resilience
JosephKutzina & SusanPSparkesa
Global and national initiatives focused reduce the gap between the need for and reforms. In the case of Ebola-affected
on health systems strengthening, uni- the use of quality health services.6 countries, for example, this has required
versal health coverage, health security, Health system strengthening comprises efforts to not only restore how the sys-
and resilience suffer when these terms the means (the policy instruments), while tem functioned before the crisis but to
are not well understood or believed to be universal health coverage is a way of fram- transform and fundamentally improve
different ways of saying the same thing. ing the objectives of policy. Without this the health system.
Here we aim to facilitate understanding distinction, there is a risk that instruments Conceptual clarity is essential for a sys-
and highlight key policy considerations of reform become the objective, with the tematic approach to policy-making. Con-
by identifying critical attributes of each perception that the problem to be solved is fusion and inefficiency arise when health
concept and emphasizing the distinction the absence or presence of a particular policy system strengthening is defined as an
between ends and means in health policy. instrument. When this occurs, policy dia- objective and also when universal health
Set within the political and institution- logue shifts quickly away from where it needs coverage, health security or resilience are
al framework of a country, a health system to be getting to consensus about the nature described as separate programmes to be
is the ensemble of all public and private and causes of underperformance relative to implemented. So here is a simple guide:
organizations, institutions, and resources universal health coverage goals to what is health system strengthening is what we
mandated to improve, maintain or restore often an ideologically polarized debate about do; universal health coverage, health se-
health.1 This definition, along with efforts the inherent merits or flaws of particular curity and resilience are what we want.
to more concretely specify the functions, reform instruments. In health financing,
building blocks, or control knobs of a for example, this has been observed in the References
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World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Correspondence to Joseph Kutzin (email: kutzinj@who.int).

2 Bull World Health Organ 2016;94:2 | doi: http://dx.doi.org/10.2471/BLT.15.165050