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  • Explore the most current issues of health services management in low- and middle-income countries
  • Understand the structure of health systems
  • Understand the concept and dimensions of health system performance
  • Explore national, organizational, provider, and patient interventions to improve the performance of health systems

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Have you ever wondered why, in light of great scientific advances, modern communications, and the availability of many cures, treatments, and preventive measures for most diseases commonly found in low- and middle- income countries (LMICs), those diseases still persist and often with great prevalence and incidence? This is the conundrum that we hope to explore in this chapter, especially as it relates to the organization, management, and delivery of services to reach those in need of prevention or treatment of the many diseases, both chronic and infectious, found in LMICs.

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To begin, it is important to understand how services that maintain, improve, and restore health are provided to individuals and populations in both urban and rural areas, in light of growing disparities in privilege.1,2

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The perspective that is most often used in understanding the delivery of health and medical services is that of a “system,” which is a set of components and their interrelationships, attributes, and properties. From systems theory we understand a system as the continuum of inputs, processes, and outputs. Therefore, within our understanding of the need for health services, the health system is:

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  • The totality of the required resources, including human, mechanical, material, and financial
  • The formal and informal organization interactions and conversions of these resources in the provision of services to individuals and populations to help them maintain good or acceptable health status and improve on it when it is perceived in need, either from disease, physical disability, trauma, or even when perceived as suboptimal3
  • The final product of health, which can vary in definition but is commonly understood as the state of complete physical, mental, and social (and even spiritual) well-being or the ability to live one’s life in a manner compatible with achieving one’s social and personal goals, achieving dignity and human rights.

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The last theoretical component of systems, for now, is that they are either “closed” or “open.” Closed systems are completely self-contained, are not influenced by external events, and eventually must die because nothing is self-sustainable on its own. Open systems, in contrast, interact with their external environments by exchanging materials, energies, or information, and they are influenced by or can influence this environment; they must adjust to the environment to survive over time. The environment can generally be classified as political, economic, social, and technological, as well as physical (the space available and the way system components relate physically to each other). Thinking of natural disasters and climate and population change, the environment always has an ecological perspective, too.

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Health systems are open and must be approached from this perspective. They are open ...

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