Health System Research:

Concept and Practices

Nyoman Sutarsa
sutarsa84@gmail.com
087860380028
 System?

A system is an organised collection

of parts or subsystems that are
highly integrated to accomplish an
overall goal
 What is Health
System?
All the organizations, institutions, resources and
people whose primary purpose is to improve health

Includes efforts to influence determinants of health as

well as more direct health-improvement activities

Delivers preventive, promotive, curative and

rehabilitative interventions (comprehensive)

Both State and non-State actors

 Subsistem SKN (2009 dan
2012)
SKN 2009
SKN 2012
1. Subsistem upaya kesehatan
2. Subsistem pembiayaan 1. Upaya kesehatan
kesehatan 2. Penelitian dan
3. Subsistem sumber daya pengembangan kesehatan
manusia kesehatan 3. Pembiayaan kesehatan
4. Subsistem sediaan farmasi, 4. SDM Kesehatan
alat kesehatan, dan 5. Sediaan Farmasi, alkes dan
makanan makanan
5. Subsistem manajemen dan 6. Manajemen, informasi dan
informasi kesehatan regulasi kesehatan
6. Subsistem pemberdayaan 7. Pemberdayaan masyarakat
masyarakat
Health System Research

What?
How?
Health System Research =
Applied Health Research
Inform policy and practices
Empower decision makers (evidence-
based)
Improve health status and well-being
Optimal use of scarce resources
Enable participation
Fokus HSR (Julio Frenk, The New Public Health, 1993)
 Contoh: Sifilis
Life cycle micro- Efficacy various
organism treatment modality

Clinical
Biomedical

cal
Epidemiologi HSR

Estimate number of Health system function

disease, risk factors and to ensure treatment to
distribution people who need it
Topik Umum HSR (example)
Comparative performance
Comparability of health care systems!
Effectiveness
Theory, measurement, evaluation and outcomes
Clinical & population perspectives
Efficiency
Allocative and production
Derived demand function for medical care
Equity
Sociology & behavioural model
Substantive & procedural
Characteristics of community variations
Policy analysis
Rational comprehensive
Problem of allocative processes cost utility
Informed democratic decisions, veil of ignorance
 Type of HSR

Operational Research
Health Policy Research
 Karakteristik HSR
Priority problems
Action-oriented
Multi disciplinary approach
Participatory
Timely
Simple and effective
Affordable
Accessible and easy to understood
Policy and practices change evaluation on its
impact
 Langkah-Langkah
Memilih siapa yang akan dilibatkan
(right people)
Mengembangkan Decisionpertanyaan
makers and senior
Relevance of the study level managers
penelitian
Duplication? Health workers
Feasibility Community leader and
Political acceptability
members
Applicability
A multi disciplinary of
Urgency of data needed
ethical acceptability researcher
Question?
 Case Study

Barriers to integrating HIV

and AIDS services into
community health centres in
Bali