Introduction

Why do some countries deliver better healthcare than others? Why do some bounce back quickly from health crises while others struggle for years? The answer often lies not just in the number of doctors or hospitals, but in the strength of the health system as a whole.

A health system is the backbone of healthcare delivery. It determines whether medicines are available, whether patients can afford care, whether health workers are motivated, and whether decisions are guided by reliable data. To make sense of all this, the World Health Organization (WHO) developed a framework that breaks down a health system into six building blocks. Understanding these blocks is the first step in strengthening them.

What is a Health System?

The WHO defines a health system as “all organizations, people, and actions whose primary intent is to promote, restore, or maintain health.”

This definition shows that health systems go beyond hospitals and clinics. They include policies, financing, supply chains, health workers, data systems, and even community programs. A strong health system ensures that people not only receive care when they are sick but also stay healthy through prevention and promotion.

In short: a strong health system means healthier populations, better resilience, and more equitable access to care.

The Six Building Blocks of a Health System

1. Service Delivery

This is the most visible part of a health system—how care reaches people. It covers hospitals, primary health centers, pharmacies, community clinics, and outreach programs

Good service delivery means healthcare that is accessible, safe, effective, and patient-centered. Weak service delivery, on the other hand, results in overcrowded hospitals, long waiting times, and poor patient satisfaction.

Example: In Kenya, many patients bypass local primary health centers and go straight to referral hospitals, creating congestion and reducing efficiency. Strengthening primary healthcare (PHC) is therefore essential.

2. Health Workforce

Health workers are the beating heart of any health system. Doctors, nurses, clinical officers, midwives, community health volunteers, managers, and support staff all ensure that care is delivered.

Challenges include shortages, brain drain, poor distribution, low motivation, and burnout. Sub-Saharan Africa, for example, bears 25% of the global disease burden but has only about 3% of the world’s health workforce.

Example: In Kenya, frequent strikes by healthcare workers highlight gaps in motivation, working conditions, and financing. Addressing these issues is central to strengthening the system.

3. Health Information Systems (HIS)

“Without data, you are just another person with an opinion.” Reliable health data is the compass for decision-making in health systems.

A strong HIS collects, analyzes, and reports health data—covering everything from disease surveillance to hospital performance. With the right data, policymakers can allocate resources, plan services, and track progress.

Example: Kenya uses DHIS2 (District Health Information Software) to collect and report data nationally. However, challenges like underreporting, poor internet access, and limited training still affect data quality.

4. Medical Products, Vaccines, and Technologies

A health system cannot function without medicines, vaccines, diagnostics, and medical equipment. Availability, affordability, and quality are critical.

Problems such as stockouts, counterfeit drugs, high costs, and weak supply chains undermine care delivery.

Example: During COVID-19, many African countries faced shortages of PPE and oxygen, exposing weaknesses in supply chains and procurement systems.

5. Health Financing

How is healthcare paid for? Financing determines whether people can afford care or fall into poverty because of it.

A strong financing system ensures adequate funding, risk pooling, and financial protection. In many countries, out-of-pocket payments remain the biggest barrier to access.

Example: In Kenya, the National Health Insurance Fund (NHIF) has been central in efforts toward Universal Health Coverage (UHC). However, low enrollment in the informal sector and inefficiencies remain major hurdles.

6. Leadership and Governance

Also known as “stewardship,” this block covers the policies, regulations, and accountability mechanisms that guide health systems.

Good governance ensures transparency, efficiency, and fair resource distribution. Poor governance often leads to corruption, mismanagement, and inequality in care delivery.

Example: Kenya’s devolution of healthcare to county governments has improved local accountability but has also exposed gaps in coordination, financing, and leadership capacity.

Why the Building Blocks Matter Together

Health systems are like interconnected gears—if one fails, the whole machine slows down. A well-trained workforce cannot perform without medicines. A modern hospital cannot function without financing. Data cannot drive decisions if leadership ignores it.

The WHO building blocks help us see where the system is weak and where reforms should focus.

Analogy: Think of the system as a table with six legs. Remove one, and the table wobbles. Remove two, and it collapses.

Real-World Relevance

Kenya’s UHC Journey: The government has piloted UHC in counties like Nyeri and Kisumu, focusing on expanding insurance coverage and strengthening PHC. Progress is being made, but financing, workforce shortages, and governance challenges remain.

Global Lessons from COVID-19: Countries with strong systems (South Korea, Germany) contained the crisis better, while those with weak systems faced overwhelmed hospitals, high mortality, and economic shutdowns.

Conclusion

A health system is more than just doctors and hospitals—it is the sum of people, institutions, and resources working together for health. WHO’s six building blocks provide a roadmap for identifying weaknesses and building stronger, more resilient systems.

Ultimately, strong health systems save lives, reduce inequalities, and ensure that health is a right—not a privilege.

Next in this series: Why Investing in Health Workers is the Key to Strong Health Systems.

References

World Health Organization. (2007). Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes.

Kenya Ministry of Health. (2014). Kenya Health Policy 2014–2030.

World Bank & WHO. (2017). Tracking Universal Health Coverage.