At the heart of a robust health system lies its capacity to effectively respond to the health needs of its people. The primal health need of living beings is relief from suffering. The urgency of this relief often correlates with the intensity of the suffering experienced. A truly responsive health system is characterized by its ability to offer relief promptly and inclusively—addressing the needs of anyone, anytime, and anywhere.

In certain situations, readily available solutions such as over-the-counter medicines or home remedies may suffice to provide relief. Individuals without access to formal healthcare providers may resort to seeking assistance from informal sources when in need. The establishment of round-the-clock medical helplines has proven instrumental in offering timely advice, while ambulance services ensure the swift transfer of patients to emergency facilities. The recent integration of round-the-clock teleconsultations into healthcare services further enhances the spectrum of choices available to patients. 

A responsive health system not only ensures access to healthcare services and goods but also ensures affordability. Either patients should be able to afford the care needed or someone has to bear the cost. While public healthcare systems provide free services or subsidized care, some of the private providers have flexible pricing to be affordable as per the patients’ capacity. A responsive healthcare system shall not refuse lifesaving and essential medical care just because patients cannot afford it or the insurance does not cover it.

While access and affordability are key attributes of responsive systems, they have to assure quality care for people to gain their confidence and trust. People tend to delay or forego care if they do not have access to a trusted provider. While providers are accountable for safe and effective care, the governments have to ensure that the providers assure quality through regulation. Everyone should have equitable access to quality care. An ambulance must arrive on time and be equipped with competent emergency medical personnel to be of use. Similarly, an emergency facility is of no use if it does not assure quality emergency services.

Responsive health systems provide timely care, especially in time-sensitive medical emergencies like heart attack, brain stroke, polytrauma, septic shock, etc. Even for elective health needs, the waiting times are not unduly long. Many patients die while waiting for elective coronary artery bypass surgery. The time it takes for an ambulance to arrive after an emergency call and to reach an emergency facility are indicators of a responsive emergency healthcare system. Emergency care within the golden hour saves many lives. Long waiting times for an elective consultation diagnostic test or elective procedure reflect inadequate and unresponsive health systems.

A responsive health system coordinates with other social, economic, and environmental systems that have an impact on the health of people. Since health is a fundamental right, governments are responsible and accountable to respond to people’s health needs during normal and crisis times. If governments are unable to provide needed healthcare services and goods themselves, they should purchase the same from the private sector and make them accessible to all. A responsive system is well prepared to provide needed services even when there is a sudden surge in demand or disruptions to supplies seen during public health emergencies. Real-time monitoring of demand-supply status in the system becomes essential to respond adequately.

Governments are responsible for preventing financial hardships in accessing needed essential healthcare. A responsive system maintains a close watch on the indicators of financial hardship. While out-of-pocket expenses (OOPE) have been used as a proxy indicator of financial hardship, foregoing essential health and social needs and being pushed into poverty are better indicators of hardships. Middle- and high-income people may spend more out of pocket because they can. It doesn’t imply financial hardship. Similarly, poor people may not spend while foregoing needed healthcare. It does not imply any financial hardship.

A responsive health system proactively promotes health and disease prevention, as people may not perceive the need for these or be motivated enough to pursue them. It invests in health literacy to improve public awareness about these. Low awareness is one of the key reasons for the low demand for healthcare despite higher health needs as assessed by the prevalence and incidence of disease. It counters mounting misinformation being spread through various social media channels and the internet to ensure the right awareness.

A responsive health system has a robust disease surveillance system to alert it to take appropriate action against emergent and emerging health threats. It continuously monitors the adequacy of health systems to meet the health needs of people through real-time demand-supply gap assessment and its performance through various input, output, and outcome indicators. The insights derived from robust monitoring and evaluation systems, surveillance systems, and additional health systems research will provide rich evidence to formulate appropriate policies, strategies, and operational plans.

A responsive health system ensures that the essential health diagnostics and drugs are in sufficient quantity to not only meet current needs but also during any unanticipated public health crisis. Inventory levels of not only finished formulations but also the ingredients that go into these formulations are planned through simulation modeling mimicking various public health emergency scenarios. In addition, a responsive system puts in place a plan to develop and/ or procure new diagnostics and drugs in case of emergencies arising out of novel pathogens.

A responsive health system is a learning system. It institutes a culture of learning through robust monitoring and evaluation, basing key actions on the insights derived from it. These learnings are drawn not only from researchers but also from the experiential wisdom of practitioners. People themselves and frontline health workers offer practical solutions to the problems they face. A learning and responsive health system involves all stakeholders in the process for a rounded and appropriate assessment.

A responsive health system regulates itself to manage the complexity and to realize its purpose. The stakeholders may regulate themselves or be regulated by designated agencies or through market forces. Elected representatives of the people will enact appropriate laws in response to emerging situations. Laying down standards is the first step in regulation. These will be continuously refined over time to ensure the utmost safety and quality of healthcare services and goods.

In summary, health systems are continuously evolving in response to the changing health needs of people and advances in technologies. Ideally, governments are best positioned to orchestrate the responsive evolution of these complex dynamic open systems. When governments fail to provide stewardship and orchestrate responsive evolution, non-state actors may step into the role. If not coordinated, orchestration by multiple actors leads to dysfunctional, non-responsive, and fragile health systems.

Dr. Krishna Reddy Nallamalla
President, InOrder- The Health Systems Institute

Photo Credits: Mat Napo on Unsplash

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