Health Systems

Health is defined as, “… a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO 1946). Many factors (economic, sociocultural and political), influence the health of individuals (WHO 1978). Heath can be considered at many levels, including personal, family, community, sub-national (e.g. district, state, province, region), national or global. Overall policy direction is set at the national level by national governments through their respective ministry or ministries . Health is generally addressed through national health systems (African Union 2007), although the actual delivery of health care is decentralized to the district level in “a well organised health system” (Ibid, p.7). Health systems throughout low and middle-income countries (LMICs), especially sub-Saharan Africa, need to be strengthened if health care is to improve and the burden of disease confronted effectively (Travis, Bennett et al. 2004; WHO 2007; WHO-AFRO 2010).

Yet debate continues over which components and relationships most need strengthening (Sundewall, Swanson et al. 2011; Mills 2012). WHO (2007) states, “A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health”. What fields of education and, subsequently, occupations are actually included in a health system is contested. Often there is a tacit or explicit focus on health care service providers and a relative de-emphasis on individuals involved in health promotion, management, policy or research and the professional education needed to address these professions (WHO 2007). In contrast, A Joint Learning Initiative (2003) stresses two dimensions of human resources for health that includes a range of interventions starting with illness and extending to population health. The interventions include disease/care, health promotion/prevention, policy/advocacy and jobs/housing/education.

Finally, all universities with medicine, nursing and public health programs accept that their mandate includes education in the form of training health-care professionals to provide healthcare services and conduct research. See for example: University of Nairobi College of Health Sciences, Revised Strategic Plan 2008 – 2013 (CHS 2011) and KCMUC Vision & Mission (, accessed, 16 Sept 2012). However, it is often not clear if, or to what extent, service provision is within the mandate of universities or their colleges of health sciences.