Centre for Health Systems Studies (CHSS)
 Coordinator, Professor Anwar Islam

A health system includes all actors (formal and informal), organizations (public and private and non-governmental organisations) and resources whose primary purpose is to improve health. It is inclusive of inter-sectoral actions which also share responsibility in improving health. Policies in sectors other than health may impact on the health sector if they result in the occurrence of diseases or injuries. For example, although the responsibility of prevention of diseases lies with the health sector, other sectors (finance, education, local government and planning commission) can be instrumental in implementing or delivering related actions, such as dissemination of nutrition related knowledge through school curriculum.

There are three main defining goals of health systems as identified by the World Health Organization. These include, improving the average level of health of populations and reducing health inequalities within populations; ensuring responsiveness to the expectations of the populations both in terms of provision of services but also quality care and treatment; and finally, establishing fairness in financial contribution to ensure financial protection for the poor against the costs of ill-health. To achieve these goals the health system has to perform four basic functions: service provision (cost-effective and of acceptable quality), resource generation (health labour force, infrastructure, drugs and equipments); financing (taxation, insurance) and stewardship (coordinated policy formulation and supervisory regulation).

In Bangladesh, in most low-income countries, the concept of health system lack clarity among government and non-government organizations. While a health system exists in the country, it is yet to function to its optimal level and there is an absence of harmonization in its operations. The importance of a comprehensive, integrated and coordinated health system remains largely unrecognized in the development and research agenda in Bangladesh.

For basic health gains to be sustainable and improved, the country requires a strong, equitable, functional and effective health system, allowing for health promotion activities to be routinely carried out and for existing and new health problems timely and efficiently tackled. Although the vertical and selective health care interventions are necessary and required to successfully tackle specific health problems, the health system of a country should be instrumental in the delivery of such interventions rather than creating parallel systems. A health system should have the capacity to identify and address health problems as they arise and also reach out to disadvantaged populations. The effectiveness, efficiency and reach of a health system are critical determinants of the health status of a population.

The effectiveness efficiency and the functional clarity as a health system can be improved and strengthened only through the generation and application of new knowledge. And research is the essential tool to generate such useful knowledge.

The James P Grant School of public Health at BRAC University established the centre for Health System Studies (CHSS) with the explicit goal of strengthening the health system in Bangladesh through the generation and application of new knowledge. The CHSS is therefore, involve not only in the generation of knowledge through research but also in the dissemination and utilization of such knowledge. Its mission is to contribute to the challenging task of making the health system in Bangladesh more equitable, effectibe and efficient.

Specific objectives of the Centre:

  • To define in the context of Bangladesh (and other low-income countries) the concept of health systems and its scope.

  • To form national coalition of stakeholders in Bangladesh and reach agreement on definition, functions and structure of the health systems in the country, on common and cross-cutting set of health system goals and the specific actions through which to achieve them.

  • To develop indicators (in relation to goals and objectives previously established) which will assist policy makers to assess performance of the health systems.

  • To identify ways of empowering the civil society and general public to become active partners in health policy formulation.

  • To work with other partners in health systems research and its strengthening.

Current Research Portfolio:

Currently the CHSS is engaged in the following innovative research activities/projects:

  1. Bangladesh Health Watch (BHW)

  2. EU Asia Link

  3. Comprehensive primary health care (CPHC)

  4. Chronic Disease

  5. Nutrition
Centres & Initiatives