Howo Well do Health Systems Perform? performance variations over time and among countries. Some evidence about these func tions, and how they influence the attainment of the fundamental objectives in different health systems, is examined in the next four chapters In the view of most people, the health system is simply those providers and organ ons which deliver personal medical services. Defining the health system more broadly leans that the people and organizations which deliver medical care are not the whole system; rather, they exercise one of the principal functions of the system. They also share, sometimes appropriately and sometimes less so, in the other functions of financing, inves ment and stewardship. The question of who should undertake which functions is one of It is common to describe the struggle for good health in quasi-military terms, to talk of fighting"malaria or AIDS, to refer to a"campaign"of immunization or the"conquest"of mailbox, to“free area of some arms race"that constantly occurs between pathogens and the drugs to hold them in check, to hope for a"silver bullet"against cancer or diabetes. In those terms, the providers of direct health services-whether aimed at individuals, communities or the environment -can be considered the front-line troops defending society against illness. But just as with an army, the health system must be much more than the soldiers in the field if it is to win any battles Behind them is an entire apparatus to ensure that the fighters are adequately trained, in formed, financed, supplied, inspired and led. It is also crucial to treat decently the popula tion they are supposed to protect, to teach the "civilians"in the struggle how to defend themselves and their families, and to share equitably the burden of financing the war. Unless those functions are properly carried out, firepower will be much less effective than it might be, and casualties will be higher. The emphasis here on overall results and on the functions more distant from the front line does not mean any denigration of the impor- ance of disease control. It means rather to step back and consider what it is that the system as a whole is trying to do, and how well it is succeeding. Success means, among other things, more effective control of diseases, through better performance. Figure 2.1 Relations between functions and objectives of a health system Functions the system performs Objectives of the system Delivering services (investment and trainingHow Well do Health Systems Perform? 25 performance variations over time and among countries. Some evidence about these func￾tions, and how they influence the attainment of the fundamental objectives in different health systems, is examined in the next four chapters. In the view of most people, the health system is simply those providers and organiza￾tions which deliver personal medical services. Defining the health system more broadly means that the people and organizations which deliver medical care are not the whole system; rather, they exercise one of the principal functions of the system. They also share, sometimes appropriately and sometimes less so, in the other functions of financing, invest￾ment and stewardship. The question of who should undertake which functions is one of the crucial issues treated in later chapters. It is common to describe the struggle for good health in quasi-military terms, to talk of “fighting” malaria or AIDS, to refer to a “campaign” of immunization or the “conquest” of smallpox, to “free” a population or a geographical area of some disease, to worry about the “arms race” that constantly occurs between pathogens and the drugs to hold them in check, to hope for a “silver bullet” against cancer or diabetes. In those terms, the providers of direct health services – whether aimed at individuals, communities or the environment – can be considered the front-line troops defending society against illness. But just as with an army, the health system must be much more than the soldiers in the field if it is to win any battles. Behind them is an entire apparatus to ensure that the fighters are adequately trained, in￾formed, financed, supplied, inspired and led. It is also crucial to treat decently the popula￾tion they are supposed to protect, to teach the “civilians” in the struggle how to defend themselves and their families, and to share equitably the burden of financing the war. Unless those functions are properly carried out, firepower will be much less effective than it might be, and casualties will be higher. The emphasis here on overall results and on the functions more distant from the front line does not mean any denigration of the impor￾tance of disease control. It means rather to step back and consider what it is that the system as a whole is trying to do, and how well it is succeeding. Success means, among other things, more effective control of diseases, through better performance. Figure 2.1 Relations between functions and objectives of a health system Stewardship (oversight) Health Responsiveness (to people's non-medical expectations) Fair (financial) contribution Creating resources (investment and training) Financing (collecting, pooling and purchasing) Functions the system performs Objectives of the system Delivering services (provision)