Systems factors and constraints
The delivery and uptake of any health intervention will be influenced by a range of systems factors.
Systems factors can include how well the health system is set up to deliver the intervention to the people who need it. Examples of health system facilitators and constraints include having appropriate facilities, healthcare worker capacity and availability, medical equipment, and supplies.
There are other systems factors beyond the health sector that can affect delivery, quality, and uptake of health interventions. These include access to electricity, inadequate or unreliable internet connectivity, access to clean water, transportation and road infrastructure.
While systems factors and constraints may never be perfect for the introduction of a new health intervention, taking stock of them can help shape the overall assessment of expected benefits and harms of an intervention and who experiences them. It can also enable appropriate investments or complementary services that may be needed to support implementation.
When assessing each domain:
- Consider what the health system’s existing capacity is, and whether it would be able to deliver the health intervention at a high enough quality and coverage to achieve its intended benefits. This includes:
- Do facilities have what they need to provide the intervention, such as trained staff, guidelines, equipment/supplies, diagnostic capacity, medicines and commodities?
- Are there enough health workers with the right skills and training to deliver the health intervention?
- Identify and take into account the ways other systems factors and infrastructure may affect how well we can deliver the health intervention.
- For example, a medical intervention may rely on access to electricity, clean water, or other telecommunications services. Yet there may not be reliable access to electricity, water supply, or phone/internet services in many parts of the country that are most in need.
- When there are constraints, identify what additional investments are needed to enable adequate implementation.
- If additional investments are needed, assess how much they would cost and whether it is possible to get the additional investment. The answer to this might shift whether the intervention is considered cost-effective and what the total budget impact would be.