Health systems should ultimately seek to serve people and society. They must aim to bring value in people’s lives not only by caring for them when sick or giving support to prevent or limit illness and its effects, but also, more broadly, by offering the promise of economic security to all for times of great vulnerability.
Health systems are also human systems. At their heart is a personal encounter, the interaction between the patient and the health provider—sometimes tenuous, often contested, but always with the potential for humanity and compassion. But many different types of people—individuals, groups and communities—make up health systems, ‘live’ within them, have roles, stakes and power in them, and are central to their existence and functioning. People make all the most important decisions in health systems—either by accessing services as patients, setting rules and allocating resources as policymakers, or enacting, coping with and subverting those rules, as implementers, managers, providers and service users. Communities and citizens influence these systems by shaping the social norms and contexts in which they operate. Community norms and behaviour drive health market forces and practices, influence how individuals and families access services, and can help hold systems accountable. Citizens may also influence system development through their electoral voting power, exercising the ‘long route’ to accountability…..more