Assignment- PUB 655- TOPIC 3- Integrating Health Care and Public Health Systems

Assignment- PUB 655- TOPIC 3- Integrating Health Care and Public Health Systems


-This assignment invovles selecting a low- or middle-income country of interest. I want to leave that to the writer’s choice.
-Please read the question page in details.
-Details of the question and the rubric are also uploaded
-Please read the Rubric before you start
-Please include the Introduction, Thesis statement, and conclusion in the paper.
– Include section headings for each section component where needed
– Sources must be published within the last 5 years. It must be from 2016 and after
– Sources must be appropriate for the assignment criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Add references to reference page
-Add the hyperlink for each reference in APA 7th edition format.
Thank you



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Integrating Health System

Integration of the health system entails combining health services into a more advanced level that is manageable and cost-effective to enhance quality care services to everyone. Mainly, it involves financial plans, health approaches, and operational activities that can be implemented for sustainability purposes and favors all (Topp et al., 2018).

Many scholars have described the integration of the health system in different ways. Still, all their concepts aim in the framework of coordinating, organizing, and managing several healthcare activities and resources to enhance efficient and effective service delivery (Topp et al., 2018). However, this process can be challenging in low and middle-income countries due to pre-conditions such as fewer health centers with few staff members, insufficient medical health equipment, and accessibility. Thus requires more advanced approaches in facilitating the integration process. This study discusses the assessment of the health system in the low-income country through a causal diagram of system thinking.

Causal Loop Diagram

In low-income countries such as Afghanistan, the health system has become a major issue due to inefficiencies of health information and funds to advance healthcare (Paul et al., 2018). A study review conducted in Afghanistan shows various reforms made with improving the health system. The health system used is Pay for Performance (P4P) to strengthen health system performance and identify the agency problems blocking the systems from coordinating (Alonge et al., 2017).

A causal loop diagram is a presentation of system thinking that improves the cognitive thinking of individuals through creativity and logical reasoning. It follows four basic frameworks in its development; the variables, links between them, the signs on the links, and the loop sign. Based on the health system issue of Afghanistan, the causal loop diagram helps determine causal relationships between variables identified (Alonge et al., 2017). The arrows connect through the links and variables to help understand the connection, forming a structural statement that can be applied in developing an effective health system to solve the health problem in this country.



For instance, the diagram above represents a causal diagram of public health services provided in bridging the identified gaps to enhance strong health system in the country.  The arrows are moving in the same direction thus proving positive relationship in the three variables, hence an indication, that the pay for performance system has helped in bridging the gap and restoring quality healthcare in the country, ever since it was introduced (Alonge et al., 2017).

Major Components of the Pay for Performance System

Pay for performance system is an approach used especially in low and middle-income countries to strengthen their health systems. Mainly it involves donor organizations that decide to invest in program activities and projects that can benefit these low-income countries and improve the health system (Alonge et al., 2017). The major components are; quality maternal and child health, accessibility of essential drugs and availability of trained health staffs. For instance, pay for performance enables the donor to provide monetary incentives to the beneficiary of the implemented programs based on the agreement.

The monetary incentives are then used to fund other similar programs that can help improve the health system in Afghanistan. Therefore, the health system discussed above also helps recognize agency problems that might arise. For instance, problems such as an agent using the projects’ funds for personal gains are discouraged and can easily be identified using the pay for performance approach.

Core Services Provided

The pay for performance system enhances quality service delivery, health workforce, and leadership (Manyazewal, 2017). Through the sponsorship of programs by the donors, the beneficiaries, such as women in the community, can access free maternal and child immunization services. The health system also equips the programs’ participants with enough knowledge and skills through training, thus managing their wellbeing. These systems are managed mainly by non-governmental organizations.


Payments and Funding of the Services

This health system is mostly provided to low-income countries to improve their healthcare services through available resources. The payments and funding of services are done mainly by the donor, stakeholders, and volunteers and not necessarily the beneficiaries. Therefore, it is challenging for donors to ensure that they are financially, physically, and psychologically ready to engage in health system programs. Implementation of poor pay for performance system can lead to low quality and service delivery though not beyond the optimum level. In such situations, it can cause financial constraints too.

Application of a System Thinking Tool

A causal loop diagram implies the causal relationships between variables and the links in integrating the health system. In this case, the pay for performance system converges the application of the causal loop diagram tool in understanding its formation, benefits, and weaknesses in strengthening the healthcare services in Afghanistan.

The three positive causal relationships identified in the causal loop diagram above show the interconnection. The public health services provided in Afghanistan after the introduction of pay for performance system, has increased the number of skilled births and child immunization in the country. The system has also reduced maternal mortality in the region with most women and girls accessing health basic trainings.

The causal  diagram can be used to implement the appropriate health system in Afghanistan in reducing infectious diseases such as waterborne diseases. Most of the regions in this country are partly rural and thus contribute to the low development. The country is mostly faced with challenges of frequent military wars and immigration that threaten the wellbeing of the population (Wagner et al., 2017). Due to poor sanitation and lack of safe water in the country, the most vulnerable groups are the children, women, and young girls.

Most children suffer from infectious and communicable diseases mainly caused by poor sanitation and the environment they live in. Women and young girls face gender inequality and are highly prone to contracting infectious diseases (Wagner et al., 2017). Therefore, a causal loop diagram can be used in implementing effective health systems to reduce the transmission of infectious diseases. For instance, the donor-funded programs can be implemented, and identified gaps such as gender inequality, poor sanitation, and lack of food can be denoted on the causal loop diagram to determine the public health services that can be provided in ensuring strong health system in the country.


Implementing the health system in low and middle-income countries remains a battle in improving healthcare in such countries. Therefore, applying system thinking tools is essential in ensuring that an effective health system is implemented in providing quality health care to the people, thus improving public health. The major links, variables, and loops should be identified in cases where causal loop diagrams are implied in solving health problems.



Alonge, O., Lin, S., Igusa, T., & Peters, D. H. (2017). Improving health systems performance in low-and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan. Health Policy and Planning, 32(10), 1417-1426.

Manyazewal, T. (2017). Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Archives of Public Health, 75(1), 1-8.

Paul, E., Dramé, M. L., Kashala, J. P., Ndema, A. E., Kounnou, M., Aïssan, J. C., & Gyselinck, K. (2018). Performance-based financing to strengthen the health system in Benin: challenging the mainstream approach. International Journal of Health Policy and Management, 7(1), 35.

Topp, S. M., Abimbola, S., Joshi, R., & Negin, J. (2018). How to assess and prepare health systems in low-and middle-income countries for integration of services—a systematic review. Health Policy and Planning, 33(2), 298-312.

Wagner, A. L., Mubarak, M. Y., Johnson, L. E., Porth, J. M., Yousif, J. E., & Boulton, M. L. (2017). Trends of vaccine-preventable diseases in Afghanistan from the Disease Early Warning System, 2009–2015. PloS one, 12(6), e0178677.