Beyond Health-System Building Blocks: Context and Determinants of Health

The WHO health-system building block framework represents a construction that has been widely used to analyse health systems. While the framework has shown success and become a useful analytical tool, however, gaps exist in relation to critical elements and the dynamic interplay required to effectively implement some interventions. As countries move to universal health coverage, in particular through the primary health-care approach, more gains could be achieved if the framework addresses the context and determinants of health. This chapter, using the primary health-care context in Tanzania, suggests an expansion of the WHO health-system building blocks to recognize interventions targeting families and households, community resources and structures, social representations, societal partnerships, multisectoral actions and a wide spectrum of determinants of health.