The world is at a watershed, on the brink of monumental change in what constitutes health care and life in general so much that the absence of health systems may even be desirable. To combat the challenge of non-communicable diseases (NCDs), we may even want to wish away current health systems altogether. Factors that are changing the way we perceive life and health include communication with internet and mobile connectivity, population ageing, the shift from acute and inpatient care to long-term care, and management of risk factors instead of disease states in themselves.
The new paradigm for service delivery, a shift from infectious disease of earlier centuries, will be self-management, risk factor management (hypertension, diet, inactivity, tobacco, alcohol), chronic disease and comorbidity. The question then arises as to how we may build a health system for the 21st century. This makes the thought experiment of a country without a health system necessary: it sets the mind free for uncluttered imagination and allows one to think as if one is building afresh.
Seye Abimbola, a research fellow at the National Primary Health Care Development Agency, Abuja, Nigeria, uses the case of a country without a proper health system (Nigeria) to reflect on how one might build a health system for the 21st century: