The first part of this course is concerned with the principles and practice of health system analysis and comparison, the sources and utilization of information relating to the development, organisation and operation of health services, and frameworks for assessing their performance. Then, drawing on material for a wide range of affluent and developing countries we examine the constitutional, legal, economic, social, epidemiological and political environments within which health care systems operate. We review patterns of health service organisation and management,: health policy development and planning; characteristics of personal, community and environmental health services and their activities; health service financing arrangements including health insurance systems; the health workforce; other health service inputs and health information systems. The impact of some recent attempts at health system reform is assessed and proposals for future re-structuring are critically reviewed.