The CONCEPT OF THE HEALTH DISTRICT AND ITS APPLICATIONS

1. The CONCEPT OF THE HEALTH DISTRICT AND ITS APPLICATIONS

2. OBJECTIVES • By the end of this lecture students know how to: • Provide a standardized definition of health district and district health system • Explain the advantages presented by the concept of health district, with emphasis on information and the roles of the District Health Management Team (DHMT) • Describe the tasks performed in a health district setting • Explore the adequate characteristics of a health district • Justify the current focus on district health systems

3. Levels of health care • PRIMARY HEALTH CARE • SECONDARY HEALTH CARE • TERIEARY HEALTH CARE

4. Introduction to health care system What is health care system? A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. • A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction.

5. Introduction to health care system • Health is a complex and multidimensional issue. Many of the factors influencing over all health either not in the traditional domain of health care or are difficult to influence , e.g.: Water quality , diet , genetics , and consumption of tobacco & other.

6. Introduction to health care system • According to World Health Organization's (WHO's) "health "is defined as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. • Historically, all the great advances in health have been caused by prevention of diseases.

7. Aspects to health • Most people accept that health can be divided into two broad aspects - physical and mental health. • Physical health : For humans, physical health means a good body health, which is healthy because of regular physical activity (exercise), goodnutrition, and adequate rest. • Physical health is defined as health relates to anything concerning our bodies as physical entities

8. Aspects to health • Mental health: Mental health refers to people's cognitive and emotional well-being. A person who enjoys good mental health does not have a mental disorder. • According to WHO, mental health is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".

9. Determinants of health • The health of individual people and their communities are affected by a wide range of contributory factors. People's good or bad health is determined by their environment and situations  • WHO says that the following factors probably have a bigger impact on our health than access and use of health care services: • 1.Where we live 2.The state of our environment 3.Genetics 4.Our income

10. Determinants of health 5. Our education level 6 .Our relationship with friends and family • WHO says the main determinants to health are: Our economy and society ("The social and economic environment"),Where we live, what is physically around us ("The physical environment"), What we are and what we do ("The person's individual characteristics and behaviors")

11. Components of Healthcare System • Health care system Consist of a number of interrelated subsystems . • Each of these subsystems has a purpose which, if attained, aids the larger system in reaching its overall goals. • For examples the healthcare systems of Saudi Arabia ,U.S.A, Canada , and other countries

12. Elements of Healthcare System • Inputs ( human resources , material , technology , information , capital , ……. • Process • Outputs ( patient care , acceptable costs , training , other objectives ) . • Outcome (improvement in morbidity and mortality rates and life expectancy at birth.

13. Overview of the Healthcare System in Saudi Arabia • The Ministry of Health is responsible for the supervision of healthcare and hospitals in both the public and private sectors. The system offers universal healthcare coverage. • The healthcare system has two tiers. One is a network of primary healthcare centers and clinics. The second tier is represented by the hospitals and specialized treatment facilities located in urban areas.

14. What is a health district ? ...It is the point of the national health system where people can get comprehensive health care ...It is a clearly defined geographical/administrative area ...It is the implementation spot for primary health care (Alma Ata, 1978) ...It is the optimal operation unit for the identification of the excluded from health care and for the implementation of health improving strategies (Harare, 1987)

15. What are the characteristics of a health district ? Clearly delineated geographical area Population between 30,000 and 500,000 (most cases) Identifiable form of local government Managed by few officers Balance between population size and availablity of technical specialised staff

16. What advantages presents the health district ? ...It is close enough to the community to understand and act on its problems and constraints ...It has easier communicationwith the community to ensure its participation in planning and organization ...It is the most appropriate level for coordinating top-down and bottom-up planning

17. What are the tasks of the health district ? ...Implementation of all community based health programmes ...Supervision and control of all community health workers in the district ...Organization and operation of district hospital services ...Management of all other public health facilities ...Coordination and supervision of all public, non-government and private health systems

18. What are the tasks of the health district ? ...Promotion of active links with local government entities ...Promotion of community participation in the local health service planning ...Preparation of annual health plan ...Raising additional local funds ...In-service training of health workers ...Collection, compilation and dissemination of routine health information

19. What is a DHS ? ...more or less self-contained segment of the national health system ...it comprises first and foremost a well-defined population ...within a clearly delineated administrative and geographical area ...it includes all the relevant health care activities in the area, whether governmental or otherwise.

20. What is a DHS? ...it will be most effective if coordinated by an appropriately trained health officer ...to ensure as comprehensive a range as possible of promotive, preventive, curative and rehabilitative health activities

21. What is a DHS ? ...ideally contains a network of primary health units and a district hospital for referral of cases ...it is the point and level at which different health service activities are integrated into a comprehensive and holistic approach to health care ...it is able to acceptthe transfer of responsibility, resources, authority and seniority from central levels of management to the periphery

22. Why the focus on DHS ? ... too much emphasis on curative services ... little attention to preventive and promotive areas ... weak assessment of the health status of the population ... data gathering is low priority, unreliable and routinely performed, it strongly affects the information circulation in the health system ... frail coordination with other sectors: water, sanitation, agriculture, housing, roads and transportation ... lack of skills ... growing pressure for health reform and decentralisation

23. Why the focus on DHS ? ...the many responsibilities of the district health team ...the need to carefully allocate the scarce resources ...the necessity of sound health management  obvious need for adequate informationBUT  the main constraint for implementing the primary health care approach in practically all countries: ...inadequate information for the managerial processes !

24. Why the focus on DHS ? The district information system has yet to make available... • ... the right information and the right knowledge • ... to the right persons and institutions • ... in the right form • ... at the right time • ... in the right place

25. The implications of a DHS The DHS can only be a functioning entity if the following assumptions are met.

26. The implications of a DHS  DHS is a means to an end, rather than an end in itself ... the "means" to achieve the "end" of an equitable, efficient and effective health system based on the principles of the Primary Health Care (PHC) approach  DHS is more than just a structure or form of organisation ...it is also the manifestation of a set of activities: community involvement, integrated and holistic health care delivery, inter-sectoral collaboration and a strong "bottom-up" approach to planning, policy development and management

27. The implications of a DHS the PHC approach and the DHS model apply to the whole of the health system and at all levels of health care delivery ... the health district and its management structure should be the core building block of the entire heath system, ... DHS should be the underlying framework for the organisation of health care as a whole the essence of the DHS is the organisation of health care according to geographic sub-divisions of a country which are managed through a decentralised management structure

28. Health District versus District Health System • Health District = geographical/administrative area • District Health System = a segment of the national health system with a complex set of actors interacting in a health district

29. ThankYou