PRESTATIONS DE SERVICE

1. E. ALIHONOU PRESTATIONS DE SERVICE INTERNATIONAL CONFERENCE ON THE PRIMARY CARE OF HEALTH AND THE SYSTEMS OF HEALTH IN AFRICA: TOWARDS THE REALIZATION OF THE OBJECTIVES OF THE MILLENNIUM FOR DEVELOPMENT LINKED TO HEALTH OUAGADOUGOU OF 28 - APRIL 30TH, 2008

2. Introduction The benefits of service are an essential function of the systems of health. They allow to satisfy the needs of populations. To provide services includes: for the contractor the obligation to assure activity, for the State and the society, necessity to guarantee continuity notably for urgent care. In Africa, credit of the services of care which fulfill these 2 conditions: the obligation to be provided, regularity and continuity in the const provisioning

3. Introduction 2 The services of health constitute an investment competing not only to the productiveness of a country, but still to the social stability which the country needs to develop from all points of view. It is a serious breach of the system of health when efficient services at accessible expense do not touch the populations which should benefit from it.

4. Plan of présentation Account will be subdivided into 3 big parties: 1.Party dedicated to considerations of general order 2 Party dedicated to tries of answer to purposes defined for Conference: . Identification of the essential interventions to be put in the ladder for the attack of OMD and definition of ways and means to implement these interventions in a integrated way, Of the level of use of the services of health which allows to attain OMD Prop

5. General considerations on the benefits of service 1 Definition Performance of service of health: it is to assure an activity imposed by function. It is also to fill towards the State / The society, the obligation / duty contracted in a domain given by the skills which they have. Services of health are not salable services. Quality care: consult the process by which is provided the beneficiary about the place is (domicile, centre of health, hospital) of appropriate care which draw away his contentment. For it, the agent owes there

6. General considerations on the benefits of service 2 1.2.- DIFFERENT TYPES OF SERVICES 1 1.2.1. According to their function Direct benefits: benefits of service to satisfy the needs of health of the beneficiaries as soon as they come back in contact with the contractor. Indirect benefits: of support, those who allow direct benefits to be provided, all indirect benefits is qualified " as enabling environment ". These are:

7. Indirect benefits 1 Existence of a policy of health and an institutional frame of regulations applied: Training of the health workers Financing of program Management

8. Indirect benefits 2 v) Operational research on services vi) Activities related to: these are Generative activities of incomes Strategical alliance with the others areas of development (services of agriculture, education, communication, public works). vii) Collaboration / collaboration at national and international level

9. In total, qualified personnel indirect benefits or environment "capacitance enabling environment = Assistance qualifiée/soins compétitive / Quality benefits

10. 1.2.-DIFFERENT TYPES OF BENEFITS OF SERVICE 2 Benefits according to the nature of care Role of the system of health 1-to preserve health by following benefits: Promotional care (Education for a change of behavior) Precautionary care (vaccination, service of screening, treatment of complications

11. Role of the system of health 2 2-to Restore health / care remedial and precautionary care (secondary prevention 3-to Favor the readjustment by réadaptatifs care 4-to Lighten suffering / re-establishment impossible health / palliative care.

12. 1.2.-DIFFERENT TYPES OF BENEFITS OF SERVICE 3 Performance of care according to the place or the level of the system of health: Care in establishment: centre of health / hospital: basic care, secondary care, care service sectors, ambulant care Care except establishment: care individual, at the level of the family, at the level of community

13. General considerations on the benefits of service3 Process of identification, implementation and valuation of the benefits of service 1-Conceptualization, Planning Identification of needs / problems // disease = Asks Determination of priority problems Elaboration of plans 2-Execution of activities 3-Valuation

14. General considerations on the benefits of service 4 The actors Contractors and users of services -Level (i): family / health workers of health of family - Level (ii) :community: Communautaires/relais -Community health workers - Level (iii) :centers of health / hospitals: health workers, team of health / clerical assistants of support

15. General considerations on the benefits of service 5 1.7.1 Decentralization of the services of health Creation of new fixed centers: where people come to accept care (fixed strategy) Mobile units: are taken in villages in a punctual way for specific interventions as PEV Advanced strategy: regular sessions in villages, carried out by the team of the centre of health / strategy and active screening Active screening Visits at home / home of the target populations

16. Strategies of performance of services 2 1.7.1. Incorporation of services 1.7.2. Draft of community / Community Participation 1.7.3. Use AVS / Intermediary communications

17. 2.1. Identified diseases (AFRICAN WHO Picture: Packet of essential activities of health for the countries of Africa Identification of essentialinterventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions

18. 2.1. Identified diseases (AFRICAN WHO) Picture: Packet of essential activities of health for the countries of Africa Identification of essentialinterventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 2

19. 2.1. Identified diseases (AFRICAN WHO) Picture: Packet of essential activities of health for the countries of Africa Identification of essentialinterventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 3

20. 2.1. Identified diseases (AFRICAN WHO) Picture: Packet of essential activities of health for the countries of Africa Identification of essential interventions / bets in theladder / attack of OMD / ways and means / incorporation interventions 4

21. 2.1. Affections identifiées (OMS AFRO)  Tableau : Paquet d’activités de santé essentielles pour les pays d’Afrique Identification des interventions essentielles/ mise à l’échelle/ atteinte des OMD/ voies et moyens/intégration interventions 5

22. 2.1. Diseases identified (AFRICAN WHO) Picture: Packet of essential activities of health for the countries of Africa Identification of essential interventions / bets in theladder / attack of OMD / ways and means / incorporation interventions 6

23. Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 7

24. 2.1. Identified diseases (AFRICAN WHO) Picture: Packet of essential activities of health for the countries of Africa Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 8

25. Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 9 1.Passage in the ladder ways and means / incorporation of interventions Two Levels: Decision-making Level and operational Level Political decision in the most of high level Approach system, Approach SSP, Approach SWAP Financing: institute national self-sufficiency at the farthest: produce all necessary means as many as possible to face up needs (WHO): Health insurance: mutual insurance company of health.

26. Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 10 Passage in the ladder ways and means / incorporation of interventions 2 Operational level Incorporations of acts: health centers polyvalent, care to the adults, to the mothers and to the children of the polyvalent personnel and specialist (training) Incorporations of functions of support (indirect Activities): Decentralization (Zone of health or region of health) Coordination Community participation

27. Level of use of services /Attack of OMD linked to health 1 1-Taken into account by the determiners of the coverage Model TANAHASHI 2-Improvement of services / performance / effectiveness output 3-Use of tools / rationalization of services: Definition norms / standards Care / level of scientific proof Strategies Following training of the personnel (change of curricula and mode of training)

28. Strategies (suite and at the end) Incorporation of services: - to resolve the problem of geographical accessibility - to reduce expenses - better coordination of activities between the hospital and the care of the community. Integrated services: - individuals and communities better meet needs - bigger convenience for the expert, moreaugmented contentment, user Insert the services of community development

29. Level of use of services / Attack of OMD linked to health 2 1-Taken into account by the determiners of the coverage: Model TANAHASHI

30. DETERMINANTS DE LA COUVERTURE Couverture effective (SRO utilisé régulièrement et 20 % correctement quant à la dilution et à la quantité). Couverture adéquate (SRO utilisé pour chaque 25 % épisode de diarrhée). Utilisation (utilisation dans au moins 30 % un cas de diarrhée) Accessibilité 80 % (SRO à domicile) Disponibilité 90% (SRO au niveau CCS) 0 10 20 30 40 50 60 70 80 90 100% Level of use of services / Attack of OMD linked to health 2

31. Level of use of services / Attack of OMD linked to health 3 - Condition 2 IMPROVEMENT OF SERVICES: answer in a optimum way at the request of care (meet needs of health, assure the quality of benefits, control expenses and assess) - Profitable approach - Create at the professional's of health, frame of mind service to the beneficiaries - The professionalism and competences of teams procreate a quality production. - Availability kindness of the personnel - Monitoring of the patient

32. IMPROVEMENT OF SERVICES Standard / norms of services Purpose: A standard serves for establishing norms and establishes the level of performance requested for the getting of a desired specific result. Advantage: He assures protection the public: this last having criteria however such product they give him. He allows to identify the performance of the practitioner. Characteristics: A standard is efficient if it is: - visible, measurable, accomplishable, - if it is attained - if it is desirable quality has ét

33. Format of standard Every standard has 7 major elements: - code and title, purpose / objectives - the swording of standard - result - préréquis - process and audit

34. Le préréquis The essential elements which have to be in position so that the agent can carry out standard efficiently for instance: 5.1. Administrative directives 5.2. The contents of the training necessary for intervention 5.3. The essential equipment 5.4. Structures and requested mechanisms so that standard is implemented Examples: An entirely operational reference system is in position for the weakened pregnant women Equipment for catch of blood; of the soap, of l ’

35. 4-Modalities of the benefits of service / improvement of the coverage and use of services by the most vulnerable groups 1 Identification of the vulnerable groups At the stage of comprehension (identification of needs / request), to take into account all population and different coats which compress it. Mother and child - ethnic minorities - handicapped persons - old persons - divested persons (paupers) - displaced persons - persons / country in war

36. 4-Modalities of the benefits of service / improvement of the coverage and use of services by the most vulnerable groups 2 Modality of performance of service / improvement of the coverage Approach SSP: Equity Decentralization: Provide services in the places where live / work people Appropriate technology Functional links and provided organiques/services vulnerable groups / and other services and activities of systems of health

37. Conclusions Without a good management efforts to ameliorate the systems of health will not succeed (26th WHA 1974) Fundamental principle good management / choice methods adapted to available means / s ’ to act as it / attained definite objective Constant adaptation of benefits to the health and social needs of the population / progressive needs

38. Conclusion 2 Services must be spread in all coats of the population. The privileged of the health system are always at risk of pollution by those who are not covered by the system of health. SSP it is the key (Primary Health Care simple percentage the key "OLIKOYE Ransome Kuti"

39. Je vous remercie