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Health System

Health System. Jagrati Jani, MD, PhD. Outline. Provide a broad overview of health system Highlight Health System Domains Health systems in context of Developing countries. What is health ?. Health is ” a state of complete physical, mental and social well-being. WHO 1946

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Health System

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  1. Health System Jagrati Jani, MD, PhD

  2. Outline • Provide a broadoverviewofhealth system • Highlight Health System Domains • Health systems in contextofDevelopingcountries

  3. What is health? • Health is” a state of complete physical, mental and social well-being. WHO 1946 • Disease as an organic-level disorder confined to the individual (scientific medicine). Merson et al 2006 • Illness as a subjective state of dysfunction from the disorder at the individual level. Merson et al 2006 • Ill health is an umbrella used to refer to the experience of disease plus illness. Naiodoo and Wills 2000 • Sickness as a social dysfunction within society that goes beyond the individual. Merson et al 2006

  4. The PRECEDE-PROCEED Model by Green and Kreteur, 1999:35)

  5. Determinants of health Political Environment Economic social Death Disability Recovery Living conditions Diseases Health Systems WHO framework for action 2007 Dahlgren and Whitehead 1991

  6. Source: Good Health at LowCost 25 Yearson What make a successfulhealth system?

  7. Source: Good Health at LowCost 25 Yearson What make a successfulhealth system?

  8. Factorscontributing to goodhealth? • Politicalcommitment to health as a social goal • Societalvaluesofequity, politicalparticipation • and communityinvolvement in health • Investmentson PHC or othercommunity • based services • Widespreadeducation (women) • Intersectorallinkege for health

  9. Social and politicalfactorssupportinggoodhealth at lowcost

  10. Health promotion an preventative work is more than health care Health Care 10% Education 90% Work Personal Lifestyle Health Promotion & Preventative Work Family and network Social security Shelter Societal conditions ETC The 10-90 rule (Wildavsky 1977)

  11. Conceptualframeworkof Health System • WHO def: All organizations, people and actions to • promote, restore or maintain health. • This includes efforts to influence determinants of health • And health improving activities through • public, • private • non profit organizations)

  12. Service availability • Health system is not only Health Facility or hospitals Health facility Curative care Preventive care vaccination Outreach program Supplementary vacc program Health facility

  13. India administrative structure MoH State District 38 – 180 million 1 – 2 million Block 1 – 200.000 500 - 5000 Village

  14. Health System Domains Determinants of Health • H.S. outputs • Plans, # vaccines • ,# train staff • HIS • Service availability • Quality of Care • Health Status • Disease incid • Morbidity • Disability • Mortality • Cure • H.S. inputs • Policy • Financing • H.R. • Organization • Supplies • H.S. Outcomes • Service utilization • Target pop receiving • intervention • (coverage) Sustainability Efficiency Effectiveness Impact

  15. Life expectancy and GDP per capita in USD, 2005 Source: Good Health at Low Cost 25 Yearson What make a successfulhealth system?

  16. Source: Good Health at LowCost 25 Yearson What make a successfulhealth system?

  17. Whatshapes Health Care System policy? Financial mechanisms, coverage and methodsofhealthcaredeliver

  18. Chroniccommunicable and NCD • Foodsecurity • Injuries accidents and obesity • Multiprofessional and cross levelscare • Global structureofthe programs • Horzvertical programs Challenges

  19. Challenges • HR • Africa carries 25% of the world's disease burden yet has only 3% of the world's health workers and 1% of the world's economic resources. • Human resources • Quantity • inequity of distribution • Brain drain or migration of local health workers • Quality • knowledge • poor working conditions (multi-task) • misdistribution of personnel within and between countries • Health tourism The lancet. 2008 Volume 371, Issue 9613:623

  20. Countries with a Critical Shortage of Health Care Providers. N. Engl. J.Med 2007, 2564-67

  21. Only22% of 68 count down countries met minimum threshold of 23 physicians, nurses, midwives per 10,000 people necessary to deliver essential health services • Interventions include: - education of more health workers, strategies for motivation and retention, substitution of roles/task shifting Challenges

  22. Figure 2: Monthly income for health workers in Zambia (US$) Source: Health Policy. Vol 371 February 23, 2008

  23. Increased recognition of role of Community Health workers

  24. Human resources

  25. Private Public partnerships Private Public partnerships for childhealth • Global Alliance for VaccineInitiatives, Global Fund for Malaria • Increasedresources for newvaccines – Hib, Pneumocaccalvaccine • New technologies – autodisablesyringes • Push to minimisemissedopportunities and reacheverychild • Vaccinationcampaigns as part of polio eradication, measleselimination • Health financing mechanisms to increase access for vulnerable group- increase risk pooling schemes and minimise out of pocket payments. EX JSY Scheme in India Financing

  26. Challenges in output • Population covered • Infrastructure • Logistic and management

  27. RajasthanState depot • Zonal depot (total 7) • District depot Blokk level N= 14 36 lak pop NGOs Private hospitals Community Health Centres (CHC) N=24 1 lakpopulation Primary Health Care N=72 30.000 pop Subcenter - ANM N= 375 5000 pop Anganwalicenter 1000 pop Anganwalicenter 1000 pop Anganwalicenter 1000 pop

  28. Birth registration • Death audits Interest in mobile technologies Challenges of current health information systems and need for Electronic systems Health Information

  29. Health System is more thanpointofcare • Have huge challenges • Demandinovativeapproach • Urgentneed for strengtheninghealth systems to provide better health for all Take home messages...

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