1_Health systems and Policy for health science stds.pptx

HPM

1. By: Birhanu Desu ( Bsc , Msc EMCCN) Chapter 1: Health systems and health policy

2. Chapter Objectives After completion of this chapter , students will be able to: Analyze key health system building blocks and their interactions Analyze health system strengthening frame work Apply systems thinking approaches for health systems strengthening Describe national health policy Analyze the national HSDP and national health care delivery model Discuss primary health care practice in Ethiopia Comply with national health policies, strategies and initiatives 2

3. Health system building blocks What is a health system? A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. 3

4. Health System Building blocks... It includes, for example, A mother caring for a sick child at home; Private providers; Behavior change programs; Vector-control campaigns; Health insurance organizations; Occupational health and safety legislation. 4

5. Health System Building blocks... Six health system building blocks or functions that together constitute a complete system (WHO) The six building blocks of the health system are: Leadership and governance (stewardship). Health workforce; Information; Medical products, vaccines and technologies; Financing; and Service delivery; 5

6. Health System Building blocks... Leadership and governance ( stewardship) : involves ensuring strategic policy frameworks and are combined with effective oversight, coalition building, regulation, attention to system-design and accountability is arguably the most complex but critical building block of any health system is about the role of the government in health and its relation to other actors whose activities impact on health Involves overseeing and guiding the whole health system in order to protect the public interest 6

7. Health workforce Health workers are all people engaged in actions whose primary intent is to protect and improve health A country’s health workforce consists broadly of health service providers and health management and support workers private as well as public sector health workers; unpaid and paid workers; lay and professional cadres. a “well-performing” health workforce is one which is available, competent, responsive and productive. 7 Health System Building blocks...

8. Health information systems : ensuring the generation, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status; Medical technologies : including medical products, vaccines and other technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use; Health financing : raising adequate funds for health in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them; 8 Health System Building blocks...

9. Service delivery including effective, safe, and good quality health interventions that are provided to those in need, when and where needed, with a minimal waste of resources; Effective provision requires trained staff working with the right medicines and equipment, and with adequate financing requires an organizational environment that provides the right incentives to providers and users The service delivery building block is concerned with how inputs and services are organized and managed, to ensure access, quality, safety and continuity of care 9 Health System Building blocks...

10. Definition of terms Access : lack of geographic, economic, socio-cultural (including gender), organizational, or linguistic barriers to services Effectiveness : the degree to which desired results or outcomes are achieved Efficiency : the appropriate use of resources to produce effective services processes and institutions produce results that meet the needs of society by making the best use of resources Sustainability : continuity of positive results Coverage : Services reaching more people or target group 10

11. Equity : equity means fairness Equity in health means that people’s needs guide the distribution of health services and opportunities for health and well-being Quality : “the proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and that have the ability to produce an impact on mortality, morbidity, disability, and malnutrition Safety : the degree to which the risks of injury, infection, or other harmful side effects are minimized 11 Definition of terms…

12. Health System Building blocks... Management systems are connected The building blocks alone do not constitute a system It is the multiple relationships and interactions among the blocks – how one affects and influences the others, and is in turn affected by them – that convert these blocks into a system Changes in one system can trigger changes in another intervention targeting one building block will have certain effects (+/-) on other building blocks Improvements in one area cannot be achieved without contributions from the others Interaction between building blocks is essential for achieving better health outcomes. 12

13. building block interactions 13

14. Health System Strengthening WHO (2007) defines health system strengthening, as: improving the six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes. If all six components function effectively and deliver their intended results, the assumption is that the entire health system is strong 14

15. A framework for people-centered health systems strengthening People : those who lead, manage, and use the systems – are the central element for health system strengthening, On one side are the nurses, doctors, midwives, health officers, laboratory technicians, pharmacists, and health facility administrators who lead and govern; manage human resources, financial resources, supplies, and information; and deliver health services On the other side are the people in the cities, towns, and rural areas who need information and community support to engage in health-seeking behaviors The goal of providing quality health care cannot be achieved without the powerful interaction of these two groups of people 15

16. People-Centred Health Systems Strengthening Framework 16

17. A framework for people-centered… The six key health system building blocks in the outer circle are the focus of the interaction among critical stakeholders: government, health care providers, clients, and communities It is so obvious that people run a health system that we sometimes overlook this critical fact much attention is devoted to the process aspect of systems Health systems strengthening is an empty exercise if we forget the people at the center of it all The people in the “people-centred” framework are those who develop the systems, use the systems to do their work, and benefit from strong systems 17

18. It is critical to focus on the people who need the skills and support to integrate and use the six building blocks and management systems to deliver high-quality health care Recognizing that no system can operate without skilled and motivated staff, you should always put people first when designing, modifying, or improving a health management system Recognize, support, and reward the staff members who take on the management and leadership roles that make the health system work every day, at every level 18 A framework for people-centered…

19. The People at the Centre of Health Systems are: Health managers and administrators who have the knowledge, skills, responsibility, and authority to build and maintain the management systems needed to deliver health services; Personnel at all levels , including health care providers and administrators, who use the management systems to address challenges and achieve results; Communities and families that are educated and empowered to promote their own health and demand quality services; Clients who have adequate information to use health services appropriately 19 A framework for people-centered…

20. Systems thinking “Systems thinking” is an approach to problem solving that views "problem" as part of the wider, dynamic system (WHO, 2009) It involves more than a reaction to present problems involves more than “fixing” a problem - quick-fixes that are likely to backfire It demands a deeper understanding of the linkages, relationships, interactions and behaviours among the elements that characterize the entire system 20

21. Historical development of health services in Ethiopia

22. Modern medicine was introduced into Ethiopia in the 16 th century & remained as a privilege to the members of the royal circles until the establishment of 1 st hospital in Addis Ababa in 1900. The first government sponsored health facilities were established in Harar ( Ras Mekonnen Hospital) and Addis Ababa ( Menelik II Hospital) by 1909 The government formally assumed responsibility for the provision of health services with the establishment of Health Department within the Ministry of Interior in 1908 22 Historical development…

23. A separate Ministry of Health was established in 1948 Ethiopia became member of WHO in 1949 Gondar Public Health College, the first of its kind, was established in 1954 and started training of health professional Ethiopia became one of the pioneering countries in implementing basic health services (BHS) approach since 1954 with health centre as its backbone The era of “ BHS ” since 1954 in Ethiopia is considered as one of the success stories 23 Historical development…

24. BHS gives more attention to rural areas through the construction of health centers and health stations and training auxiliary health workers to provide both curative and preventive services The BHS approach was also combined with Vertical Health Service (VHS) that included specialized control programs for communicable diseases Both BHS and VHS failed to reach the desired goal In 1978 another approach was invented to achieve desired goal of “health for all by the year 2000 ” This approach was the “primary Health Care (PHC) Approach” 24 Historical development…

25. Since 1980 , PHC has been the main strategy on which the health Policy has been based The current Health Extension program is designed based on the principles of PHC during the period between 1974 & 1984 Modern health care during this period was structured into a 6-tier health system The 6 tier health system consists of: Referral (central) hospital, regional hospital, rural hospital, health center , health station and community health service. 25 Historical development…

26. Historical development- 1991 onwards The Ethiopian health system is reformed and the main program being implemented is the Health Sector Development Program (HSDP ) The HSDP was launched in 1998 in response to the prevailing and newly emerging health problems in Ethiopia and in recognition of weaknesses observed in the existing health delivery system The initial HSDP which was drafted in1993/94 was designed for a period of 20 years , with a rolling five-year program period 26

27. Other key events during this period are: The development of current national health policy of the country (1993) A change in the health service delivery structure from 6 – tier to a simpler 4 – tier system (during the first HSDP) Re-structuring of the 4 – tier health service delivery system to 3 – tier delivery system (during the 4 th HSDP) The development of the Health Service Extension Package (HSEP initiative); which seeks to provide health promotion and extension services to communities (2 nd HSDP) 27 Historical development- 1991 onwards…

28. Health Policy, Strategy and Reform in Ethiopia

29. National Health Policy of Ethiopia A policy is a set of clear statements that defines the intention of a community, organization or government’s goals and priorities. Policies outline the role, rules and procedures They create a framework within which the administration and staff can perform their assigned duties. A policy involves agreement or consensus on the following main issues: Goals and objectives to be addressed, Priorities among those objectives and Main directions or strategies for achieving them 29

30. National Health Policy of Ethiopia… The 1993’s health policy of Ethiopia is one among the prominent developments of the country The policy envisioned the health care sector development (HSDP) for the next twenty years The policy principally focuses on fiscal and political decentralization, expanding the PHC services to all segments of the population and encouraging partnerships and the participation of nongovernmental actors 30

31. General theme of the policy…1 Democratization and decentralization of the health service system. Development of the preventive and promotive components of health care. Development of an equitable and acceptable standard of health service system that will reach all segments of the population within the limits of resources. Promoting and strengthening of inter- sectoral activities. 31

32. General theme of the policy…2 Promotion of attitudes and practices conducive to the strengthening of national self-reliance in health development by mobilizing and maximally utilizing internal and external resources. Assurance of accessibility of health care for all segments of the population Working closely with neighbouring countries, regional and international organizations to share information and strengthen collaboration in all activities contributory to health development including the control of factors detrimental to health 32

33. General theme of the policy…3 Development of appropriate capacity building based on assessed needs. Provision of health care for the population on a scheme of payment according to ability with special assistance mechanisms for those who cannot afford to pay. Promotion of the participation of the private sector and nongovernmental organizations in health care. 33

34. Health Sector strategies in Ethiopia The Health Sector Development Program (HSDP) is the main health sector strategy of Ethiopia since 1998 The HSDP was designed for a period of 20 years, with a rolling five-year program period. Three main goals of HSDP: Build basic infrastructure, Provide standard facilities and supplies and develop Deploy appropriate health personnel for realistic and equitable primary health care delivery at the grassroots level four phases of Health Sector Development Plans : 34

35. HSDP I (1997/98–2001/02) Prioritized disease prevention A change in the health service delivery structure from 6 – tier to a simpler 4 – tier system The main change is to replace health stations (popularly known as ‘clinics’) with PHCUs: with each PHCU having a health center surrounded by five Health Posts, each serving a population of 5,000 for a total of 25,000 for the PHCU The four-tier system comprised of PHCU, District hospital, Regional hospital and specialized hospital. The three one’s principle and harmonization - “One plan, one budget, one report” 35

36. HSDP-II (2002/03–2004/05) Introduced the Health Service Extension Program (HSEP) Innovative health service delivery system Health Extension Programme ( HEP) in Ethiopia was embarked in 2003 and is hence a sub-component of the HSDP since then. “It is a package of basic and essential promotive , preventive and selected curative health services, targeting households in the community, based on the principles of primary health care to improve the health status of families with their full participation , using local technologies and the skill and wisdom of the communities” 36

37. Health Extension Programme HEP is similar to PHC in concept and principle, except HEP focuses on households at the community level, and it involves fewer facility-based services The philosophy of HEP is that if the right knowledge and skill is transferred to households they can take responsibility for producing and maintaining their own health The overall goal of the HEP is to create a healthy society and reduce rates of maternal and child morbidity and mortality. 37

38. HSDPIII (2005/6-2009/10) The ultimate goal of HSDP-III is “to improve the health status of the Ethiopian peoples through provision of adequate and optimum quality of promotive , preventive, basic curative and rehabilitative health services to all segments of the population.” Directly aligned with the health-related MDGs To improve maternal health To reduce child mortality To combat HIV/AIDS, malaria, TB and other diseases 38

39. HSDP IV (2010 –2015) The expression of the renewed commitment to the achievement of MDGs Gives priority to maternal and child health, nutrition, as well as the prevention and control of major communicable diseases, such as HIV/AIDS. Emphasizes the strengthening of Health Service Extension Program to improve the quality of PHC, human resource development and health infrastructure. Community empowerment/ownership Developed the three tier health delivery system Ethiopia drafts another 20 year health plan to be implemented 2015 onwards 39

40. Urban 40 Specialized Hospital 3.5-5.0 million People General Hospital 1.0-1.5 million people Primary Hospital (60,000-100,000 people) Health Center (15,000-25,000) People Health Post (3000-5000) People Health Center 40,000 People Primary Level Health Care Tertiary Level Health Care The three tier health delivery system o f Ethiopian Rural Secondary Level Health Care

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