1.Health systems.pptx all organisations working towards good health

Public health: health systems

1. Health systems

2. Definition Health systems are defined as comprising all the organizations, institutions and resources that are devoted to producing health actions. A health action is defined as any effort, whether in personal health care, public health services or through intersectoral initiatives, whose primary purpose is to improve health. But while improving health is clearly the main objective of a health system, it is not the only one. The objective of good health itself is really twofold: the best attainable average level – goodness – and the smallest feasible differences among individuals and groups – fairness. Goodness means a health system responding well to what people expect of it; fairness means it responds equally well to everyone, without discrimination WHO

3. What is a health system? It 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. It needs to provide services that are responsive and financially fair, while treating people decently.

4. National health systems have three overall goals:  1 .   Good health,  2.   Responsiveness to the expectations of the population, and  3.   Fairness of financial contribution.

5. Health System Components: WHO describes health systems as having six building blocks: S ervice delivery; H ealth workforce ; I nformation ; M edical products, Vaccines and technologies; F inancing ; and leadership and G overnance (stewardship).

6. Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focuses on nine major priority areas Leadership and Governance for Health; Health Services Delivery; Human Resources for Health; Health Financing; Health Information Systems; Health Technologies; Community Ownership and Participation; Partnerships for Health Development; and Research for Health.

7. Zambia Policy Objectives Health Services Delivery Structures Health Workforce Medical Commodities Infrastructure , Equipment and Transport Leadership and Governance Health Information and Research Health Care Financing Public Private Partnerships

8. Health systems in Zambia The 2017-2021 strategic plan’s vision is having ‘A Nation of Healthy and Productive People’, while the mission is ‘To provide equitable access to cost effective, quality health services as close to the family as possible’. Zambia has three levels of public health facilities that are: Hospitals health centers health posts ; M oreover , the hospitals are divided into: primary (district ) S econdary ( provincial ) T ertiary (central) facilities- Currently All third-level hospitals are Government owned.

9. Health systems in Zambia Community-level care is provided through health posts and health centres . Where primary health care and preventive health services are provided. Health Posts- These are the lowest levels of health care and are built in communities far away from health centres . They cater for a catchment population of approximately 3,500 in rural areas and 1,000 to 7,000 in the urban settings and are set up within 5km radius for sparsely populated areas. The types of health services offered at this level are basic first aid rather than curative Health centres -There are two types of health centres in the health care delivery system in Zambia. These include urban health centres or clinics (UHC), which serve a catchment population of between 30,000 to 50,000 people; and Rural Health Centre (RHCs)s , which a population of 10,000 people.

10. D istrict-level care is provided in Level 1 hospitals Also offers primary health care and preventive health services are provided . First Level Hospitals- First level hospitals, also referred to as District Hospitals are found at district level. They are the third largest levels of care after the Second and Third Level referral hospitals. These serve a population of between 80,000 and 20,000 and provide services such as medical, surgical, obstetric and diagnostic services and all clinical in support of health centre referrals.

11. Provincial-level care is provided in Level 2 hospitals Second Level comprising the provincial and general hospitals, which provide the curative care Second Level Hospitals -Second level hospitals, also referred to as Provincial or General Hospitals , are found at provincial level. They are intended to cater for a catchment area of between 200,000 and 800,000 people, with services in internal medicine , general surgery, paediatrics , obstetrics and gynaecology , dental , psychiatry and intensive care services. These hospitals also act as referrals for the first level institutions, including the provision of technical back up and training functions.

12. T ertiary or specialist care is provided in Level 3 hospitals Tertiary level comprising Central hospital and the National University teaching Hospital. Provide specialized care. Third Level Hospitals -Third level hospitals also called Specialist or Tertially Hospitals are the highest referral hospitals in Zambia. These hospitals cater for a catchment population of approximately 800,000 and above, and have subspecializations in internal medicine, surgery, paediatrics , obstetrics, gynaecology , intensive care, psychiatry, training and research. All complicated cases not attended to at second level hospitals are referred to third level hospitals.

13. The structuring of the health system suggests that a managed hierarchal referral system is in operation. The arrangement of health services is along the same administrative lines with the district as the main focus of service delivery, the provincial as the secondary level and central and the university Teaching Hospital as the tertiary level of care.

14. F our-tier structure: Zambia is divided into 10 administrative provinces and 105 districts. Health management is done through provincial health offices (PHOs) (10), DHOs, and statutory bodies. Ministry of Health , with responsibility for policy, regulation and standard-setting. The national level is responsible for overall coordination and management, policy formulation, strategic planning, and resource mobilisation . Provincial Health Offices , with responsibility for performance management at the provincial level. The PHO is the link between the national and district level and is charged with backstopping provincial and district health services. The provincial is also tasked with the provision of second-level referral services (through general hospitals). District Health Offices , with responsibility for coordination, planning and support at district level. The district is responsible for implementation of health promotion, preventive, curative, and rehabilitative services. Administratively, the district health office is responsible for coordinating service delivery at that level. Each district has a district hospital, which provides first-level referral services. Neighbourhood Health Committees , with responsibility for overseeing services at the community level.

15. The health services in Zambia are provided by four main players, namely The Government , Faith-based (not-for-profit) providers, The mines, and Private (for-profit) providers.

16. Health care systems The performance and organization of health care systems is influenced by a number of factors Some of the issues include the following:

17. 1. Governance Governance refers to the wide range of functions carried out by governments as they seek to achieve national health policy objectives.

18. 2. Financing The purpose of health financing is to ensure that adequate funding is available and the right financial incentives are in place to guarantee that all individuals have access to needed preventive and personal health care.

19. 3. Workforce The performance of health care systems depends on the knowledge, skills, motivation and distribution of the people responsible for organizing and delivering services.

20. 4. Information Accountability, resource allocation, programme improvement and management decisions all rely on sound health information Evidence based decision making

21. 5. Knowledge Fostering environments that encourage the creation, sharing, and effective application of knowledge is vital for a health system to function well.

22. 6. Drugs and technology The availability, quality, efficacy, safety and rational use of drugs and health technology are necessary for effective health service delivery.

23. 7. Research There remain many unanswered questions about how to develop and maintain well-functioning health systems that progress towards universal coverage. Research in this area is vital at all levels of the health care system.

24. 8. Service delivery Just as the principal objective of a health system is to improve people's health, the chief function the system needs to perform is to deliver health services.

25. 9. Equity Reducing health inequities is important because health is a fundamental human right and its progressive realization will eliminate inequalities that result from differences in health status.

26. 10. Health and Development Strengthening health systems and making them more equitable are key strategies for fighting poverty and fostering development.

27. Quality of Healthcare A New Health System for the 21st Century , a study by the Institute of Medicine (IOM), a committee of experts identified six interrelated characteristics of a healthcare system that should guide efforts to improve the quality of care. These include a healthcare system that must be safe, effective, patient-centered, timely, efficient, and equitable (IOM, 2001):

28. Safe —avoiding injuries to patients from the care that is intended to help them Effective —providing services based on scientific knowledge to all who could benefit and refraining from providing service to those not likely to benefit (avoiding underuse and overuse, respectively ) Patient-centered —providing care that is respectful of and responsive to individual patient preferences, needs , and values and ensuring that patient values guide all clinical decisions Timely —reducing waiting times and sometimes harmful delays for those who receive and those who give care Efficient —avoiding waste, including waste of equipment, supplies, ideas, and energy Equitable —providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status

29. PLANNING The process of setting goals, developing strategies, and outlining tasks and schedules to accomplish the goals.

30. Planning is deciding in advance what to do, how to do and who is to do it. Planning bridges the gap between where we are to, where we want to go. It makes possible things to occur which would not otherwise occur . “Failure to plan is planning to fail.” — Benjamin Franklin (commonly attributed)

31. Health care Planning Orderly process of defining community health problems, identifying unmet needs and surveying resources to meet them, establishing priority goals, that are realistic and feasible and projecting administrative action to accomplish the purpose of proposed programs Planning is the foundation for sustainable, equitable, and effective health care delivery

32. Importance of planning Ensures evidence-based, data-driven decisions Sets clear goals and priorities Allocates resources efficiently Enhances accountability and transparency Builds resilient and responsive health systems

33. Health Systems Context Without structured planning, health systems become reactive instead of proactive.Leads to: Resource misallocation Poor service delivery Wastage of funds Unmet population needs Health inequalities

34. Elements Objectives Policies Programs Schedules Budget

35. Planning cycle

36. Planning cycle

37. Planning cycle Analysis of the health situation Population Statistics of morbidity and mortality Epidemiology Medical care facilities Manpower (HR) Attitudes and beliefs

38. 2. Establishment of objectives and goals It should be set by a person having authority. The goal should be realistic. It should be specific. Acceptability Easily measurable

39. 3. Assessment of resources Manpower Money Materials Skills and knowledge Technical needs

40. 4. Fixing priorities What determines priorities? 5. Write formulated plans Detailed detecting input and output Contained working guidance for execution Evaluation should be built in

41. 6. Programming and implementation Assign and fix responsibilities Define roles and tasks Selection, training, motivation and supervision Organization and communication Efficiency of health institutions

42. 7. Monitoring continues process of observing, recording and reporting on the activities of the organization or project 8. Evaluation measures the degree to which objectives and targets are fulfilled and the quality of results obtained

43. Thank you