Apply Basic Principle of Health System.pptx

WHO defined health as “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.”

1. Applying Basic Principles of Health System BY Esrom k [ Bsc and MPH] 1 12/29/2022 Esrom

2. Introduction Health is a highly subjective concept. Good health means different things to different people, and Its meaning varies according to individual and community expectations and context. Many people consider themselves healthy if they are free of disease or disability. However, people who have a Disease or disability may also see themselves as being in good health if they are able to manage their condition so that it does not impact greatly on their quality of life. 12/29/2022 Esrom 2

3. Introduction… WHO defined health as “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.” Physical health – refers to anatomical integrity and physiological functioning of the body. To say a person is physically healthy: - All the body parts should be there. - All of them are in their natural place and position. - None of them has any pathology. - All of them are doing their physiological functions -And they work with each other harmoniously. 12/29/2022 Esrom 3

4. Introduction Mental health - ability to learn and think clearly. A person with good mental health is able to handle day-to-day events and obstacles, work towards important goals, and function effectively in society. Social health – ability to make and maintain acceptable interactions with other people. E.g. To feel sad when somebody close to you passes away. The absence of health is denoted by such terms as disease, illness and sickness, which usually mean the same thing though social scientists give them different meaning to each. 12/29/2022 Esrom 4

5. introduction Disease is the existence of some pathology or abnormality of the body, which is capable of detection using, accepted investigation methods Illness is the subjective state of a person who feels aware of not being well. Sickness is a state of social dysfunction: a role that an individual assumes when ill   12/29/2022 Esrom 5

6. What is Health system? System is an arrangement of parts and their interconnection that come together for a purpose Health system is t he sum of the organizations, institutions, and resources whose shared primary purpose is to improve health status . 12/29/2022 Esrom 6

7. Health system … Health system consist of all organization, people and action whose primarily intent is to promote, restore and maintain health. The ultimate responsibility for the overall performance of a country health system lies with government but good stewardship by religion and individual health institution is vital. 12/29/2022 Esrom 7

8. Health System Goal to improve health and health equity To achieve greater access and coverage for effective health intervention 12/29/2022 Esrom 8

9. Function of Health system Stewardship Financing For Human and physical resource Organization and management of service delivery 12/29/2022 Esrom 9

10. Health System Building blocks Service delivery Leadership and governance Health financing Health Information system Medical products Health workforce 12/29/2022 Esrom 10

11. Building block of HS Good Health service – are those which deliver effective , safe quality personal and non personal health intervention to those who need them, when and where needed with minimum waste of resource. Health Workforce – sufficient number of staff fairly distributed 12/29/2022 Esrom 11

12. Cont.. 3. Health information system – that ensure the production analysis dissemination and use of reliable and timely information on health determinant. 4. Medical product – vaccine and other medical product assured quality , safety, efficacy and cost effectiveness. 12/29/2022 Esrom 12

13. Cont… 5. Health Financing – require adequate fund for health in ways that ensure people can use needed service. 6. Leadership and governance – involve ensuring strategic policy frame work exist and are companied with effective over sight. 12/29/2022 Esrom 13

14. Health System Actors Main Actor or Responsible body in Health system is include Public sector 2. Private sector 3. Community and patient 12/29/2022 Esrom 14

15. Health System Actors Public sector - Its also called government sector, its complex group of actors that include minister of health [ MoH ], Line ministers and public servant. - Public health funding come from variety of source such as tax, social security payment and donors. 12/29/2022 Esrom 15

16. Public sector Essential public health function Monitoring , evaluation and analysis of health status Surveillance research and control of the risk and threats to public health Health promotion Social participation in health Development of policy and institutional capacity for public health planning 12/29/2022 Esrom 16

17. Public Sector Function Cont.. 6. Strength of public health regulation 7. Evaluation and promotion of equitable access of health service 8. Human resource development and train 9. Quality assurance in health service 10. Research in public health 11. Reduction of impact of emergency and disaster in health 12/29/2022 Esrom 17

18. Challenge facing Public Health sector Mainly two challenge 1. Internal challenge include lack of financing Insufficient management and skill corruption 2. Environmental Challenge Include Changing epidemiologic and demographic trend New medical technology Globalization Health Reform 12/29/2022 Esrom 18

19. 2. Private sector Government health service only is not often sufficient in achieving improvement health status indicators. Private sector is also key source of health service and its coverage is rapidly expanded. Therefore its high utilization of private sector is essential. 12/29/2022 Esrom 19

20. Private sector cont… Private health sector comprises for profit commercial entities and for not profit organization like NGO and FBO[ Faith based] that engaged in health care. 12/29/2022 Esrom 20

21. There are two type of private provider Formally trained and licensed private provider – it include Doctors, Nurse, midwife, HIT and paramedic staff also private pharmacy and drug saller are often the first line provider in the formal health sector that serves people in poor and remote community. The informal health sector - consist of traditional healers, traditional birth attendant [TBA] and market drug saller. 12/29/2022 Esrom 21

22. 3. Community and Patient With focus on the supply side of health care provision recognize that importance of people as financer of care as citizen with role in governance as care provider and consumer. 12/29/2022 Esrom 22

23. Problem with Health System Inadequate arrangement social protection Escalating cost because of Insufficient use of recourse Deep inequities in health status Falling or inadequate health system 12/29/2022 Esrom 23

24. Essential Public health Service Monitor Health status to identify and solve community health problem Diagnose and investigate health problem and health hazard in the community Inform , educate and empower people about health issue. Mobile community partnership and action to identify and solve health problem 12/29/2022 Esrom 24

25. Cont… Develop policies and that support individual and community health effort Enforce laws and regulation that protect health and ensure safety Link people to needed personal health service and assure the provision of health care when otherwise unavailable. Assure competent public and personal health care work force Evaluate effectiveness, accessibility and quality of personal and population based health service. Research for new insight and innovation solution to problem. 12/29/2022 Esrom 25

26. Essential Activity of Public Health Have 6 essential activity Health Protection Health Surveillance Disease and Injury Prevention Population health assessment Health promotion Emergency preparedness and response 12/29/2022 Esrom 26

27. 1. Health Protection This include ensuring that water, air and food are safe and maintain the regulatory frame work for the control of infectious disease and protection from environmental threat as well as advising on food and drug safety regulation . 12/29/2022 Esrom 27

28. 2. Health Surveillance The ongoing, systematic use of routine collected health data for the purpose of tracking and forecasting health event or health determinant. It include - the collection and storage or relevant data - integration, analysis and interpretation of these data 12/29/2022 Esrom 28

29. 3. Disease and Injury Prevention The investigation, contact tracing and development of preventive and control measure to reduce the risk of infectious disease emergency and outbreak as well as the promotion of safe, healthy, lifestyle to reduce preventable illness and injury. 12/29/2022 Esrom 29

30. 4. Population health assessment Understand the health of community or specific population. As well as the factor that underlie good health or pose potential risk. 12/29/2022 Esrom 30

31. 5. Health promotion Its preventive disease, encourage safe behavior and improving health through policy, community based intervention and advocacy or action on environmental and socio – economic determinant of health. 12/29/2022 Esrom 31

32. 6. Emergency preparedness and response Planning for natural disaster [ flood and earthquake] and man made disaster [chemical and radioactive substance] 12/29/2022 Esrom 32

33. . . Unit 2 ORGANIZATION OF THE ETHIOPIAN HEALTH CARE DELIVERY SYSTEM 12/29/2022 Esrom 33

34. Learning objectives At the end of this unit, the learner is expected to understand The historical development of the Ethiopian health care delivery system The Ethiopian health policy and strategy The components of HSDP[ health sector development strategy] Structures of the Ethiopian health system Functions of the different levels of the health care system 34 12/29/2022 Esrom

35. ORGANIZATION OF HEALTH SERVICES IN ETHIOPIA Historical Development Modern health care delivery in Ethiopia has come from traditional medicine root. Introduction of modern medicine to Ethiopia =16 th century. Since then, its development is arbitrarily divided in to 6 periods as follows 35 12/29/2022 Esrom

36. Historical Development . . . . . . . Period I = Period of introduction =1500-1900 Period II = Period of Ethiopianization =1900-1935 Period III = Period of Italian occupation =1935-1941 Period IV = Period of overtaking responsibility of health service by the government =1941-1974 5. Period V = Period of socialist economy = 1974-1991 ` 6 . Period VI = Period of market economy, Democratization, Decentralization, and Privatization = 1991- to date 36 12/29/2022 Esrom

37. Period I/ Introduction/ 1500-1900 Modern medicine introduced by diplomats, religious, explorers, and merchants Started in the16 th century ( Atse Lebnadengel )  Joao Bermudes , Portuguese surgeon, 1520 -1526 Emperior Yohannes  Vaccination But served mainly the ruling class (royal families). 1898: Dr. Workineh Martin (1 st Ethiopian doctor) 37 12/29/2022 Esrom

38. Period II /Ethiopianization / 1900-1935 =time of Menelik II Significant expansion of modern medicine: 1920: Dr. Melaku Beyan (the 2 nd Ethiopian doctor 1930-1 st medical legislation 38 12/29/2022 Esrom

39. Period III /Italian Occupation/ 1935-1941 Brought numerous doctors to Ethiopia There was expansion of hospitals and launched massive small pox vaccination. Generally – This period was a set-back to the Ethiopian health development (i.e.-no benefit to Ethiopians). 12/29/2022 Esrom 39

40. Period IV 1941-1974 Restoration and overtaking of the health care by Ethiopian government Ethiopian government took back the responsibility, 1947 public health proclamation was set MOPH- established in 1948GC 1949 - Ethiopia became member of WHO Gonder College of PH-established in 1954 First medical school is opened in AA in 1966 40 12/29/2022 Esrom

41. Period V /Socialism/ 1974-1991 = Total change of social system Completely taken over by the Government –no private sub- sectors The broad objective was ‘ promoting equity in health care’ 10 years perspective health plan was developed. The health care delivery was structured into a 6-tier system . 41 12/29/2022 Esrom

42. P yramidal arrangement of the health care structure during the Derg rule Central/Referral Hospital Regional Hospital- 1:1.6-3 million populations Rural Hospital- 1:50,000-100,000 population Health Center- 1:25,000-50,000 population Health Station- 1:10,000 population Community Health Service-1: 1000 population 42 12/29/2022 Esrom

43. Limitations of the 6-tire system Centralized management Lack of professionalism Poor community & private sector participation Concentration of service around towns Inefficient resource utilization. 43 12/29/2022 Esrom

44. Period VI 1991- to date FDRE Complete change of socio – political policy Market Economy, Privatization, Decentralization, and Democratization The health care system was restructured into a 4-tier system then in to 3 tier system. 44 12/29/2022 Esrom

45. The 4- tire system of FDRE Central/Referral Hospital = 1: 5, 000,000 population Regional Hospital- 1:1,000,000 population District Hospital 1:250,000 population PHCU- 25,000 population (1 PHCU=1HC with 5CHP) 5 CHP) 45 12/29/2022 Esrom

46. 12/29/2022 Esrom 46 Currently used 3 Health Tier system

47. The ten-years health sector plan 1977-1986 E.C. Was part of the global movement to achieve health for all by the year 2000 Objective of the plan: Apply the principles of PHC Control all major communicable disease Expand EPI services Extend medical service to 80% of the population Ensure the provision of comprehensive health services e.g. Mothers and children 47 12/29/2022 Esrom

48. The ten-years . . . . . . Target of the ten years plan were: Reduction of IMR form 155/1000 to 95/1000 Reduction of CMR from 247/1000 to 95/1000 Improve life expectancy at birth from 42 to 55 years Increase health service coverage from 43% to 80% Clean water supply to 80% of the rural population Provide health service to 80% of the population Objective To give an acceptable standard of comprehensive & integrated PHC 48 12/29/2022 Esrom

49. Health policy of Ethiopia Health policy is an organized set of values, principles and objectives for improving health and reducing the burden of diseases and disorders in a population. It defines a vision for the future and helps to establish a model for action. Policy also states the level of priority that a government assigns to health in relation to other social policies. The Government of Ethiopia formulated the National Health Policy in 1993. 49 12/29/2022 Esrom

50. General policy Democratization and decentralization of the health service system. Development of the preventive and promotive components of health care. Development of an equitable & acceptable standard of health service system that will reach all segments of the population within the limits of resources. 50 12/29/2022 Esrom

51. General policy . .. . . . 4. Promoting and strengthening of inter sectoral activities. 5. Promotion of attitudes and practices conducive to the strengthening of national self-reliance 6. Assurance of accessibility of health care for all segments of the population. 7. Working closely with neighbouring countries, regional and international organizations to share information. 51 12/29/2022 Esrom

52. General policy . . . . . 8. Development of appropriate capacity building based on assessed needs. 9. Provision of health care for the population on a scheme of payment according to ability 10.Promotion of participation of the private sector and non-governmental organizations in health care. 52 12/29/2022 Esrom

53. Priorities of the policy Information, Education & Communication (I.E.C) Emphasis shall be given to: The control of Communicable diseases and Epidemics Malnutrition and poor living conditions, Promotion of occupational health and safety Development of environmental health, Rehabilitation of the health infrastructure and Development of an appropriate health service Mgt. system. 53 12/29/2022 Esrom

54. Priorities of the policy.... Appropriate support shall be given to the curative and rehabilitative health service. 4. Due attention to Traditional Medicine and its integration into Modern Medicine. 5. Applied research addressing major health problems. 6. Strengthen of essential medicines and equipment. Development of health human resources. 54 12/29/2022 Esrom

55. Priorities of the policy.... 8. Special attention to:- the family particularly women and children those in the forefront of productivity those most neglected regions and segments victims of man-made and natural disasters. Referral System Financing health care system 55 12/29/2022 Esrom

56.   As a means of achieving the goals of the health policy, the government has formulated a twenty-year health sector development strategy (HSDP). It is being implemented through a series of five-year plans. The implementation of the first HSDP was launched in 1997, Now the fourth HSDP is under way. The National Health Strategy of Health sector development strategy ( HSDP) 12/29/2022 Esrom 56

57.   The main goals of HSDP Building basic infrastructure Provide standard facilities and supplies Develop and deploy appropriate health personnel 12/29/2022 Esrom 57

58.   Covered the first five years Prioritized disease prevention Introduced four-tier health service delivery system Characterized by PHCU, district hospital, zonal hospital and specialized hospital Development of three in one’s & harmonization HSDP I (1997/98–2001/02) 12/29/2022 Esrom 58

59.   Introduced the Health Service Extension Program Innovative health service delivery system It is a community based health care delivery system provided at kebele and household levels Focus on sustained preventive health actions and increased health awareness. HSDP-II (2002/03–2004/05) 12/29/2022 Esrom 59

60.   Directly aligned with the health-related MDGs Focuses on high-impact interventions needed to accelerate scale-up and increase coverage of key health services for HIV,TB, malaria, as well as maternal and child health . HSDPIII (2005/6-2009/10) 12/29/2022 Esrom 60

61. Developed as part of the National GTP The expression of the renewed commitment to the achievement of MDGs Gives priority to maternal and child health , nutrition , prevention and control of major communicable diseases HSDP IV (2010 –2015) 12/29/2022 Esrom 61

62.   4. Emphasizes the strengthening of HSEP to improve the quality of PHC , human resource development and health infrastructure 5. Developed the three tier health delivery system 6. Community empowerment/ownership 7. Developed two approaches: BCC & CM HSDP IV ( 2010 –2015) (2) 12/29/2022 Esrom 62

63. 12/29/2022 Esrom 63

64.   Maternal and newborn health Child health TB and HIV/AIDS Malaria and nutrition The priorities and targets of the HSDP IV 12/29/2022 Esrom 64

65. The priorities and targets of the HSDP IV 12/29/2022 Esrom 65

66. Assignment Write Health extension service package Write Ethiopian health tier system briefly Write and explain type of health care 12/29/2022 Esrom 66

67. Major findings IMR 2000  97 /1,000 live births 2011  59 /1,000 2015  31/1,000 U5MR 2000  166 /1,000 live births 2011  88 /1,000 2015  68/1,000 12/29/2022 Esrom 67

68. The eight Components of HSDP Health services delivery and quality of care Health facility rehabilitation and expansion Human resource development Strengthening pharmaceutical services Information education and communication Health management and information system Health care financing Monitoring and evaluation 68 12/29/2022 Esrom

69. Health Extension Program (HEP) It is a community based program introduced in 2003 To make essential health services available at grass root level Strongly focused on sustained preventive actions and increased health awareness. It is a package of promotive, preventive & basic curative services It is a mechanism of shifting health care resources to rural people for achieving MDGs 69 12/29/2022 Esrom

70. Objectives of HEP The objective was to: To increase awareness among community To Promote healthy life style To improve access to basic health care services To promote equity in health care delivery To improve quality of health care To promote women empowerment 70 12/29/2022 Esrom

71. Principles of HEP Preventive & promotive interventions are more cost-effective Communities identify & prioritize their own health needs and problem Community involvement, ownership, empowerment and self-reliance need to be promoted to ensure sustainability Women involvement in all decision-making process is central Learning/teaching by doing 71 12/29/2022 Esrom

72. HSEP includes 16 packages in four main areas: 1. Hygiene and environmental sanitation Excreta Disposal Solid and liquid waste disposal Water supply and safety measurers Food hygiene and safety measures Healthy home environment Control of insects and rodents Personal hygiene 12/29/2022 Esrom 72

73. HSEP includes 16 packages 2. Disease prevention and control TB, HIV/AIDS and STI prevention and control. Malaria prevention and control. First aid and emergency measures. 12/29/2022 Esrom 73

74. HSEP includes 16 packages 3. Family health services Maternal and child health Family Planning Immunization Adolescent Reproductive Health Nutrition 4. Health Education and Communication 74 12/29/2022 Esrom

75. HEP Implementation Strategy O rganization Health Post (HP) will be constructed at Kebelle/Peasant Association level Two female HEWs will be assigned in each HP Each HEWs will be supported by 10 VCHWs Supported and led by nearest HC and Woreda HO 75 12/29/2022 Esrom

76. HP for 5,000 population HC for 25,000 Population Primary Health Care Unit (PHCU) 76 HP HP HP HP 12/29/2022 Esrom

77. 1 HEW (HP) Link of Health Post to community 77 2 HEWs per Health Post 10 VCHWs per each HEW, 20 VCHWs in each Kebele 1 VCHW per 30 – 50 House Holds VCHW VCHW VCHW VCHW VCHW VCHW VCHW VCHW VCHW VCHW 12/29/2022 Esrom

78. Quiz 10 % What is component of Health Extension package Write Disease prevention and control package of HEW What is the main focus of Ethiopian Health policy Write Ethiopian current Health care tier system Write a care more focus on behavioral change increase awareness 12/29/2022 Esrom 78

79. Unit 3 Primary Health Care 12/29/2022 Esrom 79

80. Unit objectives At the end of this chapter, the student is able to: Describe the historical development of PHC. Identify the philosophy, principles, components and strategies of PHC. Analyze the situation in the Ethiopian context. Discuss the PHC approaches 12/29/2022 Esrom 80

81. Definition It is an essential health care based on practical , scientifically sound and socially acceptable methods and technology , made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford 81 12/29/2022 Esrom

82. Historical development of PHC Establishment of WHO in 1948 Failurity of the WHO to meet its goal of delivering highest possible health to all people The expensive and unsuccessful vertical approach of control programmes as malaria, TBc and STI. Low health status of majority of people in disadvantaged areas globally 82 12/29/2022 Esrom

83. Historical development of PHC . . . . .. Practical focus to curative service than preventive, promotive and rehabilitative Thus -the magnitude of health problems and inadequate distribution of health resources called for a new approach and the concept of PHC was born. 83 12/29/2022 Esrom

84. Historical development of PHC . . . . . In 1977 the WHO set a goal of providing "Health for All by the year 2000” The strategy to meet this goal was later defined in the 1978 WHO/UNICEF joint meeting at Alma-Ata USSR = The Primary Health Care (PHC) strategy 84 12/29/2022 Esrom

85. The PHC philosophy Equity and justice Ensures equitable distribution of health care by narrowing the gap. 2. Individual and community self reliance Personal responsibility for their own health. 3 . Inter relation ship of health and development Good health status leads to productive life. 85 12/29/2022 Esrom

86. Principles of PHC Inter- sectoral collaboration Community participation Appropriate technology Equity Health Promotion and prevention Decentralisation 86 12/29/2022 Esrom

87. 1. Inter sectoral collaboration It means a joint concern and responsibility of other sectors for identifying problems, plan and implement to be able to improve the health of local people the PHC programme needs not only the health sector, but also the involvement of other sectors, like agriculture, education and housing is important. This is to identify community needs together b/c the causes of ill health are not limited only to health sector. 87 12/29/2022 Esrom

88. 2. Community Participation this includes meaningful involvement of the community in planning, implementing and maintaining their health services. Through the involvement of the community, maximum utilization of local resources, such as manpower, money and materials, can be utilized to fulfill the goals of PHC. 88 12/29/2022 Esrom

89. 3. Appropriate technology   Technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and for whom it is used. Criteria for Appropriate technology Effective Culturally acceptable Affordable---cost effective Locally sustainable Measurable Politically responsible Environmental accountable (harmless) 89 12/29/2022 Esrom

90. 4.Equity (Equitable distribution) Implies addressing differences that are unnecessary, avoidable and unfair. Planning for equity requires identification of disadvantaged groups in terms of access to or utilization of health services. Healthcare services must be equally shared by all the people of the community irrespective of their race, creed or economic status. 90 12/29/2022 Esrom

91. 5. Health Promotion and prevention Adopting a promotive or preventive approach to health problems. Such an approach sees health as a positive attribute, rather than simply" the absence of disease“. Through health promotion individuals and families build an understanding of the determinants of health and develop skills to improve and maintain their health and wellbeing 91 12/29/2022 Esrom

92. 6.Decentralization Bring decision making to the communities and to field level providers of services. Enhance multisectoral collaboration at the lower service-delivery level. 92 12/29/2022 Esrom

93. Elements of PHC Health Education how to prevent and control them Food supply and proper nutrition Maternal and child healthcare, including family planning Adequate and safe water supply and basic sanitation Immunization against major infectious diseases Local endemic diseases control Appropriate treatment of common diseases and injuries Provision of essential drugs 93 12/29/2022 Esrom

94. Additional elements incorporated After Alma-Ata: Oral Health Mental Health Occupational Health HIV/AIDS The use of traditional Medicine ARI 94 12/29/2022 Esrom

95. PHC in Ethiopia Increased health awareness of the population. Increasing number of medical and paramedical personnel. Expansion of health services to the broad masses Locally endemic diseases prevention and control . EPI against six major CDs , MCH (FP) 95 12/29/2022 Esrom

96. Provision of essential drugs Nutrition & promotion of food supply Treatment of common diseases and injuries Sanitation and safe water supply PHC in Ethiopia…. 12/29/2022 Esrom 96

97. Major problems in implementation of PHC in Ethiopia Absence of infrastructure Failure to achieve intersectoral collaboration Inadequate resource allocation Absence of clear guidelines on how to implement PHC Weak community involvement Poor leader ship Presence of culturally dictated HTP 97 12/29/2022 Esrom

98. Approaches in PHC Two approaches in PHC implementation Selective PHC (SPHC) Comprehensive PHC (CPHC) 98 12/29/2022 Esrom

99. 1. Selective PHC approach Directing health services toward diseases with high mortality and morbidity Making health care accessible to the greater number, using criteria of morbidity, prevalence, mortality and disability 99 Approaches in PHC 12/29/2022 Esrom

100. Selective PHC approach . . . . . . . Views health as the absence of disease. sPHC is a low cost strategy to treat and prevent few selected diseases which have greater impact to mortality. 100 12/29/2022 Esrom

101. The low cost strategy of Sphc GOBIFF Strategy G = Growth monitoring O = Oral rehydration B = Breast feeding I = Immunization F = Female education F = Family planning 12/29/2022 Esrom 101

102. Approaches in PHC . . . . . . . Advantage of sPHC approach Easier decision-making Faster and more satisfactory results 102 12/29/2022 Esrom

103. Disadvantage of sPHC approach Limited scope of activities Is disease oriented. (treats individuals who are sick) Failure to address general community Failure to address priorities of the community It is Doctor dependent Failure to involved other sectors 12/29/2022 Esrom 103

104. 2. Comprehensive PHC Comprehensive PHC Focus on a positive (holistic ) state of well being Advantage of the cPHC approach It looks at health holistically Sees health as part of the development It involves and empowers people It promotes equity and priorities of the community It advocates multisectoral collaborations 104 12/29/2022 Esrom

105. Comprehensive PHC Disadvantages of the cPHC approach It is expensive initially to set up an infrastructure It requires conscious planning Results are gradual It is a long and complex process 105 12/29/2022 Esrom

106. Unit 4 Health service provision Esrom kebebew /MPH/ 106 12/29/2022 Esrom

107. Session Objectives Define equity of health care Differentiate Equity and Equality Appreciate the implications of equity in the health sector What is health utilization Determinants of health care utilization Domains of health service coverage 107 12/29/2022 Esrom

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109. Equity possibly defined as: Justice according to natural law or right; specifically : freedom from bias or favoritism . The state of quality of being justce, impartial, and fair. Equity is an ethical principle and closely related to human rights. 109 12/29/2022 Esrom

110. What does ‘Equity’ in Health mean? Equity in health implies addressing differences in health status that are: Unnecessary Avoidable and Unfair 110 12/29/2022 Esrom

111. What does ‘Equity’ in Health mean? Equity in health can be defined as the absence of disparities in health that have social disadvantage The absence of differences in one or more aspects of health across socially and economically defined population groups. 111 12/29/2022 Esrom

112. Difference of inequality and inequity Health inequality : Differences or disparities in health achievements of individuals or groups Health inequity :Those inequalities that are considered to be unfair, injustice, avoidable or unnecessary so, health inequity is t he subset of health inequalities that are unjust or unfair. 112 12/29/2022 Esrom

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114. Equality is sameness and e quity is fairness . Equal may not be equitable, or equal may be precisely equitable . In some case unequal may be a way to be equitable. 114 12/29/2022 Esrom

115. Dimension of equity Horizontal Equity : the allocation of equal or equivalent resources for equal need ; persons with same ability to pay make same contributions; Vertical Equity : the allocation of different resources for different levels of need ; persons with unequal ability to pay make dissimilar contributions; 115 12/29/2022 Esrom

116. Dimension of equity… If two individuals are in fact unequal in capacity, equal treatment would be unfair to the more capable of the two. In such a case, equity might call for un equal treatment 116 12/29/2022 Esrom

117. Health care utilization and coverage What is utilization? Utilization is when the individual actually acts on his demand or need and receives health services 12/29/2022 Esrom 117

118. Determinant factors of Health care utilization Anderson model : three factor Predisposing factor Knowledge, attitude, values, belief, etc Enabling factor Availability, accessibility and acceptability of service, 3. Need factor Perception of severity, days missed from work 12/29/2022 Esrom 118

119. The 4 A’s Model Availability Demographic distribution of health facility 2. Accessibility Transport and road, etc 3. Affordability Treatment coast, direct, indirect coasts 4.Acceptability Relates to cultural and social distances 12/29/2022 Esrom 119

120. Health Service Coverage What is Health Service Coverage What are the domains of Health Service Coverage 12/29/2022 Esrom 120

121. Health Service Coverage … Health Service Coverage is considered as a concept expressing the extent of i nteraction between the service and the peopl e for whom it is intended The ratio between the number of people for whom the condition is met and the target population, 12/29/2022 Esrom 121

122. Health Service Coverage Limiting the target population to specific subgroups differentiated by certain conditions or by demographic or socio- economic factors. 12/29/2022 Esrom 122

123. Health Service Coverage … WHO proposes five domains of coverage measure : 1. Availability coverage 2. Accessibility coverage 3. Acceptability coverage 4. Contact coverage 5. Effective coverage 12/29/2022 Esrom 123

124. Health Service Coverage … 1. Availability coverage First of all, some resources – human power, facilities, drugs, etc- are always required in order to provide a service, The ratio between this resources and the size of the target population gives the measurement of availability coverage 12/29/2022 Esrom 124

125. Health Service Coverage … 2.Accessibility coverage The service must be located within reasonable reach of the people who should benefit from it. Meeting this condition can be considered as the next stage in the process of service provision, Here , the capacity of the service is limited by the number of people who can reach and use it . 12/29/2022 Esrom 125

126. Health Service Coverage … 3.Acceptability coverage The service needs to be acceptable to the population , otherwise people may not use it This “acceptability” may be influenced by such factors as the cost of the service, religion, etc. Here service capacity is limited by the number of people who are willing to use the service. Quality is most closely related to acceptability . 126 12/29/2022 Esrom

127. Health Service Coverage … 4. Contact Coverage The next stage in the process of service provision is the actual contact between the service provider and the user. The ratio between number of people who have contacted and the size of the target population gives measurement of contact coverage. Utilization is related to contact coverage. 127 12/29/2022 Esrom

128. Health Service Coverage … 5.Effectiveness coverage The contact between the service provider and the user does not always guarantee a successful intervention related to the user’s health problem or an effective service. We can, therefore, consider another stage in the process of service provision where a service performance that is appraised as satisfactory by specific criteria is achieved. The number of people who have received satisfactory service is thus another measurement of service output called effective coverage. 12/29/2022 Esrom 128

129. Coverage.. Potential coverage Availability coverage Accessibility coverage Acceptability coverage B. Actual coverage Contact coverage Effectiveness coverage 12/29/2022 Esrom 129

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