LECTURE 1 INTRODUCTION TO HEALTH SSTEMS MANAGEMENT.pptx

LECTURES NOTES

1. LECTURE ONE: INTRODUCTION TO HEALTH SYSTEMS MANAGEMENT WEEK ONE

2. NURS 417: HEALTH SYSTEMS MANAGEMENT LECTURE ONE: 1.

3. LECTURE ONE: WEEK ONE CONTEXT OF THE HEALTH SYSTEM

4. Objectives/OVERVIEW By the end of this module the participant should be able to: • Define concepts of a health system • Describe the components of a health system • Explain the importance of systems thinking for health systems strengthening

5. Objectives; cont’d • Discuss the characteristics of a functioning health system • Describe the challenges and emerging health systems issues in Africa

6. UNIT 1: DEFINITIONS: DEFINING A HEALTH SYSTEM

7. 1. WHAT IS A SYSTEM? 2. WHAT IS A HEALTH SYSTEM?

8. “ A system is a group of interacting, interrelated, or interdependent elements forming a complex whole” (Heritage Dictionary, 4th ed., 2000 by Houghton Mifflin Company)

9. “ A health system consists of all organizations , institutions, people and actions whose primary intent is to promote, restore or maintain health” (WHO, 2007)

10. Illustration of a health system

11. A healthcare system: is a means of organized social response to the health conditions of the population. It is narrower than a health system and is often described in terms of the levels of healthcare and organizational structure of the Ministry responsible for health in most countries

12. Definition of systems thinking • Systems thinking is a paradigm shift that emphasizes a deeper understanding of dynamism, linkages, relationships, interactions and behaviors among the elements that characterize the entire system • It focuses on holistic approach to designing, implementing and evaluating health interventions

13. Definitions: health systems strengthening Health Systems Strengthening ( HSS ) is defined as... building capacity in critical components of health systems to achieve more equitable and sustained improvements across health services and health outcomes (WHO, 2007)

14. Principles of a health system • People- centered - Equity and fairness • Results-oriented - Quality management system for continual quality improvement • Evidence-based - Technocrats, academicians , politicians, community/local context and change • Community-driven- Leadership, governance accountability, transparency and sustainability

15. Principles cont’d ; • Context-specific – circumstance specific , context is synonymous with resource-constrained environment • Ethically sound – Human rights and dignity, safety for the client, community and environment • Systems thinking- Holistic view of the health system

16. Context of the health system in Africa • Organizational arrangements • Economic context • Socio-cultural and political context • Legislative context • Main actors in the health system

17. 1. Organizational arrangements a. Centralized health systems b. Decentralized health systems c. Organizational levels of health systems

18. a. Centralized • Top-down approach Authority concentrated at the top Bureaucratic Minimal community involvement. • Vertical programming

19. b. Decentralized • Bottom–up approach. Active participation of community actors. Ownership. Sustainability. • Horizontal, primary health care programming

20. Types of decentralization; • Various types of decentralization include: i. Deconcentration ii. Delegation iii. Devolution and iv. Privatization – outsourcing and contractual

21. Devolved health system and its linkages to other structures

22. b. Organizational levels of health system The service delivery levels vary across countries. The following are generic levels: • Tertiary Central or national level eg referral Hospitals • Secondary Regional, provincial or counties eg county referral hospitals

23. Cont’d; • Primary District, sub-district or sub-county eg sub-county hospitals • Community health centres, Dispensaries , clinics, villages or groups • Household Individuals or families

24. Decentralized organizational system: client focus

25. See page 21 leadership and management book for diagram of decentralized health system (HSS Mannual ) Check resouces reference books in Moodle

26. c. Health systems: economic context • High poverty levels • Low investments in health at all levels • Unsustainable and fluctuating donor support • Uneven progress in health, growing gaps Focus on few programme areas, with others ignored / missed

27. Economic context cont’d ; Gaps in health services increasing, as focus driven by priorities of donors Burden of healthcare financing through user fees • Persisting inequalities in access, use and financing of services Poor, illiterate, and other disadvantaged groups still not accessing services • Inappropriate application of technology

28. Health systems: socio-cultural and political context • Strong cultural norms and values that influence behavior • Resilient yet ineffective traditional health system • Poorly operationalized social dimensions of health • Political and civil strife from protracted wars and/or conflicts • Weak political will to implement policies and commitments

29. • Poor stewardship • New challenges to health and health systems New / re-emerging conditions, and health threats Changing behaviour, leading to new risks for various diseases

30. Social and political context cont’d; •Rising expectations and growing dissatisfaction Globalization, better information flows mean persons aware of rights. Mismatch between expectations and performance

31. d. Health systems: legislative context Laws, declarations and commitments on Health • Global • Regional • National

32. Ct… legislative context Declarations and commitments on health •Global MDGs with emphasis on health related goals Paris declaration – Aid effectiveness Regional health declarations and commitments Ouagadougou Declaration on primary health care (mentioning Bamako and Alma Atta) and health system strengthening

33. Cont’d; Abuja declaration - health sector financing Maputo declaration – strengthening of laboratory systems Libreville –social determinants of health. Algiers - research for health.

34. e. Main actors in the arena Core partners have the following primary roles: funders, providers, purchasers, implementers, watchdogs: • Government. • Private /NGOs. Not for profit (e.g. faith-based) • Civil society organizations

35. • Development partners - International - Bilateral - Foundations • Media