Health Care Services

• Health care services include services provided to individuals or communities.
• Agents of health services or professions generally provide this health care.
• Actions promoting, maintaining, and restoring health are the purpose of all activities.

Medical Care Defined

• Medical care is not synonymous with health care,.
• It refers to personal services provided directly by physicians.
• Also includes services rendered because of physician's instructions.

Levels of Health Care

• Primary care level.
• Secondary care level.
• Tertiary care level.

Primary Health Care

• The point at which individuals and families receive essential health care services is the primary health care level.
• Services include health promotion, protective measures, preventive care, simple diagnostics, curative treatments, and rehabilitative activities for ambulant patients.
• Primary health care facilities typically have no beds, except for emergency and maternity care.
• Staff may or may not include a physician.
• Rural areas, it is typically housed in a health center.
• Urban areas, it may include a general medical practitioner's clinic, polyclinic, health center, or outpatient department of a hospital.

Secondary Health Care

• More difficult cases are managed at this level.
• Curative services are its main focus.
• It is mainly found in district hospitals.
• It is considered the first referral level.
• Includes hospitals and more advanced centers.

Tertiary Health Care

• A more specialized level compared to secondary care.
• It needs specific facilities.
• It requires highly specialized health workers
• Specialized hospitals and centers are where it's provided.
• It is provided by regional or central level institutions.
• It provides the country's/region's highest level of medical care.
• A functional health care system requires referral.
• Information exchange and patient return are necessary for follow-up and continuity.

Major Components of Health Services

• Curative services providing care for the sick.
• Preventive services protecting population health.
• Special services addressing specific problems/groups.
• Social welfare services for the chronically ill, orphans, etc.
• Health education.

History Iraqi Health Services

• Iraq's health care delivery historically followed a hospital-oriented and centralized model.
• Less emphasis was placed on preventive measures.
• The system lacks the ability to address major health problems faced by the majority of the population.
• The system struggled provide equitable and sustainable services.
• 1983: Iraqi Health Policy incorporated primary health care.
• The health system depends primarily on primary health care delivery.
• The Ministry of Health (MoH) provides most health care via curative and preventive measures.
• Health care is provided through primary health care centers.
• Health care provided through public hospitals of varying levels.
• Health care also available at specialized centers.
• The private sector provides curative services.
• The current PHC system needs to be capable.
• Respond effectively and efficiently to complex and growing health needs.

Basic Health Services Package (BHSP)

• Is defined as a minimum collection of essential health services that all the population need to have a guaranteed access to.
• Provides essential services that are health services that provide a maximum gain in health status.
• It occurs on national level.
• Services occur for the money spent (cost effective services).
• A new health care approach was introduced in 1978 at international Alma-Ata conference.
• Essential health care is universally accessible, acceptable, and affordable for communities and countries.

Primary health care facilities classifications in Kurdistan

• Type C, B, A
• Family medicine
• Detention
• University
• Emergency coordination
• Common Designs and Plans for Primary Health Centers are architecturally developed.
• Type C health centers are small, non-medical sub-centers.
• Type B health centers are major centers lacking urgent and delivery services.
• Type A health centers are main centers that urgent and delivery service.
• Family medicine centers include designated medical specialists.
• Detention (prison) health centers provides care for detainees.
• University health centers providing services to university students.
• Emergency coordination centers are pre-hospital centers.

Elements of PHC centers

• Health promotion and education.
• Maternal health care including family planning and antenatal care.
• Child health care.
• Immunization against major infectious diseases.
• Prevention and control of locally endemic diseases.
• Appropriate treatment of common diseases with essential drugs.
• Training activities for medical and paramedical staff.
• Delivers simple emergency care services.
• Services for normal labour.
• Structure of health system in Iraq.
• The MoH is the main health provider in Iraq
• Directorates of Health (DoH) exist in each governorate.
• DoH are divided into districts for administration.
• Each district has 5-10 PHC centers providing primary care to populations of 10,000-45,000.
• There is currently an average 0.7 PHC per 10,000 people.
• Lower than neighboring countries (2-3 PHC/10,000) and international standards.
• Those staffed by at least one medical doctor are called main PHC centers.
• Those staffed by trained health workers (nurses, medical assistants), they are referred to as sub-centers.
• Sub-center care includes:
• Simple maternal.
• Child health services along with immunization.
• Simple curative services.
• PHC centers are intended to refer patients to the second level of MoH district care.
• Each hospital serves 50,000-150,000 people depending on geographical access.

Functions of PHC centers includes

• Medical care.
• Maternal and Newborn Health.
• Child health as well as immunization and includes:
  • Growth monitoring.
  • Expanded program on immunization (EPI).
  • Integrated management of childhood illnesses.
• Communicable disease treatments including:
  • TB.
  • Typhoid.
  • Hepatitis.
  • Cholera.
  • Malaria.
  • STD.
• Non-communicable diseases treatment and prevention includes:
  • HTN.
  • CVS.
  • DM.
  • Malignancies.
• Food safety, environmental health, and school health.
• Health promotion and education.
• Collection and reporting of vital statistics.
• Training of health personnel.
• Diagnostic laboratory and imaging services.
• Referral services.
• Health Information System.
• Support to health functions.
• It is essential to development of health system.

The thealth infomration data deals with 3 types of records

• Health and disease records.
• Health services records.
• Resources records.

Challenges to health system in Iraq and KRI highlighted in Health system assessment in 2011

• Includes some low health indicators
• Service delivery not consistent with resource availability
• Inequities in inputs, outputs, and outcomes
• Absence of incentives in public service for better performance
• Weak accountability arrangements
• Lack of strong "drivers" for key strategy of PHC / Family Medicine
• Objectives and structures for regulation are inadequate
• Insufficient human resources and motivation for the system transformation
• Inadequate evidence base for policy making, strategic planning, monitoring and evaluation

Health care services are provided to individuals or communities to promote, maintain, and restore health. Medical care, a subset of health care, refers to services provided directly or indirectly by physicians. Health care is delivered through primary, secondary, and tertiary levels.