Health System and Services Overview

Health System and Services

• A health system consists of all organizations, people, and actions to improve, promote, and maintain health. This includes improving determinants of health.
• A high-quality health system optimizes care in a given context, improving or maintaining health outcomes, and is valued and trusted by the population while responding to changing population needs.

Learning Outcomes

• Describe the different levels of the health system and types of services at each level.
• List and explain the components and functions of the health system and how they contribute to health outcomes.
• Explain how Sustainable Development Goals and Primary Health Care Principles influence health.
• Discuss how to manage the health workforce.

Levels of Health Service Delivery

• Primary Level: The first point of contact, frequently a General Practitioner (GP), Practice Nurse, Public Health Nurse, or Allied Health Professional (e.g., pharmacist, physiotherapist).
• Secondary Level: Hospital specialist outpatient clinics, investigations, diagnosis, and treatment. Usually, patients are referred from primary care.
• Tertiary Level: The highest level, involving advanced diagnostics, treatment, and support services in intensive care units and specialized medical, nursing, and ancillary staff. Referrals are common from primary and secondary care.

First Point of Contact

• The most common first point of contact for health advice or treatment is a General Practitioner (GP).
• Other points of contact include Practice Nurses, Public Health Nurses, and Allied Health Professionals (e.g., pharmacists, therapists). Hospitals may also be a first point of contact.

Primary Care Level - Overview

• Primary care is the first contact with the national health system, bringing care close to where people live and work.
• Primary care staff, like GPs, act as a first point of consultation for all patients.
• They know their patients, families, and communities.
• They provide continuity of care for common chronic conditions.
• Patients often seek advice from other accessible professionals like pharmacists, nurses, or community health workers.

Primary Care Level - Prevention

• Health promotion and prevention services (including screening):
  • Family planning and sexual health
  • Antenatal and postnatal care
  • Infant and child feeding, supplements (e.g., Vitamin A and D)
  • Growth monitoring and developmental examinations
  • Screening for breast, cervical, colon, and prostate cancer
  • Advice and support on lifestyle and common risk factors (smoking, alcohol, obesity)
  • Case-finding (e.g., diabetes, atrial fibrillation)

Primary Level: Care + Systems Tasks

• Case management and care:
  • Essential newborn care
  • Case management of childhood illnesses
  • Management of communicable and non-communicable diseases
  • Chronic disease management
  • Supporting patients to self-manage their conditions
  • Mental health (anxiety, depression, sleep disorders)
• Health systems tasks:
  • Managing budgets, drugs, and consumables
  • Data recording and reporting (vital statistics and notifiable diseases)
  • Reaching and reporting on prevention and screening targets
  • Coordinating patient access to services (physiotherapy, occupational and speech therapy, social services)
  • Enabling/controlling access to hospital care

Secondary Care Level

• Secondary care is provided in hospitals, including accident and emergency departments, outpatient departments and clinics for antenatal services, genitourinary medicine, and sexual health services.
• Patients are frequently referred from primary care for investigations, diagnosis, and treatment.
• Specialists (e.g., cardiologists, endocrinologists, and surgeons) often provide secondary care services.
• Sophisticated investigations (e.g., imaging) may be accessible only from secondary care professionals (outpatient clinics).
• Access to allied health professionals (e.g., physiotherapists, therapists) may also be found primarily through secondary care.
• Acute care for serious illness or injuries is common to secondary care access through emergency GP referrals or hospital A&E departments.

Tertiary care Level

• Tertiary health care is the most advanced level, with referrals from primary and secondary care.
• Patients are referred for highly specialized diagnoses, treatments, and support services (e.g., intensive care units, specialist medical, nursing and ancillary staff).
• Tertiary care often involves large multidisciplinary teams for intricate procedures (e.g., coronary artery bypass surgery, organ transplants, and cancer surgery).
• National specialist centers are also part of tertiary care.

Health Systems Pyramid (Lancet 2008)

• The pyramid visualizes a hierarchical structure.
• Refers to a hierarchical structure, starting from basic primary care at the base, to hospital specialist services in the middle, and to complex tertiary level specialists at the top.

Referral Systems

• A referral is when a health professional seeks assistance from another professional or facility for patient management.
• Referral situations include outpatient attendance, inpatient admission, or A&E.
• Reasons for referring include expert opinions, diagnostic/therapeutic tools, specialist services, or admission management.
• An effective referral system has excellent communication channels in both directions, and higher-level facilities endeavor to return patients to the care of referral professionals (usually a GP).

How Patients End Up in Hospital (Simplified)

• Patients frequently consult with a General Practitioner (GP).
• Emergency Department (ED) evaluations might lead to referral to a specialist department (e.g., medicine, surgery, paediatrics, obstetrics and gynaecology (O&G)).

WHO Health Systems Framework

• The WHO framework outlines system building blocks, including leadership, governance, healthcare financing, workforce, and medical products/technologies.
• It also emphasizes access, coverage, quality/safety, goals/outcomes including improved health and systems efficiency and responsiveness.

Health Systems Building Blocks (1)

• Service Delivery: Delivering effective, safe, quality personal and non-personal interventions when and where needed with low resource waste.
• Workforce: Responsive, fair, and efficient workforce that achieves the best health outcomes based on available resources, competent, and motivated to work hard.
• Health Information System: A system that produces, analyzes, disseminates reliable and timely information for health, health system performance, and health status determinants.

Health Systems Building Blocks (2)

• Medical Products and Technologies: Ensures equitable access to quality, safe, effective, and cost-effective medical products, vaccines, and technologies.
• Health Financing System: Raises sufficient funds for health, ensuring people can access and utilize essential services while avoiding financial difficulties.
• Leadership and Governance: Strategic policy frameworks, effective oversight, coalition building, appropriate regulations and incentives, and attention to system design and accountability are key to effective governance.

Government Stewardship Functions

• System design: Policy formulation and establishing a strategic direction.
• Priority setting: Addressing technical and political aspects.
• Performance assessment: Monitoring and evaluating effectiveness.
• Inter-sectoral actions: Cooperation across government ministries, particularly concerning population protection.
• Population protection: Addressing infectious diseases and environmental risks.
• Regulation: Setting rules and ensuring adherence.

High-Quality Health System Framework (Lancet Global Health Commission 2018)

• A model emphasizing processes, competent care, positive user experience, governance, and equitable access, accessibility, and organization of care for a resilient and efficient system.

Global Health: Primary Health Care (Alma Ata 1978)

• Primary Health Care is a fundamental human right accepted by governments and is accessible to individuals and families.
• Ensures Universal Health Coverage, community participation, intersectoral actions and intervention, and is affordable and sustainable.

Sustainable Development Goals (SDGs)

• The importance of SDGs in achieving health for all people.
• The SDGs report 2023 highlights challenges in reversing poverty, hunger, health and education progress.

Global Supply of Doctors

• Data presentation shows global variation in the doctor supply across different geographic areas.

Global Code on the International Recruitment of Health Personnel

• Aims to avoid health worker recruitment from countries with shortages.
• Provides guidelines for health workforce development and the importance of retaining health workers in each country.
• Enforce fair treatment of migrant health personnel.

Ten Actions to Strengthen the Health and Care Workforce

• The WHO Europe framework includes 10 actions to strengthen the health and care workforce, emphasizing workforce alignment with population needs and health service requirements, and promoting continuing professional development, workforce capacity building and strategic planning for workforce governance.

Additional Resources

• Lists specific resource websites, offering specific details about health insurance laws and referencing the content's sources based on slides from experts.

Questions?

• Provides a discussion forum for questions related to the course material.
• Offers an email address for students seeking additional assistance.