Healthcare System Overview

Learning Objectives

• Understand the preamble "The Road Map from Alma Ata to Astana"
• Examine Health in WHO Constitution
• Define health care, health services, and healthcare service delivery
• Understanding different aspects of healthcare, including health need, health improvement, health gain, and health outcome
• Identify the WHO health system framework
• Analyze schematic overview of health care system
• Differentiate between Primary Care, PHC, and Public Health
• Understand the cohesive definition of PHC based on its three components
• Examine the organization of health structure at the District Level
• Illustrate the '3-tiered health system of Pakistan'
• Appraise the components and desirable features of a healthcare system

Resources & References

• The material is based on resources such as Park's Textbook of Preventive Medicine and Social Sciences, Public Health and Community Medicine by Ilyas Ansari, and the Oxford Textbook of Public Health.
• It includes references to the declarations of Alma-Ata(1978) and Astana(2018)
• Links to online resources from WHO and UNICEF are provided for further reading

The Road Map: Alma Ata to Astana

• International Conference on Primary Health Care was convened by WHO and UNICEF
• The Ottawa Charter was the 1st International Conference on Health promotion
• The Jakarta Declaration offered a Vision and Focus of Health Promotion into the 21st Century
• MDGs are 8 goals that UN Member States have agreed to try to achieve
• There has been a global conference on Primary Health Care in Astana, Kazakhstan
• The Sustainable Development Goals (SDGs)"blueprint to achieve a better and more sustainable future for all by 2030

Meaning of Primary

• Usually used before a noun
• Means main or most important
• Means basic.
• Indicates something that is developing or happening first or it's earliest.

Health

• Health is defined as a state of complete physical, mental, and social well-being.
• It is not merely the absence of disease or infirmity

Health - WHO Constitution

• Health incorporates physical, mental, and social well-being and not merely the absence of disease
• The highest attainable health standard is a fundamental human right, regardless of race, religion, or economic status.
• The health of all people is essential for peace and security.
• Health depends on the cooperation of individuals and States.
• Health promotion and protection by any State are a valuable achievement for all.
• Unequal health development and the spread of communicable diseases are dangers across countries.
• Child development, medical advancements, public cooperation, and governmental responsibility are key to achieving health.

Health System

• A health system delivers health services through management, planning, resource allocation, policy implementation, and evaluation.
• Includes activities to improve or maintain health
• Includes how nations manage national healthcare services and local health services.

Healthcare

• Services provided to individuals or communities to promote, maintain, monitor, or restore health.
• Extends to self-care

Health Services

• These are performed by professionals to promote, maintain, or restore health.
• These include health protection, promotion, and disease prevention

Health Care Service Delivery

• Making health care services available to a population is health care service delivery
• Multiple services rendered to individuals, families, and communities to promote, maintain, monitor or restore health

Aspects of Health and Healthcare

• Healthcare Need is the Capacity to benefit from healthcare
• Health Improvement describes Population health benefit associated with intervention on the determinants of health
• Health Gain describes Individual or population health benefit associated with healthcare intervention
• Health Outcome measures the change in individual or population health status associated with needed healthcare

The WHO Health System Framework

• Includes Human resources, medicines and technologies, leadership, financing, information, and service delivery

The Health System

• Includes the Ministry of Health, National centres and programmes, and National hospitals and universities at a central level
• Provincial health departments and regional training centres at a provincial level
• District Level: Operational District and Referral hospitals at this level and including Health Centres at a community participation level

Declaration of Alma-Ata & Astana

• The Declaration of Alma-Ata in 1978 outlined primary health care principles as a seminal moment.
• Global leaders ratified the Declaration of Astana at the Global Conference on Primary Health Care in October 2018

Declaration of Alma-Ata

• Leaders gathered in Alma-Ata, Kazakhstan, in 1978, which was a seminal moment in global health.
• The Declaration of Alma-Ata was the first to call for urgent action to implement primary health care.

Concept of PHC

• PHC involves a whole-of-society approach.
• PHC maximizes health and well-being by focusing on people's needs.
• PHC involves health promotion, disease prevention, treatment, and rehabilitation.

5 Types of Care

• There are five types of care.
• These Include promotive, preventive, curative, rehabilitative, and supportive/palliative
• Care focuses on preventing illness and promoting health.

Definition of Primary Health Care

• WHO defined PHC in the Declaration of Alma-Ata.
• PHC describes care that is essential and health care is universally accessible at a sustainable cost.

Premise of Primary Health Care

• All people deserve the right care, right in their community.

Concept of PHC

• The concept of PHC has been reinterpreted repeatedly.

Declaration of Astana

• A Global Conference on Primary Health Care took place in Astana in October 2018.
• Primary health care was reaffirmed as an approach to achieve universal health coverage.

What is Primary Healthcare?

• It is an approach to health and well-being centered on the needs of individuals, families and the community
• It addresses comprehensive and interrelated physical, mental and social health and wellbeing

Component of Primary Health Care

• Policy and action, health and wellbeing, and community

Comprehensive Definition of PHC

• The components work by Meeting health needs through comprehensive care
• This involves addressing determinants of health, and by Empowering individuals and communities

First contact

• Is the first contact between the population and the health-care system
• The provision of care must be accompanied by multisectoral actions

Terminology in Context

• Important terms include Primary Care (PC), Primary Health Care (PHC) and Public Health (PH)

Primary Care (PC)

• Health or medical care that begins at the time of the first contact between a physician or other health professional and a person seeking advice or treatment for an illness or an injury

Primary Health Care (PHC)

• Essential health care made accessible at a cost that a country can afford.
• It promotes community participation and includes various health services, from health promotion to essential drugs.

Public Health

• Public Health is society's response to threats to the collective health of its citizens.
• Includes practitioners that work to enhance and protect the health of populations
• Includes preventing disease, disability and premature death

Levels of Health Care

• Health services are usually organized at three levels.
• Each level is supported by a higher level to which the patient is referred.

First Level of Health Care

• It is the first point of contact between the individual and the health system
• Includes Basic Health Units (BHUs) and Rural Health centres (RHCs)
• This level of care is closest to the people.

Second Level of Health Care

• More complex problems areaddressed
• Provides curative services through district hospitals and community health centres.
• It serves as the first referral level.

Third Level of Health Care

• Superspecialist care is offered
• This care is provided by regional/central level institutions.
• These institutions provide planning, managerial skills, and teaching for specialized staff.
• The tertiary level supports the actions carried out at the primary level.

Health Care System: Organization

• Tertiary Healthcare involves Teaching Hospitals and Provincial General Hospitals
• Secondary Care involves a Tertiary Health Quarters and District Health Quarters
• Primary Care involves First Level Healthcare Facilities

Structure of Provincial Health Care

• Teaching hospitals and provincial general hospitals provide tertiary-level care.
• Secondary-level facilities provide acute, ambulatory, and inpatient care.
• Primary-level health care offers preventive and health promotive services.

Primary and Secondary Health Care in Pakistan

• Pakistan has a large primary health care infrastructure.
• Infrastructure includes basic health units, rural health centres, and lady health workers.
• Primary health care services are supported by a network of secondary care hospitals.

Basic Health Units & Rural Health Centers

• Basic Health Units (BHUs) serve a population of up to 25,000.
• Maternal and child health (MCH) services are provided at BHUs.
• Rural Health Centers (RHCs) are provided to a population of up to 100,000.
• Services may include diagnostic and promotive, preventive, curative, referrals.

Tehsil Head Quarters & District Head Quarters

• Tehsil Head Quarters (THQs) serve a population of 0.5 to 1 million.
• Emergency care, obstetrics, and newborn care offered
• District Head Quarters (DHQs) serve higher populations and provides a range of services

Lady Health Workers Programme

• Aims to increase access to preventative healthcare in rural areas launched in 1994
• Main objective of reducing poverty and improve national health indicators

Desirable Feature of a Well Functioning Healthcare System

• Improves health status, defends against threats, protects against financial consequences, and provides equitable and people-centred care.

Components of the Health System

• Components Concepts, Ideas, Objects and Consumers
• All components interact to serve one another