Healthcare System Overview

• Health system consists of organizations, people, and actions to promote, restore, or maintain health, including efforts to improve health determinants.

High-Quality Health System

• Optimizes health care in a given context.
• Improves or maintains health outcomes.
• Is valued and trusted.
• Responds to changing population needs.

Health Service Delivery Levels

• Primary Level
• Secondary Level
• Tertiary Level

First Point of Contact options

• General Practitioner (GP), also called a family doctor/physician.
• Practice Nurse.
• Public Health Nurse.
• Allied Health Professional (e.g., Pharmacist, Physiotherapist, Occupational Therapist, Psychologist).
• Hospital.
• Other (e.g., health advisor).
• GPs are often considered the cornerstone of the health system.

Primary Care Level Overview

• Primary care is the initial point of contact for individuals, families, and communities with the national health system, bringing healthcare close to where people live and work.
• Primary care staff, like doctors, act as the first point of consultation for all patients.
• Primary care staff should know their patients, families, and communities.
• Primary care staff should provide continuity of care for common chronic conditions.
• Pharmacists, nurses, or community health workers also provide advice.

Primary Care in Bahrain

• Bahrain provides primary health services through 25 health centers in its five governorates.
• These centers offer curative, preventive, and rehabilitative services.
• Citizens and residents register for treatment at their local health center.
• Services are delivered by an integrated medical team with medical records coordinators.
• Physiotherapy services are available.

Primary Care Level - Prevention

• Family planning and sexual health
• Antenatal and postnatal care
• Infant and child feeding, including supplements like Vitamin A and D
• Growth monitoring and developmental examinations
• Immunizations
• Screening programs for breast, cervical, colon, and prostate cancer
• Lifestyle advice, support for smoking, alcohol, and obesity
• Case-finding for conditions like diabetes and atrial fibrillation

Primary Level: Care + Systems Tasks

• Essential newborn care
• Case management of childhood illnesses
• Managing communicable and non-communicable diseases
• Includes chronic disease management and support, with patient education for self-management of conditions
• Focuses on mental health, including anxiety, depression, and sleep disorders
• Managing budgets, drugs, and consumables.
• Data recording and reporting for vital statistics and notifiable diseases.
• Achieving and reporting prevention and screening targets
• Coordinating patient access to physiotherapy, occupational therapy, speech therapy, and social services.
• Acting as a gatekeeper, enabling or controlling access to hospital care

Secondary Care Level

• Provided in hospitals, including accident and emergency, outpatient, antenatal, genitourinary medicine, and sexual health clinics
• Patients are often referred from primary care to hospital specialists for outpatient clinics, investigation, diagnosis, and treatment
• Medical and surgical specialists and other health professionals generally don't have first contact with patients (e.g., cardiologists, endocrinologists, surgeons)
• More sophisticated investigations, such as imaging services, may require a visit to a specialist outpatient clinic
• May be the only means to access Allied Health Professionals' services, such as physiotherapists, respiratory therapists, occupational therapists, speech & language therapists, social workers, and dietitians
• Access to acute care for serious illness or injury takes place through emergency GP referral or hospital Accident and Emergency department (A&E)
• Access to A&E is a difficult balance because of limited resources

Tertiary Level

• Tertiary healthcare is the highest level of the health system, where patients are referred from less sophisticated secondary care settings.
• It is characterized by advanced diagnostic, treatment, and support services, such as intensive care units, and specialist medical, nursing, and ancillary staff.
• Two features distinguish tertiary from secondary hospitals; interventions that require large multidisciplinary teams and national specialist centers.
• Examples of interventions requiring large multidisciplinary teams include coronary artery bypass surgery, organ transplant surgery, and increasingly cancer surgery.
• The National Kidney Transplant Service is coordinated through Beaumont Hospital
• The two main specialist centers for neurosurgery in Ireland are Beaumont Hospital Dublin and Cork University Hospital

Referral System Summary

• It involves a health professional seeking assistance from another health professional or facility at the same or higher level, to support or take over patient management
• Types of referral are outpatient attendance, inpatient admission, and A&E.
• Reasons to Refer include seeking expert opinion, access to diagnostic tools, specialist services, and client admission and management
• Key components include excellent communication and ensuring patients return to the referring professional (GP).

How Patients End Up in Hospital

• Routes include referrals to Medicine, Surgery, Paeds, and O+G
• Patients can arrive to the hospital via route of a GP or from ED

WHO Health Systems Framework

• Focuses on leadership/governance, healthcare financing, workforce, medical products/technologies, information/research, and service delivery.
• The goals/outcomes include improved health, responsiveness, financial risk protection, and improved efficiency.
• Aims to ensure strategic policy framework with oversight, regulations, and accountability ("Government Stewardship functions").

Health Systems Building Blocks (1)

• Service delivery involves effective, safe, quality interventions when and where needed, with minimum waste.
• A well-performing health workforce is responsive, fair, and efficient, with sufficient, competent, and motivated staff.
• A health information system ensures reliable and timely information on health determinants and system performance.

Health Systems Building Blocks (2)

• Medical products and technologies ensures equitable access to quality vaccines, technologies, and cost-effective use.
• Health financing should raise adequate funds, ensure access, and protect against financial hardship.
• Leadership and governance ensures strategic policy frameworks, oversight, and accountability

Government Stewardship Functions

• Include system design, priority setting, performance assessment, inter-sectoral action through government ministries, population protection, and regulation.

Primary Health Care (PHC)

• Essential healthcare accessible to individuals and families made accessible through the community and affordable by the country.
• Involves a consensus that health (physical, mental, and social well-being) is a fundamental human right.
• Principles include Universal Health Coverage and underlying principles of population health
• Principles include community participation, intersectoral action for health (social determinants), evidence-based interventions, and affordable/sustainable systems.
• Universal Health Coverage (UHC) ensures people can use promotive, preventive, curative, rehabilitative, and palliative services of sufficient quality without financial hardship

The SDG Report 2023

• Polycrisis era presents climate crisis, war/conflict, and economic challenges with lasting COVID-19 effects (only 15% SDGs on track)
• Reversal of progress impacts poverty, hunger, health, education, and basic services
• Action needed for urgent progress.

Global Code on the international recruitment of health personnel

• Involves ethical international recruitment, avoiding active targeting of countries with health worker shortages
• Calls health workforce development and systems sustainability
• Ensures fair treatment of migrant health personnel, which includes the right to emigrate, accurate information, and equal treatment.

Explore key concepts in healthcare systems, including the transition between levels of care (primary, secondary, tertiary). Understand the roles of primary care and challenges in managing acute care services. Also learn the WHO's definition of a health system and the role of GPs.