Introduction to Health Systems

Introduction to Health System

• A health system comprises people, institutions, and resources who deliver healthcare services to fulfill the health needs of a target population.
• It includes formal healthcare services, non-formal services like health promotion and disease prevention, and activities that focus on factors other than health, like education, industry, and agriculture.

Static vs Dynamic Health Systems

• Static health systems try to manage emerging issues with old strategies, while dynamic health systems evolve and respond to changes in demographics, epidemiology, client expectations, private sector growth, and medical technology.

WHO's Health System Performance Assessment

• The World Health Organization (WHO) assesses health system performance to understand how well healthcare systems are achieving their goals.

Goals of a Health System

• Health: Focuses on mortality, life expectancy, and disability-adjusted life expectancy. Fairness is assessed by comparing life expectancy between rich and poor populations.
• Responsiveness: Evaluates the system's response to non-health aspects of patients' needs, including treating them with dignity and providing amenities like access to visitors, newspapers, clean water, and the ability to choose a healthcare provider.
• Fairness in Financing: Ensures cost distribution based on ability to pay, not risk of illness. Assessed through out-of-pocket expenditure and insurance contributions.

Functions of the Health System

• Stewardship: The government's role in overseeing health policy, exerting influence through regulations, and collecting and using health information.
• Financing: Includes revenue collection, fund pooling, and purchasing.
• Resource Generation: Involves acquiring human resources like doctors and staff, physical resources like buildings and equipment, and consumables such as medicines.
• Service Provision: Involves combining inputs to deliver personal health services like prevention, diagnosis, treatment, and rehabilitation, and non-personal health services like mass education, safe water supply, and vector control.

Health System of Pakistan

• The Pakistani health system operates in three tiers: Federal, Provincial, and District levels.

Federal Level

• Includes tertiary care hospitals, primary and secondary hospitals, and vertical programs like the LHW program, malaria control program, AIDS control program, provincial TB control program, maternal neonatal and child health program, expanded program on immunization, food and nutrition program, and the DDOs (District Development Officers) responsible for administration and finance.

Responsibilities of tiers since 18th Amendment

• Federal: Generation of national health policy, management of vertical programs (66% funding), international coordination, regulation of institutions and drug control, and administration of some hospitals (20% funding).
• Provincial: Coordination with federal government, supervision of District Health Services (DHS), recruitment, promotion, and disciplinary action, financial distribution, and generation of intelligence and national health policy.
• District: Management of staff, record-keeping, planning, problem solving, developing partnerships, conducting health service research (HSR), and disaster preparedness.

Healthcare Financing in Pakistan

• Sources: Public revenues (28%), development assistance (3%), insurance and safety nets.
• Issues: Low tax-to-GDP ratio, inadequate allocation to health, inconsistent development assistance, limited employer insurance coverage, inadequate safety nets, misalignment between available and needed services, delays in disbursement, corruption, and unsatisfactory incentives for healthcare workers.

Resources of Pakistan's Health System

• Human Resources: 195,000 doctors, 18,000 dentists, 100,000 nurses, 10,000 LHV's, 25,000 midwives, 100,000 LHW's, 36,488 Tabibs/Hakeems, 21,341 Homeopaths, and 537 herbalists.
• Infrastructure: 1142 hospitals, 118,041 hospital beds, 5374 BHUs, 584 RHCs, 1000 MCH Centers, and 400 TB Centers.

Human Resource Issues

• Inadequacy: High dropout rates among female graduates, emigration of male doctors, shortages of specialists, and low incentives in the public sector leading to dual job holding.
• Unfair Distribution: Poor facilities in rural areas.
• Training and Capacity: Lack of merit-based recruitment, inadequate curriculum, and limited exposure to common problems.

Issues Related to Service Delivery

• Service Utilization: Incomplete figures, lack of data for private healthcare, and gaps in data collection between hospitals and primary healthcare facilities.