نظام الصحة في اليمن

Health Information Management

• Good management is a prerequisite for increasing the efficiency of health services.
• An improved health information system is clearly linked to good management.
• Information is crucial at all management levels of health services from the periphery to the center.
• It is required by policymakers, managers, health care providers, and community health workers.
• Changing the way information is gathered, processed, and used for decision-making implies changing the way an organization operates.

Definitions

• System: Any collection of components that work together to achieve a common objective.
• Health System: All the activities whose primary purpose is to promote, restore, or maintain health.
• Information: A meaningful collection of facts or data.
• Information System: Systems that provide specific information support to the decision-making process at each level of an organization.
• Health Information System: A set of components and procedures organized with the objective of generating information that will improve health care management decisions at all levels of the health system.
• The ultimate objective of a health information system is not "to gain information" but "to improve action."

What is wrong with current Health Information Systems (HIS)?

• Irrelevance of the information gathered.
• Poor quality of data.
• Duplication and waste among parallel health information systems.
• Lack of timely reporting and feedback.
• Poor use of information.
• Differences in culture between data people and decision-makers: Planning and management staff rely primarily on "gut feeling" to formulate ad hoc decisions rather than seeking pertinent data.

Challenges

• Health financing
• Performance of human resources for health
• Usage of health information for decision-making
• Access to medicines and technology
• Service delivery
• Existing strategies for addressing these challenges in the Yemen Health System
• Progress the Yemen health sector is making

Weaknesses

• Most countries around the world, and in developing countries, have weaknesses in their health systems.
• This module seeks to provide participants with a comprehensive approach to health system strengthening.

Definition of Concepts

• What is a system? A system is a group of interacting, interrelated, interdependent elements/parts forming a complex whole, that work towards a common goal. The malfunctioning of one part of the system affects the other parts.
• Examples from the health system in Yemen should be provided using the above definition.

What is a Health System?

• Health systems encompass all levels: central, regional, district, community, and household.
• A health care system is a means of organized social response to the health conditions of the population.
• It is narrower than a health system and is often described in terms of the levels of healthcare and organizational structure of the Ministry responsible for health in most countries.

Investments in Health

• Investment and efforts in a country like Yemen, whether they involve disease control, quality of health care delivery, health promotion, or policy making, will fail if the health system itself is weak or ineffective.
• Health interventions depend upon an existing infrastructure and use of services that are themselves very weak.
• Health systems are fundamental to global health and their strengthening is vital by the global health community.

State of Health Systems

• The poor state of health systems in many parts of the developing world is one of the greatest barriers to increasing access to essential healthcare.
• Some richer countries have larger populations without access to care due to inequitable arrangements for social protection.
• Others are struggling with escalating costs due to inefficient use of resources.
• What is the situation like in Yemen?

Principles of a Health System

• People-centered - Equity and fairness
• Results-oriented - Quality management system for continual quality improvement
• Evidence-based - Technocrats, academicians, politicians, community use information for decision-making.
• Community-driven - Leadership, governance accountability, transparency and sustainability.
• Systems thinking - Holistic view of the health system is adopted.

Context of the Health System in Yemen

• Organizational arrangements
• Economic context
• Socio-cultural and political context
• Legislative context
• Main actors in the health system: Government, Private/NGOs (Not for profit, e.g., faith-based), Private for profit.

Main Actors in the Health System

• Civil society organizations
• Development partners (International/Bilateral/ Foundations)
• Media
• Primary roles of these players: Funders, providers, purchasers, implementers, and watchdogs.
• Do they work within the system's concept?

Types/Models of Health Systems

• Public Health Systems
• Social security health systems
• Publicly funded health systems
• Social health systems
• Private Health Systems: Health services are offered by purely private health enterprises.

Health System Goals

• Improving health and health equity, in ways that are responsive, financially fair, making the best or most efficient use of available resources.
• Achieving greater access to and coverage for effective health interventions without compromising efforts to ensure provider quality and safety.

Functions of a Health System

• Service provision
• Resource generation
• Financing
• Stewardship

The WHO Health System Framework

• The diagram displays the structure of the WHO Health System Framework. The framework is built around key elements of the health system.

Service Delivery Pillar

• Includes effective, safe, quality personal and non-personal interventions.
• Delivery to those that need them and when and where needed minimizes resource waste.
• Demand, integrated packages, leadership, management, infrastructure, and logistics are pertinent.

Health Workforce Pillar

• Refers to Human Resources for Health (HRH) who are responsive, fair, and efficient to achieve the best health outcomes possible.
• This requires norms/standards that govern production of sufficient staff and fair distribution, and ensuring competency, responsiveness, and productivity.
• HRH observatories are essential for facilitating HRH management.

Medical Products and Technologies Pillar

• Equitable access to essential medical products and technologies that are scientifically sound, high quality, safe, efficacious, and cost-effective.
• Medical products include medicine and reagents.
• Technologies relate to health infrastructure (e.g., X-ray, lab, vaccines).
• Norms/standards and policy options on products and technologies are required.
• Procurement processes, monitoring, innovation, and patenting are vital.

Health Financing Pillar

• Raising adequate funds for health services
• Ensuring that people have access to needed services
• Protection from financial catastrophe or impoverishment associated with paying for healthcare
• Providing incentives (for providers and users) for efficiency
• Policies that support sustainable options and social protection

Leadership and Governance

• Stewardship to ensure that existing strategic policy frameworks are combined with effective oversight, coalition-building, regulation, attention to system design, transparency and accountability.
• Understanding the arrangement and interaction of system parts for achieving the system's purpose
• How one building block affects and influences the others.

Common Systems Characteristics

• Self-organizing : Weak stewardship structures (leadership and governance) often disregard valuable communication and feedback, resulting in policies and practices that do not adequately respond to the latest information or evidence.
• Constantly changing - systems adjust and readjust at many interactive time scales.
• Tightly linked - change in one sub-system affects other sub-systems.
• Related to the characteristic of change and adaptation is the notion that any intervention targeting one building block will have certain effects (positive and negative) on other building blocks.
• Governed by feedback: systems are controlled by "feedback loops" that provide information flows on the state of the system.

Characteristics of a Functional Health System

• Access to services (availability, affordability, acceptability, physical accessibility, and adequacy of supply).
• Quality of care and service delivery.
• Safety.
• Coverage.
• Equity.
• Efficiency.
• Effectiveness of health care delivery.
• Ethics and rights-based approach in delivery of services.
• Sustainability of services.

Characteristics of a Responsive Health System

• Health system responsiveness—one of the intrinsic goals of health care systems, together with health outcomes and fairness of financial contributions.
• Responsiveness relates to a system's ability to respond to the legitimate expectations of potential users about non-health enhancing aspects of care.
• Individuals are treated and the environment in which they are treated encompasses the notion of an individual's experience of contact with the health system.

The Eight Domains of Responsiveness

• Autonomy: respect of patients' views of what is appropriate and allowing the patient to make informed choices
• Choice: right or opportunity to choose a health care institution and health provider and to secure a second opinion and access specialist services when required
• Clarity of communication: Clear explanation to patients and family the nature of the illness, details of treatment and available options
• Confidentiality of Personal Information: privacy in the environment in which consultations are conducted.
• Dignity: ability of patients to receiving care in a respectful, caring, and non-discriminatory setting
• Prompt attention: ability to access care rapidly in the case of emergencies or readily with short waiting times for non-emergencies
• Quality of basic amenities: physical environment and services.
• Access to family and community support: extent to which patients have access to their family and friends.

Group Assignment

• Based on your knowledge of health system building blocks, identify the current health system problems in Yemen and discuss how "systems thinking" can contribute to the improvement of the existing Health System Strengthening in Yemen.

استكشف التحديات والفرص المتاحة في نظام الصحة في اليمن من خلال هذا الاختبار. سيغطي هذا الاختبار عناصر رئيسية مثل الصحة العامة، التفكير الأنظومي، وأهمية العمل الجماعي في تحسين النظام الصحي. انضم واختبر معرفتك حول مستقبل الصحة في البلاد.