Introduction Health System Study Guide

Unit 1: Introduction to Health Systems Mrs. Sinkala E objectives Define the Concepts Discuss the Goals and Functions Describe the Guiding Principles and Values To identify the Actors Concepts and definition A HEALTH SYSTEM may be described as:' A set of cultural...

Unit 1: Introduction to Health Systems Mrs. Sinkala E objectives Define the Concepts Discuss the Goals and Functions Describe the Guiding Principles and Values To identify the Actors Concepts and definition A HEALTH SYSTEM may be described as:' A set of cultural beliefs about health and illness that forms the basis for health-seeking and health-promoting behaviour; The Institutional arrangements within which that behaviour occurs; and The socioeconomic/political/physical context for those beliefs and institutions. Definitions A system is a complex whole formed from related parts. (It is a combination of related parts organized into a complex whole). A health system, also sometimes referred to as health care system is defined as the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.  According to WHO a health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. Health care services are a wide range of health products that are accessible to the consumers of health Goals and Functions WHO has identified 3 main goals for health systems: 1) Improving the health of populations 2) Improving the responsiveness of the health system to the population it serves 3) Fairness in financial contribution i.e. the extent to which the burden of paying for health system is fairly distributed across households. Functions of the health system. functions and four key actors. Regulation Financing Resource allocation service provision the major stakeholders (ACTORS) involved in each: government or professional bodies responsible for regulation; the population (including patients); financing agents responsible for collecting and allocating funds; and service providers. Guiding Principles and Values Five personal values 1.Honesty: Team members put a high value on effective communication within the team, including transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical to continued improvement and for maintaining the mutual trust necessary for a high functioning team. 2. Discipline: Team members carry out their roles and responsibilities with discipline, even when it seems inconvenient. At the same time, team members are disciplined in seeking out and sharing new information to improve individual and team functioning, even when doing so may be uncomfortable. Such discipline allows teams to develop and stick to their standards and protocols even as they seek ways to improve. 3. Humility: Team members recognize differences in training but do not believe that one type of training or perspective is uniformly superior to the training of others. They also recognize that they are human and will make mistakes. Hence, a key value of working in a team is that fellow team members can rely on each other to help recognize and avert failures, regardless of where they are in the hierarchy. In this regard, as Atul Gawande has said, effective teamwork is a practical response to the recognition that each of us is imperfect and “no matter who you are, how experienced or smart, you will fail.”  4.Creativity: Team members are excited by the possibility of tackling new or emerging problems creatively. They see even errors and unanticipated bad outcomes as potential opportunities to learn and improve. 5.Curiosity: Team members are dedicated to reflecting upon the lessons learned in the course of their daily activities and using those insights for continuous improvement of their own work and the functioning of the team. Principles 1. Shared goals: The team—including the patient and, where appropriate, family members or other sup-port persons—works to establish shared goals that reflect patient and family priorities, and can be clearly articulated, understood, and supported by all team members. 2.Clear roles: There are clear expectations for each team member’s functions, responsibilities, and ac-countabilities, which optimize the team’s efficiency and often make it possible for the team to take ad- vantage of division of labor, thereby accomplishing more than the sum of its parts.  3. Mutual trust: Team members earn each others’ trust, creating strong norms of reciprocity and greater opportunities for shared achievement. 4. Effective communication: The team prioritizes and continuously refines its communication skills. It has consistent channels for candid and complete communication, which are accessed and used by all team members across all settings. 5.Measurable processes and outcomes: The team agrees on and implements reliable and timely feedback on successes and failures in both the functioning of the team and achievement of the team’s goals. These are used to track and improve performance immediately and over time. Actors The health care providers The population, The state as a collective mediator, The organizations that generate resources, and Other sectors that produce services that have health effects Unit 2: Functions and Goals of a Health System  Progress towards them depends on how systems carry out four vital functions: provision of health care services, resource generation, financing, and stewardship.  Other dimensions for the evaluation of health systems include quality, efficiency, acceptability, and equity. regulation, financing, Resource allocation, service provision Improving health It is the responsibility of the health system of the country to improve the health of the population. Universal health coverage is defined as ensuring that all people have access to needed health services (including promotion, prevention, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship. This is done through the promotive, preventive, curative Rehabilitative and palliative interventions.  Universal health coverage ensures affordable access to high-quality health services for all; this will inevitably require governments to find additional budgetary resources and therefore to increase the fiscal space for health. Lessons from ten countries have shown that the following can help in improving health 1. Prioritization of primary health care 2. Alignment of financing and delivery 3. Better accountability through outcome- and output-based contracts with providers  4.The right input mix Finding the optimal mix of skills in health workers and type of health facility can stretch limited health care resources and improve technical efficiency. 5.Implementation in a decentralized system The organization of service delivery, including changes in incentives and the autonomy of decision- making, must be aligned with the policy objective 6.Independent regulatory agencies Countries that are successful in ensuring quality standards tend to have engaged an independent regulatory agency to license and accredit facilities and providers and for monitoring and evaluation. 7.Managerial capacity and information systems All these reforms require managerial capacity and health information systems that allow monitoring and evaluation of health system performance to improve transparency and accountability. 8. Fragmentation: a common source of inefficiency Fragmentation of organization and service delivery is a common source of inefficiency 9.Alignment of donor support with country priorities Collaboration with development partners in Burundi helped the Government to pool resources for harmonized policy objectives, facilitate the design and implementation of performance-based financing and develop local capacity for negotiating contracts and monitoring and evaluating provider performance Defending population against threats to health Health security has become an issue in the recent past. Among the broadest challenges the nation faces is protecting its security—and the safety of the population—from both natural disasters and threats linked to hostile human actions. One threat that has emerged in recent years is the possibility that enemies of the nation will attack using biological agents. To address that the Zambian government has through an act of parliament established the and other countries have a established the Zambian National Health Institute whose functions are  The objects of the Act are to - (a) coordinate public health security; (b) establish the Public Health Emergency Operations Centre; (c) establish the National Public Health Laboratory (d) establish the National Public Health Emergency Fund Protection against catastrophic expenditure and impoverishment Health systems have the responsibility to Protecting against catastrophic expenditure and impoverishment ‘‘Fairness in financial contribution’’ is defined by WHO to be one of the three intrinsic goals of a health system. The fairness in financial contribution index measures whether a country collects contributions from households to finance health in a equitable manner. It captures the extent of catastrophic health spending by households, and also identifies households thus affected.  Catastrophic health expenditure is defined in relation to the households’ capacity to pay. A Health spending is viewed as catastrophic when a household must reduce its basic expenses over a certain period of time in order to cope with the medical bills of one or more of its members. WHO proposes that health expenditure should be called catastrophic whenever it is greater than or equal to 40% of the capacity to pay. However, individual countries could well adopt a higher or lower percentage in their respective national health policies. One such intervention is the pooling of risks through the creation of the health insurance scheme. Provision of equitable access to people centred care Equitable Health Care Access means - all individuals have access to affordable, high quality, culturally and linguistically appropriate care in a timely manner. This includes regular preventive care, in addition to emergency care, as well as mental health support. Person-centered care supports people to develop the knowledge, skills and confidence they need to help them effectively manage and make informed decisions about their own health and care.  The four principles of person-centered care are: 1. Treat people with dignity, compassion, and respect 2. Provide coordinated care, support, and treatment 3. Offer personalised care, support, and treatment 4. Enable service users to recognise and develop their strengths and abilities, so they can live an independent and fulfilling life Importance of person centred care helps patients receive more appropriate care and feel more wholly cared for as a human being. Patients feel more comfortable and confident in your service, as upholding their dignity and independence builds mutual respect. The patient will trust you to do what’s best for them, which makes the situation easier for you both. You will meet their emotional, social, and practical needs, which ensures they maintain a high quality of life.  You can support those who may not be able to directly communicate their wants and needs. Numerous conditions or disabilities can affect a person’s ability to communicate effectively.Person-centred care helps you find suitable ways to help them communicate and maximise their quality of care. It improves their independence. Not only is this beneficial on a personal level for the patient, but it also encourages them to take part in decisions. It raises their engagement, which helps you reach better, more suitable decisions relating to their care. it gives them the confidence and ability to look after themselves with less input from you  Patients are more likely to stick to treatment plans and take their medicine if they feel respected, involved, and in control. This relieves the pressure on you and the burden on your healthcare service, such as repeated checks and wasted medication It motivates patients to adopt positive health behaviours that improve and help them manage their own health. This is particularly important for people with long-term conditions, who may rely heavily on healthcare services. Everyone will feel happier and more positive. This increases the team’s morale and ability to deliver effective, compassionate care. It is time and cost efficient. Personalised, enabling care ensures patients receive medication they will actually take, as well as attend and engage in the right services. You’ll spend your valuable time and money on what people really want and need. Community involvement, participation & decision-making capacity Advocates for participation note that policy and development which adopt a bottom-up framework where local communities are actively involved in decision-making, better facilitate the achievement of target objectives. Community-Based Natural Resource Management (CBNRM) is one of the most important manifestations of true decentralization as it relates to control of rural resources. CBNRM programs, if successful, can be models of local empowerment, imbuing communities with greater authority over the use of natural resources. CBNRM is a shift in decision-making from Centre to periphery. It takes decision-making to the local community both in the formulation stages up to the implementation in contrast to the traditional method of involving the communities in the implementation of programs(Murphree 2009).  Under the right circumstances, they can also bring important benefits to poor people and poor communities. In many countries, community-based natural resource management has improved livelihoods for the poor. The benefits of CBNRM can range from job creation to substantial management rights and long-term revenue-generation (Malla 2000). CBNRM can successfully benefit the poorest members of the community when it empowers them to play a full decision-making role in resource management.