Health Systems and Services Presentation 2024 PDF

HEALTH SYSTEM AND SERVICES Dr. Nitya Kumar “Medicine in Ancient Egypt” (1952), By Robert Thom vha.org.au  Learning outcomes 1. Describe the different levels of the health system and...

HEALTH SYSTEM AND SERVICES Dr. Nitya Kumar “Medicine in Ancient Egypt” (1952), By Robert Thom vha.org.au  Learning outcomes 1. Describe the different levels of the health system and the types of services delivered at each level 2. List the components and functions of the health system and explain how they contribute to health outcomes 3. Explain how Sustainable Development Goals and Primary Health Care Principles influence health 4. Discuss how to manage the health workforce 2  LO1 What is a health system? What is your understanding of a health system? How might you describe it (i.e. who is included; what is its purpose)? World Health Organization (WHO) definition: A health system consists of all the organisations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to improve determinants of health.  What is a high-quality health system? Lancet Global Health Commission 2018: optimizes health care in a given context improves or maintains health outcomes valued and trusted responds to changing population needs  LO1 Health service delivery Primary Secondary Tertiary Level Level Level First point of contact LO1 Where was your most recent encounter with the health services – where did you first go for advice or treatment? General Practitioner (GP) –also called a family doctor / physician Practice Nurse Public Health Nurse Allied Health Professional: e.g. Pharmacist/Physiotherapist/Occupational Therapist/Psychologist etc. Hospital Other (e.g. health advisor) Why is the GP often considered as the cornerstone of the health system?  LO1 Primary care level – overview Primary care is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work. Primary care staff (e.g. doctors (GPs)) – act as a first point of consultation for all patients. – know their patients, families and communities – provide continuity of care for common chronic conditions People often look for advice from another accessible health care professional, such as a pharmacist, nurse or community health worker. Primary Health centers Bahrain Primary care level – prevention Main programmes and tasks within primary care Family planning and sexual health 1. Health Antenatal care, postnatal care promotion and Infant and child feeding, supplements (e.g. Vitamin A and D) prevention Growth monitoring and developmental examination services (including Immunisations screening) Screening – breast, cervical, colon, prostate Advice / support on lifestyle and common risk factors – smoking, alcohol, obesity Case-finding (e.g. diabetes, atrial fibrillation) Primary level: care + systems tasks Main programmes and tasks within primary care 2. Case Essential newborn care management and Case management of childhood illness Management of communicable and non communicable disease care Chronic diseases management and support including empowering patients to self-manage conditions through education and support Mental health – anxiety, depression, sleep disorders 3. Health systems Managing budgets, drugs and consumables tasks Data recording and reporting – vital statistics and notifiable diseases Achieving and reporting prevention & screening targets Coordinating patient access to services (physiotherapy, occupational and speech therapy, social services) Gate-keeper: enabling/controlling access to hospital care  LO1 Secondary care level Provided in hospitals, including accident and emergency departments, outpatient departments, antenatal services, genitourinary medicine and sexual health clinics. Patients are often referred from primary care to hospital specialist outpatient clinics for investigation, diagnosis and treatment Secondary care services are provided by medical and surgical specialists and other health professionals who generally do not have first contact with patients. E.g. cardiologists, endocrinologists, surgeons. More sophisticated investigations, such as imaging services, may not be accessible from primary care – may require visit to specialist outpatient clinic. May be only means to accessing Allied Health Professionals’ services such as physiotherapists, respiratory therapists, occupational therapists, speech & language therapists, social workers and dietitians (well-designed health systems enable primary care access to these) Access to acute care for serious illness or injury through emergency GP referral or hospital Accident and Emergency department (A&E) - difficult balance due to limited resources  LO1 Tertiary level Tertiary Health care is usually the highest level of the health system, to which patients are referred from primary and less sophisticated secondary care (hospital) settings. It is characterised by advanced diagnostic, treatment and support services, such as intensive care units; and specialist (often highly specialized) medical, nursing and ancillary staff. Two features distinguish tertiary from secondary hospitals – the presence of: i) interventions that require large multidisciplinary teams of medical, nursing and support staff for complex procedures, such as coronary artery bypass surgery, organ transplant surgery, and increasingly cancer surgery ii) and national specialist centres. The National Kidney Transplant Service is coordinated through Beaumont Hospital. The two main specialist centres for neurosurgery in Ireland are Beaumont Hospital Dublin and Cork University Hospital. Lancet 2008 Alma-Ata 30 years on Health Systems Pyramid LO1  Referral systems – summary LO1 A referral is defined as: The process whereby a health professional seeks the assistance of another health professional, or a health facility at the same or higher level, to assist in, support or to take over the management of a patient Types of referral: Outpatient attendance / Inpatient admission / A & E Reasons for referring a patient – to seek expert opinion on management of patient access to diagnostic and therapeutic tools additional or specialist services not available at referring level admission and management of the client Components of an effective referral system Excellent communication in both directions Higher levels (hospital specialists) must ensure where possible that patients are returned to the care of referring professional (usually the GP)  LO1 How patients end up in hospital (simplified) Medicine GP Surgery Patient Paeds ED O+G  LO2 Definition: “a health system consists of all organizations, people and actions whose primary interest is to promote, restore or maintain health”  LO2 Health systems building blocks (1) 1. Service Good health services are those which deliver effective, safe, quality delivery personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources. 2. Health A well-performing health workforce is one which works in ways that are workforce responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances, i.e. there are sufficient numbers and mix of staff, fairly distributed; they are competent, responsive and motivated to work hard. 3. Health A well-functioning health information system is one that ensures the information production, analysis, dissemination and use of reliable and timely system information on health determinants, health systems performance and health status.  Health systems building blocks (2) LO2 4. Medical A well-functioning health system ensures equitable access to essential products, and medical products , vaccines and technologies of assured quality, safety, technologies efficacy and cost-effectiveness, and their scientifically sound and cost- effective use. 5. Health A good health financing system raises adequate funds for health, in ways financing system that ensure people can get access to and use essential services, and are protected from financial catastrophe or impoverishment due to having to pay for essential services. 6. Leadership and Leadership and governance involves ensuring strategic policy frameworks governance exist and are combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system- design, and accountability. See Government Stewardship functions  LO2 Government Stewardship functions 1. System design – Policy formulation and setting strategic direction 2. Priority setting – Technical and political dimensions 3. Performance assessment – Information and monitoring 4. Inter-sectoral action – through government ministries especially 5. Population protection – e.g. infectious diseases, environmental hazards etc. 6. Regulation – setting rules, ensuring compliance High quality health system framework (Lancet Global Health Commission 2018)  LO3 Global health: Primary Health Care Primary Health Care (Alma Ata 1978) accepted by governments as national policy …essential health care …made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford Consensus that health (a complete state of physical, mental and social wellbeing) is a fundamental human right…’attainment of highest possible level most important world-wide social goal whose realization requires action of many other social and economic sectors.’ Primary Health Care principles: Universal Health Coverage – underlying principle of population health Community participation Intersectoral action for health (importance of social determinants) Appropriate (evidence-based) interventions Affordable and sustainable systems WHO definition: Universal Health Coverage (UHC) is achieved when “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.  LO3 YouTube Do you know all 17 SDGs YouTube: The SDG Report 2023: Special Edition: https://www.youtube.com/watch?v=zF361a019zA From 0.5 to 4.5mins if time allows  LO3 The SDG Report 2023 Polycrisis era, climate crisis, war and conflict, economic outlook, and lingering effects of COVID-19. Only 15% SDGs on track. Reversal of years of progress - poverty and hunger, health and education, provision of basic services Areas needing urgent action http://www.gapminder.org/  LO4 Global Code on the international recruitment of health personnel 1. * Ethical international recruitment Avoid active recruitment from countries facing critical shortages of health workers 2. Health workforce development and health systems sustainability NB: Member states should take effective measures to educate, retain and sustain a health workforce appropriate to the specific conditions of each country 3. Fair treatment of migrant health personnel Health workers have rights, including rights to emigrate, rights to accurate information, and to equal treatment YouTube: WHO Global Code explained 2023 http://www.healthworkforceireland.com/ for RCSI research 2011-18  LO4 WHO Europe 2022  Additional Resources https://bahrainbusinesslaws.com/laws/health-insurance-law Acknowledgment: Some of the content is based on slides by Prof. Ruairi Brugha and Dr Owain Donnelly  Questions? Discussion Forum on VLE E-mail: [email protected] THANK YOU 31