Health Systems Administration PDF

Health Systems and Administration Dr. Richard Delali Agbeko Djochie (PhD, MSc., B. Pharm. MPSGH) Lecturer, Department of Pharmacotherapeutics & Pharmacy Practice, SoPPS, UCC Learning Objectives By the end of this lecture, stu...

Health Systems and Administration Dr. Richard Delali Agbeko Djochie (PhD, MSc., B. Pharm. MPSGH) Lecturer, Department of Pharmacotherapeutics & Pharmacy Practice, SoPPS, UCC Learning Objectives By the end of this lecture, students should be able to: 1. Demonstrate knowledge of organizational elements, structures, performance metrics, and terminologies in healthcare systems locally and globally. 2. Critically analyze healthcare systems to formulate innovative designs that enhance healthcare delivery. 3. Apply efficient and effective financial planning strategies to healthcare operations. 4. Integrate ethical, legal, and regulatory principles to optimize healthcare organizational effectiveness. 2 Overview of Healthcare Systems Definition: A healthcare system comprises organizations, institutions, and resources that provide health services to meet the health needs of target populations. Purpose: It aims to promote, restore, or maintain health efficiently and equitably. Types: Public systems (e.g., Ghana Health Service) focus on universal coverage, funded by taxes. Private systems (e.g., private hospitals) operate on a fee-for-service basis. Hybrid models (e.g., mission hospitals) combine elements of public and private systems. A health system consists of organized structures to provide health services to populations. Health systems administration involves planning, organizing, directing, and managing the delivery of healthcare services to ensure accessibility, equity, quality, and efficiency. It encompasses various components and functions aimed at achieving optimal health outcomes for populations. 3 The Healthcare System in Ghana Structure: Primary Level: Health Centres and Community-based services such as CHPS compounds, focusing on preventive care Polyclinics and District Hospitals that provide basic healthcare to majority of the population. Secondary Level: Regional hospitals offering specialized services hence serving as referral facility for the primary level facilities. Tertiary Level: Teaching hospitals with advanced diagnostics and specialist treatments. 4  Stakeholders in the Ghanaian Healthcare System Ministry of Health (MoH): Policy formulation and oversight. Ghana Health Service (GHS): Implementation of health policies and programs. National Health Insurance Authority (NHIA): Administers the NHIS for healthcare financing. Private Sector: Complements public healthcare. International Donor agencies such as Jhpiego, Global Fund, USAID, DANIDA, JAICA e.t.c. Local NGOs in Health: e.g. Ghana Coalition for NGOs in Health 5 Key Components of a Health System 1. Health Service Delivery Provision of accessible, high-quality healthcare services to individuals. Includes preventive, curative, rehabilitative, and palliative care. 2. Health Workforce Comprises healthcare professionals, administrators, and support staff. Recruitment, training, retention, and deployment are critical. 3. Health Financing Sources include government taxation, donor funding, insurance schemes, and out-of-pocket payments. Key goals: equity, financial protection, and sustainability. 6 Key Components of a Health System - 2 4. Health Information Systems (HIS) Collects, analyzes, and disseminates data to support decision-making. Essential for monitoring health outcomes and improving system performance. 5. Governance and Leadership Involves policy formulation, resource allocation, and regulatory functions. Focused on accountability, transparency, and equity. 6. Access to Medicines and Technologies Ensures availability of essential medicines, vaccines, and medical devices. Includes procurement, storage, and distribution systems. 7 Principles of Health Systems Administration 1. Equity: Ensuring fair access to healthcare services. 2. Efficiency: Optimal use of resources for maximum health benefits. 3. Quality: Delivering safe, effective, and patient-centered care. 4. Sustainability: Long-term financial and operational viability. 5. Accountability: Transparent decision-making and performance monitoring. 8 Health Policy and Governance Policy Formulation Aligning health goals with national development strategies. Stakeholder engagement and evidence-based decision-making. Regulation and Oversight Licensing healthcare providers and facilities. Setting and enforcing standards for quality and safety. Monitoring and Evaluation Tracking performance indicators. Identifying gaps and opportunities for improvement. 9 Financing Health Systems Sources of Financing Government funding through taxation. Donor contributions and grants. Private health insurance. Out-of-pocket payments. Goals of Health Financing Achieving Universal Health Coverage (UHC). Reducing financial barriers to care. Ensuring efficient allocation of resources. Challenges Limited funding in low-income countries. Inequitable resource distribution. Mismanagement and corruption. 10 Ethics in Healthcare Administration Core Principles: Autonomy: Respecting patients’ decisions. Beneficence: Acting in the patient’s best interest. Non-maleficence: Avoiding harm. Justice: Fair resource distribution. Ethical Dilemmas: allocation of scarce resources. Conflict of interest? 11 Health Professionals and Regulatory Law Role of Health Professionals Doctors: Diagnosis and treatment planning. Nurses and Midwives: Patient care, health education, and monitoring. Pharmacists: Dispensing, medication management, and advising on drug use. Allied Health Professionals: Laboratory technicians, physiotherapists, and others. Regulatory Frameworks Health Professions Regulatory Bodies Act, 2013 (Act 857): Governs the conduct, registration, and regulation of health professionals in Ghana. Key Bodies: Medical and Dental Council Pharmacy Council Nursing and Midwifery Council 12 Health Workforce Management Recruitment and Retention Addressing shortages of skilled professionals. Incentives for rural and underserved areas. Training and Development Continuous education to enhance skills. Specialized training programs for emerging health needs. Workforce Planning Aligning workforce supply with healthcare demand. Addressing migration and brain drain issues. 13 Universal Health Coverage (UHC) Definition and Goals Ensuring access to quality healthcare without financial hardship. Coverage of essential health services for all populations. Strategies to Achieve UHC Strengthening primary healthcare systems. Expanding health insurance coverage. Investing in preventive care. Barriers to UHC Insufficient funding and infrastructure. Inequitable resource distribution. Political and policy challenges. 14 Challenges in Health Systems Administration 1. Resource Constraints Inadequate funding for health services. Limited human resources and infrastructure. 2. Inequities in Access Geographic and socio-economic disparities. Barriers faced by marginalized populations. 3. Governance and Accountability Issues Corruption and mismanagement. Lack of transparency in decision-making. 4. Technological Gaps Inconsistent adoption of digital health technologies. High costs of implementation and maintenance. 15 Strategies for Health System Strengthening 1. Investing in Primary Healthcare Focus on prevention and early intervention. Strengthen community-based healthcare services. 2. Capacity Building Train healthcare professionals and administrators. Enhance infrastructure and equipment. 3. Promoting Public-Private Partnerships (PPPs) Collaborations to improve resource availability. Incentives for private sector participation in underserved areas. 4. Leveraging Technology Implementing electronic health records (EHRs). Using telemedicine to extend care to remote areas. 5. Monitoring and Evaluation Establishing robust systems to assess performance. Using data to inform policy and program adjustments. 16 Healthcare Policies What Are Policies? Strategic plans to achieve healthcare goals. Examples of Policies in Ghana: 1.National Health Policy (2019). 2.Primary Healthcare Policy. 17  Policies Governing the Pharmaceutical Sector in Ghana 18 Pharmacy Act, 1994 (Act 489) Established the Pharmacy Council to regulate the training and practice of pharmacists, pharmacy technicians, and licensure of premises. Outlines the qualifications required to practice as a pharmacist or pharmacy technician. Governs the issuance and renewal of licenses for pharmacies and wholesale distributors. Mandates inspection and compliance checks for pharmacy premises. 19 Health Professions Regulatory Bodies Act, 2013 (Act 857) Merged the regulatory functions of various health-related professions, including pharmacy. Replaced Act 489 and expanded the functions of the Pharmacy Council. Defines professional misconduct and stipulates penalties for breaches in practice. Provides the legal framework for establishing disciplinary committees to address grievances. 20 Public Health Act, 2012 (Act 851) Contains provisions directly impacting pharmacy practice: Food and Drugs Authority (FDA): Regulation of medicines, including registration, importation, and quality control. Control of counterfeit medicines: Pharmacies are mandated to sell only FDA- approved medicines. Handling of controlled substances: Strict regulations on dispensing and record- keeping for narcotics and psychotropic substances. Prohibits the sale of unregistered products and unlicensed manufacturing or distribution of drugs. 21 National Health Insurance Act, 2012 (Act 852) Governs the operations of the National Health Insurance Scheme (NHIS). Pharmacies providing services under NHIS must comply with guidelines on reimbursement, documentation, and auditing. 22 Food and Drugs Authority (FDA) Guidelines FDA regulates the safety, efficacy, and quality of all medicines. Registration of medicines before marketing in Ghana. Monitoring of post-market surveillance, including adverse drug reaction reporting. Guidelines for drug recall and disposal. 23 Guidelines for Pharmacy Practice in Ghana Published by the Pharmacy Council (Pharmacy Regulator Authority): Standards for dispensing and counseling in community and hospital pharmacies. Storage and inventory management standards for medicines. Requirements for Good Pharmacy Practice (GPP). 24 Narcotic Drugs (Control, Enforcement, and Sanctions) Act, 1990 (PNDCL 236) Regulates the handling of narcotics and controlled drugs. Pharmacists must maintain strict records and ensure secure storage. Specifies penalties for misuse or diversion of controlled substances. 25 Essential Medicines List (EML) and Standard Treatment Guidelines (STG) Developed by the Ministry of Health and Ghana Health Service: Serves as a reference for pharmacists and prescribers to ensure the rational use of medicines. Guides the selection of medicines for procurement and reimbursement under NHIS. 26 National Drug Policy (NDP), Revised 2020 Aims to ensure the availability, accessibility, and rational use of essential medicines. Focus areas include: Local manufacturing of pharmaceuticals. Regulation of medicine prices. Promotion of pharmacovigilance and drug safety. 27 Data Protection Act, 2012 (Act 843) Protects patient confidentiality and regulates the handling of patient health data, especially in electronic health systems and pharmacy information systems. 28 Pharmacy Premises Regulations Governs the operation and inspection of pharmacy premises. Specifies requirements for physical infrastructure, staffing, and adherence to safety protocols. 29 Code of Ethics for Pharmacists and Pharmacy Support Staff Outlines ethical obligations for pharmacists, including: Prioritizing patient welfare. Avoiding conflicts of interest. Respecting patient autonomy and confidentiality. 30 Key Stakeholders in Enforcing These Policies 1. Pharmacy Council (Pharmacy Regulator Authority): Regulates professional practice, training, and licensing. 2. Food and Drugs Authority (FDA): Ensures the quality, safety, and efficacy of medicines. 3. Ghana Health Service (GHS): Implements national policies in healthcare facilities. 4. Ministry of Health (MoH): Formulates healthcare policies, including those related to pharmacy practice. 5. Professional Associations: Government & Hospital Pharmacists Association (GHOSPA) Community Practice Pharmacist Association (CPPA) Pharmaceutical Society of Ghana (PSGH). 31 Financial Management in Healthcare Principles of Healthcare Financing Methods: Tax-funded systems (e.g., Ghana Government). Health insurance schemes (NHIS). Out-of-pocket payments by patients. Budgeting in Healthcare Steps: Define objectives and priorities. Allocate resources effectively. Monitor expenditure against targets using key performance indicators (KPIs). Challenges: Limited funds, high demand for services. Cost-Effective Resource Allocation Tools: Cost-effectiveness analysis (CEA). Cost-benefit analysis (CBA). Resource Optimization: Task-shifting, preventive care investments. 32 Health Information and Technology Role of Health Information Systems (HIS) Definition: Tools for collecting, analyzing, and using health data to improve decision- making (e.g., District Health Information and Management System-DHIMS). Functions: Patient record management, monitoring outcomes, resource allocation. Emerging Technologies Telemedicine: Remote consultation and treatment. Mobile Health (mHealth): Apps for health monitoring and reminders. Electronic Health Records (EHRs): Centralized patient data systems e.g. LHIMS, Aksoft, e.t.c. Data Privacy and Security Confidentiality Principles: Protecting patient information from unauthorized access. Laws in Ghana: Data Protection Act, 2012 (Act 843). 33 Health Information Systems (HIS) Functions of HIS Data collection and storage. Analysis and reporting. Supporting policy and operational decisions. Benefits of HIS Improved patient care and outcomes. Enhanced resource allocation. Monitoring public health trends. Challenges Limited infrastructure in low-resource settings. Resistance to technology adoption. Data privacy and security concerns. 34 Disaster Planning in Healthcare Principles of Health Disaster Preparedness Definition: The process of preparing for, responding to, and recovering from emergencies affecting public health. Types: Natural: Earthquakes, floods, pandemics. Human-made: Industrial accidents, terrorism, mass casualty (Road Traffic Accidents). Disaster Management Cycle Mitigation: Preventing or minimizing impact (e.g., vaccination campaigns). Preparedness: Training, simulations, and stockpiling supplies. Response: Immediate actions during a disaster (e.g., deploying emergency medical teams). Recovery: Rehabilitation of healthcare services post-disaster. 35 Population and Public Health Public Health Systems Definition: Organized efforts to prevent disease, promote health and prolong life through collective action. Components: Epidemiology, biostatistics, environmental health, health education, and policy-making. Key Indicators: Mortality rates (maternal and infant). Morbidity rates (disease prevalence). Life expectancy. Addressing Challenges: Immunization programs (e.g., polio eradication). Tackling non-communicable diseases (e.g., diabetes, hypertension). Health Determinants: Socioeconomic status, environment, lifestyle, and genetics. 36 Managing a Pharmacy Department 37 Introduction Overview: Pharmacy management focuses on optimizing the use of resources, ensuring compliance with regulations, and delivering high-quality pharmaceutical care. Objectives: At the end of this lecture, students should be able to: Understand key responsibilities of a pharmacy manager. Develop skills for inventory control, financial management, and staff supervision. Evaluate the effectiveness of pharmacy operations. Apply ethical and legal principles to pharmacy management. 38 Human Resource Management Staff Recruitment and Training: Identifying staffing needs and engaging qualified personnel. Continuous professional development for team members. Workforce Supervision: Assigning responsibilities, monitoring performance, and offering feedback. Conflict Resolution: Handling workplace conflicts professionally to maintain team harmony. 39 Leadership and Governance Role of Leadership in Pharmacy Administration Establishing a vision and goals for the pharmacy department. Leading by example and motivating staff. Decision-making and problem-solving in resource-limited settings. Governance Framework: Developing and implementing Standard Operating Procedures (SOPs). Ensuring compliance with national health regulations and policies. 40 Inventory Management Key Concepts in Inventory Control: ABC and VEN Analysis: Prioritizing stock based on cost and criticality. Managing stock levels to avoid stockouts and overstocking. Monitoring expiry dates to reduce waste. Procurement Process: Forecasting demand based on historical usage data. Engaging with suppliers and adhering to procurement policies. Tools for Inventory Management: Stock cards, automated systems (e.g., electronic logistics management systems). 41 Financial Management in Pharmacy Budgeting: Preparing annual budgets for medicine procurement and operational expenses. Aligning budgets with hospital objectives. Revenue Management: Tracking income from service fees and reimbursements (e.g., NHIS). Controlling expenditure to maintain financial sustainability. Auditing: Conducting regular financial audits to detect and address discrepancies. 42 Quality Assurance in Pharmacy Services Ensuring Quality in Operations: Adhering to Good Distribution Practices (GDP) and Good Storage Practices (GSP). Regular temperature and humidity monitoring. Pharmacovigilance Activities: Reporting adverse drug reactions (ADRs) and medication errors. Internal and External Audits: Conducting periodic reviews to improve performance. 43 Clinical Pharmacy Activities Clinical Roles of Pharmacists: Medication therapy management. Patient counseling and adherence monitoring. Interdisciplinary Collaboration: Participating in ward rounds and multidisciplinary meetings. Documentation and Reporting: Maintaining patient medication records. 44 Drugs and Therapeutics Committee (DTC) Role of the DTC: Evaluating and approving formularies. Monitoring rational use of medicines (RUM). Activities of the DTC: Conducting drug use evaluations. Reviewing adverse drug reaction reports. Policy Formulation: Developing guidelines for prescribing and dispensing. 45 Performance Evaluation Key Performance Indicators (KPIs): Prescription turnaround time. Stock availability rates. Patient satisfaction surveys. Performance Review Process: Setting benchmarks. Using feedback to implement corrective actions. Tools for Monitoring: Dashboards, monthly reporting templates. 46 Ethics and Legal Issues Core Ethical Principles in Pharmacy Management: Integrity, transparency, and fairness. Respect for patient confidentiality. Legal Compliance: Adherence to pharmacy laws and regulations (e.g., Pharmacy Council requirements). Record-keeping for controlled substances. Ethical Challenges in Practice: Balancing profitability with patient care. Addressing conflicts of interest. 47 Sample Question The district in the Central Region has seen a significant increase in healthcare demands due to population growth and a rise in chronic disease cases. The District Health Directorate has limited resources to support the growing needs of hospitals and community health facilities. A recent evaluation revealed inefficiencies in fund allocation, with some health centers underfunded and others overspending without achieving performance targets. Questions Identify three key financing strategies the District Health Directorate could adopt to ensure equitable resource distribution across facilities. Discuss how performance-based financing (PBF) could be implemented to improve the efficiency and accountability of resource utilization in the region. 48 Answers Key Financing Strategies: i. Needs-based Allocation: Resources are allocated based on specific population health needs. ii. Capitation Payment Model: A fixed amount is paid per patient for a defined period, covering a range of services. iii. Public-Private Partnerships: Collaboration between public institutions and private entities to improve service delivery. iv. Internally Generated Funds (IGF): Revenue generated by health facilities themselves, e.g., fees from services. v. Leveraging donor funding or grants: Financial assistance from external partners for healthcare programs. Implementation of Performance-Based Financing: i. Establishing performance indicators to measure outcomes. ii. Training facility managers to understand and apply these metrics. iii. Conducting regular audits and reviews to ensure compliance. iv. Providing financial and non-financial incentives for meeting performance targets. v. Periodic reporting and evaluation to monitor progress. vi. Transparent communication of expectations to all stakeholders. 49