Basic Concepts of Health PDF

BASIC CONCEPTS OF HEALTH Health A common theme in most cultures "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ (WHO) “socially and economically productive life” Operational Definition of Health: “ A condition o...

BASIC CONCEPTS OF HEALTH Health A common theme in most cultures "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ (WHO) “socially and economically productive life” Operational Definition of Health: “ A condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental”. Health means (a) No obvious evidence of disease and that the person is functioning normally (b) Several organs of the body are functioning adequately as well as in relation to one another (Equilibrium or Homeostasis). 2  Biomedical Concept Changing Concepts Ecological Psychosocial HEALTH of Health Concept Concept Holistic Concept 3   “absence of disease“ - if one was Biomedical Concept free from disease the person was considered health  based on the germ theory of disease  human body as a machine and disease because of the breakdown of the machine, and the doctor’s task is to repair the machine 4 Ecological  a dynamic equilibrium Concept between man and his environment  the relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function 5 Psychosocial Concept Health is influenced by social, psychological, cultural, economic, and political factors of the people concerned. 6 Holistic  The synthesis of all Concept above concepts. A unified/multidimensiona l process involving the well-being of a person in context of his environment. 7  Philosophies of Health Health is a fundamental Human Right Health is the essence of productive life Health is intersectoral Health is an integral part of development Health is central to the concept of quality of life Health involves individuals, state and international responsibility Health & its maintenance is a major social investment Health is a worldwide social goal 8  Dimensions of Health PHYSICAL MENTAL SOCIAL “Perfect functioning of the Mental Health - “a state of “The quality and quantity of an body” balance between the individual’s interpersonal ties A state in which every cell and individual and the surrounding and the extent of involvement every organ is functioning at world, a state of harmony with the community.” optimum capacity and in between oneself and others, a perfect harmony with the rest coexistence between the of the body. realities of the self and that of other people and that of the environment” 9  Basic Principles of Primary Health Care "PHC is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment," WHO and UNICEF. A vision for primary health care in the 21st century: Towards UHC and the SDGs. 11 Primary Health Care A whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. Enables health systems to support a person’s health. This strategy also ensures that health care is delivered in a way that is centered on people’s needs and respects their preferences. Widely regarded as the most inclusive, equitable and cost-effective way to achieve universal health coverage. It is also key to strengthening the resilience of health systems to prepare for, respond to and recover from shocks and crises. 3 Inter-related Components of PHC: Integrated health services to meet people’s health needs throughout their lives Addressing the broader determinants of health through multisectoral policy and action Empowering individuals, families and communities to take charge of their own health. 12 Primary Health Care PHC is rooted in a commitment to social justice, equity, solidarity and participation. For universal health coverage (UHC) to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people. PHC requires governments at all levels to underscore the importance of action beyond the health sector in order to pursue a whole-of government approach to health, including health-in- all-policies, a strong focus on equity and interventions that encompass the entire life-course. PHC addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing. Primary health care ensures people receive quality comprehensive care – ranging from promotion and prevention to treatment, rehabilitation and palliative care – as close as feasible to people’s everyday environment. 13 Objectives of PHC 1 To increase the programs and services that affect the healthy growth and development of children and youth 2 To boost participation of the community with government and community sectors to improve the health of their community. 3 To develop community satisfaction with the primary health care system. 14 Objectives of PHC 4 To support and advocate for healthy public policy within all sectors and levels of government. 5 To support and encourage the implementation of provincial public health policies and direction. 6 To provide reasonable and timely access to primary health care services. 15 Objectives of PHC 7 To apply the standards of accountability in professional practice. 8 To establish, within available resources, primary health care teams and networks. 9 To support the provision of comprehensive, integrated, and evidence- based primary health care services. 16  Self- equity Nationwide Coverage Five (5) Principles Self- of PHC reliance People- involvement Intersectoral Coordination 17 Principles and Strategies Health services delivered where the people are Accessibility, Availability, Affordability Use of indigenous/resident volunteer health worker as a health care provider and Acceptability of Health Services with a ratio of one community health worker per 10-20 households Use of traditional (herbal medicine) with essential drug Training design and curriculum based on community needs and priorities. Attitudes, knowledge and skills developed are on promotive, preventive, curative and Provision of quality, rehabilitative health care. basic and essential health services Regular monitoring and periodic evaluation of community health workers performance by the community and health staff Awareness, building and consciousness raising on health and health-related issues. Planning, implementation, monitoring and evaluation done through small group meetings (10-20 households cluster) Selection of community health workers by the community. Community Participation Formation of health committees. Establishment of a community health organization at the parish or municipal level. Mass health campaigns and mobilization to combat health problems. 18 Principles and Strategies Community generates support (cash, labor) for health programs. Use of local resources (human, financial, material) Self-reliance Training of community in leadership and management skills. Incorporation of income generating projects, cooperatives and small scale industries. Convergence of health, food, nutrition, water, sanitation and population services. Integration of PHC into national, regional, provincial, municipal and barangay Recognition of interrelationship development plans. of health and development Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services. Establishment of an effective health referral system Establishment of an effective health referral system. Multi-sectoral and interdisciplinary linkage. Social Mobilization Information, education, communication support using multi-media. Collaboration between government and non-governmental organizations. 19 Principles and Strategies Reallocation of budgetary resources. Reorientation of health professional and PHC. Decentralization Advocacy for political and support from the national leadership down to the barangay level. 20 The Four (4) Major Pillars of PHC Community Intersectoral Participation Coordination PHC Support Appropriate Mechanism Technology made Available 21 8 Essential Health Services in PHC E Education for Health L Locally-endemic disease control E Expanded program for Immunization M Maternal and Child Health including responsible parenthood E Essential Drugs N Nutrition T Treatment of Communicable and Non-communicable Diseases S Safe Water and Sanitation 22 The Health Care System  Health Care the field of medicine concerned with the maintenance and improvement of human health the process of providing or receiving medical treatment. efforts to maintain, restore, or promote someone's physical, mental, or emotional well-being especially when performed by trained and licensed professionals (as in medicine, dentistry, clinical psychology, and public health) 24  Health Care System Medical Care System According to the World Health Organization a health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health The way in which all health services are provided Refers to the agencies, organizations, and institutions involved in making sure people have access to healthcare in their community. It is a structure within which people, institutions, and organizations interact to mobilize and allocate resources for preventing and treating diseases and injuries. May include all the resources, processes, and stakeholders that make up the way healthcare services are delivered to patients, as well as all the parts of an individual person’s healthcare experience. 25  Health Systems Objectives The objectives that a healthcare system sets to improve the population health and the performance of the health system Improving Responsiveness Health Fair Financing 26  Health Systems Objectives The objectives that a healthcare system sets to improve the population health and the performance of the health system Improving Health Health is the defining objective for a health system. This means making the health status of the entire population as good as possible over people’s entire life cycle, taking account of both premature mortality and disability. Unfortunately, there is no single measure of health that can accurately encapsulate the health of a population. Life expectancy is one measure that is available for most countries. Inequalities in health are often reflected in differences in life expectancy. 27  Health Systems Objectives The objectives that a healthcare system sets to improve the population health and the performance of the health system Responsiveness Performs relative to non-health aspects, meeting or not meeting people’s expectations of how they should be treated by providers of prevention, care or non-personal services 28  Health Systems Objectives The objectives that a healthcare system sets to improve the population health and the performance of the health system Fair Financing Fair financing in health systems means that the risks each household faces due to the costs of the health system are distributed according to their ability to pay rather than to the risk of illness. A health system in which individuals or households are sometimes forced into poverty through their purchase of needed care, or forced to do without it because of the cost, is unfair. Paying for health care can be unfair in two ways: 1.Expose families to large, unexpected expenses 2.Impose regressive payments (those least able to contribute pay proportionately more than the better-off) 29 National Health System Goals Improving This might involve increasing the number of primary access to care providers in a community or ensuring that all healthcare residents have health insurance. This might involve increasing patient safety or Improving the ensuring that all patients receive evidence-based quality of care care. Reducing This might involve reducing unnecessary testing healthcare and procedures or improving the efficiency of the costs healthcare system. 30 National Health System Goals Reducing This might involve increasing the number of health minority residents who receive preventive care or disparities providing culturally competent care to all patients. Improving the This might involve increasing the number of patients who see coordination of a primary care provider on a regular basis or ensuring that all care patients have a medical home. 31  Health Outcomes The health status of a person or population at a specific point in time, or over a period of time, which can be measured using various indicators. 32 Health Outcomes MORTALITY The number of deaths that occur within a population over a specific period. 33 Health Outcomes MORBIDITY The number of people within a population who experience a particular health condition or disease over a specific period. 34 Factors that Impact Health Outcomes This includes factors such as the availability of Quality of preventive care and treatment, the effectiveness of Healthcare care, and patient safety. This refers to factors such as income, education, and Socioeconomic employment. It is well-established that people with lower socioeconomic status are more likely to experience poorer Status health outcomes. These are the conditions in which people live, work, and play. Social Determinants They include factors such as housing, transportation, and access to healthy food. The social determinants of health have a of Health significant impact on health outcomes. These are the behaviors and conditions that increase the Health Risk likelihood of developing a disease or experiencing an adverse health event. Common examples of health risk factors include Factors smoking, obesity, and high blood pressure. 35  Key Components of a Well-Functioning Health System A well functioning health system responds in a balanced way to a population’s needs and expectations by: improving the health status of individuals, families and communities defending the population against what threatens its health protecting people against the financial consequences of ill-health providing equitable access to people-centered care making it possible for people to participate in decisions affecting their health and health system. 36  Key Components of a Well-Functioning Health System Leadership and Governance Each country’s specific context and history shapes the way leadership and governance is exercised, but common ingredients of good practice in leadership and governance can be identified. These include: Ensuring that health authorities take responsibility for steering the entire health sector (not merely public sector service delivery); and for dealing with future challenges (including unanticipated events or disasters) as well as with current problems Defining, through transparent and inclusive processes, national health policies, strategy and plan that set a clear direction for the health sector 37  Key Components of a Well-Functioning Health System Leadership and Governance Effective regulation through a combination of guidelines, mandates, and incentives, backed up by legal measures and enforcement mechanisms; Effective policy dialogue with other sectors. Mechanisms and institutional arrangements to channel donor funding and align it to country priorities. 38  Key Components of a Well-Functioning Health System Health Information Systems Good governance is only possible with good information on health challenges, on the broader environment in which the health system operates, and on the performance of the health system. This specifically includes timely intelligence on: Progress in meeting health challenges and social objectives (particularly equity), including but not limited to household surveys, civil registration systems and epidemiological surveillance Health financing, including through national health accounts and an analysis of financial catastrophes and of financial and other barriers to health services for the poor and vulnerable Trends and needs for HRH; on consumption of and access to pharmaceuticals; on appropriateness and cost of technology; on distribution and adequacy of infrastructure Access to care and on the quality of services provided. 39  Key Components of a Well-Functioning Health System Health Financing Health financing can be a key policy instrument to improve health and reduce health inequalities if its primary objective is to facilitate universal coverage by removing financial barriers to access and preventing financial hardship and catastrophic expenditure. The following can facilitate these outcomes: A system to raise sufficient funds for health fairly A system to pool financial resources across population groups to share financial risks A financing governance system supported by relevant legislation, financial audit and public expenditure reviews, and clear operational rules to ensure efficient use of funds 40  Key Components of a Well-Functioning Health System Human Resources for Health The health workforce is central to achieving health. A well performing workforce is one that is responsive to the needs and expectations of people, is fair and efficient to achieve the best outcomes possible given available resources and circumstances. Countries are at different stages of development of their health work force, but common concerns include improving recruitment, education, training and distribution; enhancing productivity and performance; and improving retention. This requires: Arrangements for achieving enough of the right mix (numbers, diversity and competencies) Payment systems that produce the right kind of incentives Regulatory mechanisms to ensure system wide deployment and distribution in accordance with needs Establishment of job-related norms, deployment of support systems and enabling work environments Mechanisms to ensure cooperation of all stakeholders ( such as health worker advisory groups, donor coordination groups, private sector, professional associations, communities, client/consumer groups). 41  Key Components of a Well-Functioning Health System Essential Medical Products and Technologies Universal access to health care is heavily dependent on access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality, which are used in a scientifically sound and cost-effective way. Economically, medical products are the second largest component of most health budgets (after salaries) and the largest component of private health expenditure in low- and middle-income countries. Key components of a functioning system are: A medical products regulatory system for marketing authorization and safety monitoring, supported by relevant legislation, enforcement mechanisms, an inspectorate and access to a medical products quality control laboratory National lists of essential medical products, national diagnostic and treatment protocols, and standardized equipment per levels of care, to guide procurement, reimbursement and training A supply and distribution system to ensure universal access to essential medical products and health technologies through public and private channels, with focus on the poor and disadvantaged A national medical products availability and price monitoring system A national program to promote rational prescribing. 42  Key Components of a Well-Functioning Health System Service Delivery Health systems are only as effective as the services they provide. These critically depend on: Networks of close-to-client primary care, organized as health districts or local area networks with the back-up of specialized and hospital services, responsible for defined populations Provision of a package of benefits with a comprehensive and integrated range of clinical and public health interventions, that respond to the full range of health problems of their populations, including those targeted by the Millennium Development Goals Standards, norms and guidance to ensure access and essential dimensions of quality: safety, effectiveness, integration, continuity and people -centeredness Mechanisms to hold providers accountable for access and quality and to ensure consumer voice. 43 Levels of Health Care Levels of Health Care Delivery Section 8 “Minimum Standards and Construction of a Hospital” R.A. No. 4226 (Hospital Licensure Law), levels of health care delivery are categorized based on “service capacities and compliance with standards for manpower, equipment, construction, and physical activities. 1. Primary prevention – maintenance 2. Secondary prevention – referral hospitals 3. Tertiary prevention – highly skilled and specialized institutions 45 Primary Level 1. Rural Health Unit (RHU) 2. Barangay Health Station (BHS) 3. Puericulture Center 4. Clinics of large Industrial firms – employee 5. Private practitioners or private clinics and others Basic level of healthcare Health promotion Early disease diagnosis Disease prevention The FIRST CONTACT between the community members and other levels of health facility 46 Second Level 1. Emergency Hospital (headed by the Mayor) 2. District Hospital (headed by the Mayor) 3. Provincial Hospital (headed by the Governor) 4. City/Municipal Hospital (headed by the Governor) Moderately specialized equipment and laboratory facilities capable of minor surgeries Referral Center for PHC 47 New Classifications of Hospitals and other Healthcare Facilities: According to Ownership Government Non-Government - a hospital created by law - a hospital owned, established and - a government health facility may operated with funds through donation, principal, investment or other means by be under the national government, any individual, corporation, association DOH, LGU, DND, PNP, DOJ, SUCs, or organization GOCCs. - a private health facility may be a single Examples: Philippine General proprietorship, partnership, corporation, Hospital, Vicente Sotto Memorial cooperative, foundation, religious, NGO. Medical Center, Cebu City Medical Center, Southern Philippines Medical Examples: St. Lukes Medical Center, Center Chong Hua Hospital, Cebu Doctors’ Hospital, Asian Hospital and Medical Center 48  New Classifications of Hospitals and other Healthcare Facilities: According to Scope of Services General Specialty - provide services for all kinds of illnesses, diseases, - specializes in a particular disease/condition or in one type injuries and/or deformities of Patient -provide medical and surgical care to the sick and - A specialized hospital may be devoted to treatment of any injured, maternity, newborn and childcare of the following: - equipped with the service capabilities needed to a. Treatment of a particular type of illness or for a particular support board certified/eligible medical specialists and condition requiring a range of treatment.(Philippine other licensed physicians rendering services in, but Orthopedic Center, National Center for Mental Health, San not limited to, the following: Lazaro Hospital, a hospital dedicated to the treatment of a.Clinical Services (Family Medicine, Pediatrics, cancer.) Internal Medicine, Obstetrics and Gynecology, b. Treatment of patients suffering from diseases of a Surgery); b. Emergency Services; c. Outpatient particular organ or groups of organs.(Lung Center of the Services; d. Ancillary and Support Services (Clinical Philippines, Philippine Heart Center, National Kidney and Laboratory, Imaging Facility, Pharmacy) Transplant Institute, a hospital dedicated to treatment of eye -Example: Philippine General Hospital, St. Vincent disorders) General Hospital, Cebu Velez General Hospital c. Treatment of patients belonging to a particular group such as children, women, elderly and others. (Philippine Children’s Medical Center, National Children’s Hospital, Dr. Jose Fabella Memorial Hospital.) 49  Hospital Classification Scheme General Hospital Services for all types of illness, injuries or deformities Level 1 Hospital Shall have as minimum the services of a General Hospital (accdg. To scope of services), including, but not limited to, the following: i. Staff of qualified medical, allied medical and administrative personnel headed by a physician duly licensed by PRC ii. Bed space for its authorized bed capacity in accordance with DOH Guidelines in the Planning and Design of Hospitals iii. An operating room with standard equipment and provision for sterilization of equipment and supplies iv. A post-operative room v. A rrecovery room vi. Maternity facilities, consisting of ward/s, room/s, a delivery room, exclusively for maternity patients and newborns vii. Isolation facilities with proper procedures for the care and control of infectious and communicable diseases as well as for the prevention of cross infections viii. A separate dental section/clinic ix. Provision for blood station x. A DOH licensed secondary clinical laboratory with the services of a consulting pathologist; xi. A DOH licensed level 1 imaging facility with the services of a consulting radiologist; xii. A DOH licensed pharmacy 50  Hospital Classification Scheme Level 2 Hospital Shall have as minimum, all of Level l capacity, including, but not limited to, the following: i. An organized staff of qualified and. competent personnel with Chief of Hospital/Medical Director and appropriate board certified Clinical Department Heads; ii. Departmentalized and equipped with the service capabilities needed to support board certified/eligible medical specialists and other licensed physicians rendering services in the specialties of Medicine, Pediatrics, Obstetrics and Gynecology, Surgery; their sub-specialties and ancillary services; iii. Provision for general ICU for critically ill patients. iv. Provision for NICU (Neonatal Intensive Care Unit) v. Provision for HRPU (High Risk Pregnancy Unit) vi. Provision for respiratory therapy services; vii. A DOH licensed tertiary clinical laboratory; viii.A DOH licensed level 2 imaging facility with mobile x-ray inside the institution and with capability for contrast examinations. 51 Hospital Classification Scheme Level 3 Hospital Shall have as minimum, all of Level 2 capacity, including, but not limited to, the following: i. Teaching and/or training hospital with accredited residency training program for physicians in the four major specialties namely: Medicine, Pediatrics, Obstetrics and Gynecology, and Surgery; ii. Provision for physical medicine and rehabilitation unit; iii. Provision for ambulatory surgical clinic; iv. Provision for dialysis facility; v. Provision for blood bank; vi. A DOH licensed tertiary clinical laboratory with standard equipment/reagents/supplies necessary for the performance of histopathology examinations; vii.A DOH licensed level 3 imaging facility with interventional radiology. 52