Organisation of the Health System

Organisation of the Health System E. M.C SINKALA Definition of health system It is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communica...

Organisation of the Health System E. M.C SINKALA Definition of health system It is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. It needs to provide services that are responsive and financially fair, while treating people decently. Goals of a health care system Universal and equal access to reasonable health care control of health care costs at an affordable level effective use of resources Health Care Systems Organization in Zambia Public health systems PHC/ Health centres with subentries e.g. Community Health Posts District hospitals General Hospitals Central Hospitals including UTH Private Sector Private clinics Private Hospitals Voluntary Health Agencies (e.g. The Red Cross) Mission Hospitals Industrial Hospitals Defense Forces Hospitals Traditional Health Providers Traditional health practitioners generally Levels of Health Care Primary Health Care Secondary Health Care Tertiary Health Care  Health Care Delivery - Changing Concepts Over the years, most of the political democracies have passed through changing modes in their health care delivery which can broadly be clubbed into four groups. Comprehensive Health Care Basic Health Services Primary Health Care Health Care System Development Comprehensive Health Care means carrying services as close to the people as possible; eliciting community participation to the fullest possible; available to all irrespective of their capacity to pay for it; and should particularly look after the vulnerable section (women, children and old age) of the society (Bhore Committee(1946) in India) Involves provision of preventive, curative and promotional health services from “womb to tomb” to every individual residing in a defined geographic area Basic Health Services WHO/Unicef 1975 definition A network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of competent professionals and auxiliary personnel to perform these functions.  Change in terminology from ‘comprehensive’ to ‘basic’ did not affect materially the quality or content of health services. But it was an indication of keeping the Governments on their toes in making efforts to sharpen the delivery of health care services consistently Primary Health Care It is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford. Essentially it is the outcome of Alma-Ata convention organized jointly by WHO, Unicef and UNFPA in September 1978. Components of Health System Development Quality Care component Human Resources Development NGO participation Public-Private Participation IEC Health System Development It is a combination of management sector and involves organizational matters to translate policies into services In Zambia, the formal Health System has three main links i.e. Central, Provincial, and District The referral of patients is from health centre to district hospital to general hospital and finally to the central hospital  At each level there is a set package of care that should be provided to support the lower level (referring level). In addition to higher level of care at the referral centres, these also have a training function to impart competencies to the lower levels emphasis on developing the health systems which implies concurrent development of primary and secondary systems at large , linking them and strengthening the referral between the three levels including the tertiary level. The district health system Comprises a variety of health services that aim at promoting, restoring and improving the health status of its population A major component is the local hospital, and the way it interacts with other elements of the system goes a long way in promoting or impeding, the development of such a health system The health centre If it works as it should, it is a better functional unity than the hospital and more cost effective It has a better potential in three of its principle domains: primary curative care Preventive care Contacts with the community  It is often more geographically accessible which is good for continuity of care which presupposes a relationship between the health worker and the patient Interventions, including curative care, are much cheaper at this level It is an entry point for preventive care The district health system DISTRICT HEALTH OFFICE (DISTRICT DIRECTOR OF HEALTH) DISTRICT HOSPITAL HEALTH CENTRES (MEDICAL SUPERINTENDENT) Role of the Hospital in the District Health System To attain optimal effectiveness, regular monitoring of the organization and functioning of hospitals and their involvement with health centres is required Their capacity and activities should be adjusted in accordance with the changing needs of the populations served and their functions should be reviewed in the light of the capacity of local health centres to deal with health problems  Hospitals should support primary health care They should be centres of preventive and curative care (complementary and partnership roles) Hospitals are back up for health centres especially inpatient care and physician (scarce resource) OPD referrals The hospital must have the technical means to deal with these referral problems and must be organized accordingly  According to a model of integrated district health care these hospitals should provide the kind of care and technical support which for some reason cannot or should not be further decentralised (for economical, technical or operational reasons) Need to concentrate scarce resources in one or few places  Theoretically, no direct access to hospital. Gate way is the health centre. Patient better cared for at the primary level Why do patients prefer to go directly to the hospital? What are the consequences of the hospital being involved in primary care activities (preventive and curative)  Lower quality of care (there are tasks hc better suited than the hospital) Poor performance of health centres ( due to competition from the hospital) Hospital works below its potential due to overload of primary care work Referral care suffers Competition erodes people’s trust in h.c  Supporting primary care is not the same as delivering primary health care. When a hospital tries to be a health center and a hospital it gets in a triple jam: It provides bad primary care It provides bad referral level care It robs the health centres of their chance of gaining the credit they need to provide good quality primary care and to lessen the burden of the hospital solution What is not done at the health centre must be done at the hospital (no gaps in the system) Overlaps must be avoided (no competition) Overall responsibility for patients lies with the health centre (hospitals technical backu-up) More human relations and less technique = health centre; marginal human relations and more technique or complicate = hospital  The hospital’s roles therefore are: Expert advice Technical intervention Technical examination Inpatient care NB: referral does not mean permanent transfer of responsibility  For a health facility to qualify as a referral unit, it has to have Staff with diagnostic and technical skills other than those at the primary level The possibility of hospitalizing patients (e.g. beds, nurses with higher profile than at health centre, etc) The technical resources to make the full use of the hospital staff  What about prevention? Again only two roles: Make use of any opportunity to complete the established Programme To serve as a referral centre e.g. for high risk antenatal mothers  What is the prevailing situation in Zambia in terms of health system structures and management system and various levels of care?