Lecture 1a PUHH 4101 Health System Management Med 3 PDF

Health System Management, Administration and Legislation PUHH 4101 Med 3 Lecture 1 Dr. Loveline Lum Niba Objectives  To acquaint students with the organization and functioning of the health care system particularly as it operates in Cameroon.  Acquaint the student with...

Health System Management, Administration and Legislation PUHH 4101 Med 3 Lecture 1 Dr. Loveline Lum Niba Objectives  To acquaint students with the organization and functioning of the health care system particularly as it operates in Cameroon.  Acquaint the student with in-depth notion of administrative and management techniques which may be useful in his future carrier as team leader  Acquaint him with the elaboration and the execution of decisions relative to the budget (in Cameroon) as well as management of accounts and finances.  1. The Health system in Cameroon  The health system in Cameroon is structured into three levels of health.  Each has an administrative structure, sanitary formations and structures for dialogues Definition of Health  Health is the state of complete physical, mental and social well- being and not merely the absence of disease and infirmity (WHO)  Factors that affect the health of populations include: Physical (geography, the environment, community size, industrial development) Social and Cultural (urban and rural communities)  Health levels and their dialogue structures LEVEL HEALTH SERVICE AND STRUCTURE DIALOGUE STRUCTURES CENTRAL Administrative Service  National Health Council (CNS)  Ministry of Public Health  Management Committees of the Care structures: hospitals.  General, Reference, Teaching, and Central Hospitals INTERMEDIARY Administrative Service  Regional Fund for Health Promotion PIG  Regional Delegation of Public Health  Management Committee of the RFHP Care structure:  Regional Hospital Management  Regional Hospitals Committee OPERATIONAL Administrative Service  District Health Committee  District Health Service  District Hospital Management Committee Care Structures  Health Area Health Committee  District Hospital  Sub-divisional Hospital Management  Sub-divisional hospitals Committee  Integrated Health Centres  Health Centre Management Committee The 1948 Constitution of the World Health Organization declares the highest attainable standard of health to be a fundamental human right, “without distinction of race, religion, political belief, economic or social condition.” The Universal Declaration of Human Rights of the same year declares the right to security in the event of sickness. The Alma Ata Declaration of 1978 called for “Health for All by 2000” through access to primary health facilities. The Millennium Development Goals adopted in 2000 call for a reduction of child mortality by two-thirds, maternal mortality by three-fourths, and the control of AIDS, malaria, and other diseases, by 2015 compared with a 1990 baseline. The notion of Primary healthcare (PHC) The Alma-Ata Conference defined PHC as follows:  "Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost the community & country can afford to maintain at every stage of their development in the spirit of self determination". Elements of PHC  Education concerning prevailing health problems and the methods of preventing and controlling them  Promotion of food supply and proper nutrition  Monitoring an adequate supply of safe water and basic sanitation  Maternal and child health care, including family planning  Immunization against the major infectious diseases  Prevention and control of locally endemic diseases  Appropriate treatment of common diseases and injuries  Provision of essential drugs.  Training of health workers and health assistants.  Referral services  Primary Health Care Preventive services Curative services Outpatient clinic (referral) General services Care of vulnerable groups Laboratory services Dispensary Health education Maternal &child health s. Monitoring of environment First aid and emergency School health services services Prev.&control of endemic diseases Geriatric health services Health office services Occupational health services  Strategies of PHC (I) 1. Reducing excess mortality of poor marginalized populations: PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will directly impact on the major causes of mortality, morbidity and disability for those populations. 2. Reducing the leading risk factors to human health: PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major determinants of health outcomes for local populations. Strategies of PHC (II) 3. Developing Sustainable Health Systems: PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served. 4. Developing an enabling policy and institutional environment: PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development policy. Primary Health Care principles  Equity in distribution.  Appropriate technology.  Multisectoral approach.  Community participation  Decentralization  Equity in distribution Equity means: Services to all More services to needy & vulnerable  While continuing to provide essential health care for all the population irrespective of social, economical & cultural preferences, extended care is to be provided to the "high risk" groups in the community either within the health centers or by referral from the health centers to a higher level of care (hospital). For ensuring equity: The population to be served must be known. The vulnerable groups are to be identified & reached. Equity in distribution For ensuring equity; The health services (not necessarily health centers) have to be dispersed into: The farthest remote rural areas. The deepest parts of the underserved urban population. The failure to reach the needy & the majority is usually due to limited geographical access. Thus, to ensure equity, accessibility has to be improved by : Increasing the number of health facilities. Improving transport conditions. Organizing outreach services, thus substituting one when the other is not available. Principles of PHC- Community participation.  Involvement of individuals, families, & communities in promotion of their own health & welfare.  A continuing effort to secure meaningful involvement of the community in: Planning. Implementation. Maintenance of health services. Evaluation of health services.  Maximum reliance on local resources such as: Manpower and Money. Materials.  PHC aims to:  Correct imbalance in accessibility  Bring health services as near to people's homes as possible.  To achieve this, PHC is supported by higher level of health care to which patients can be referred for extended care.  Universal coverage by PHC cannot be achieved without the involvement of the local community.  PHC must be built on the principle of community participation (or involvement). Principles of PHC- Intersectoral coordination  There is an increased realization of the fact that the components of PHC cannot be provided by the health sector alone.  The Declaration of Alma-Ata states that “PHC involves in addition to the health sector, all related sectors & aspects of national & community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication & others sectors“. Principles of PHC- Appropriate technology  Technology that is scientifically sound, adaptable to local needs, & acceptable to those who apply it & those for whom it is used, & that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community & country can afford“.  Health technologies are required not only for: Diagnostic maneuvers. Therapeutic maneuvers. But also for: Disease prevention. Disease control. Health promotion. Primary Health care (PHC) in Cameroon I  PHC is provided in line with the health district framework proposed by the WHO Regional Office for Africa  Involving a nurse and a doctor as well as community health workers (CHWs) with the health facilities being supported either by the state, denominational or private individuals.  The PHC system has achieved high routine immunization coverage rates, high coverage of malaria-preventive technologies and high coverage of HIV screening  PHC performance in Cameroon is below expectations when compared to the current health expenditure due to: growing privatization weak regulatory system lack of accountability.  Primary Health care (PHC) in Cameroon II  Cameroon has one of the highest levels of health care expenditure occurring in the informal sector (up to 30%, mostly in primary health care).  User fees are usually charged at the point of use, except for some services for specific population groups.  About 66% of health expenditure in Cameroon is out-of-pocket payments.  The maternal mortality ratio has increased in Cameroon during the last 20 years, despite the increasing annual per capita health expenditure, which reached US$ 59 in 2015  Growing privatization has led to a low use for health districts, especially in the rural areas and there are lot of inequalities in the distribution of human resources in health. Key PHC indicators, Cameroon Source: WHO, 2017 Historical background –The Health Care Revolution (I) “Health for All”  30th World Health Assembly resolved in May 1978;  Main social targets of governments and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 of the level of health that will permit them to leads a socially and economically productive life.  This culminated in the international objective of “Health for All by year 2000”. The goal had three perspectives;  The attainment by all people of the highest possible level of health.  Removal of obstacles of health.  Health for all has been described as a revolutionary concept and a historic movement.  Health Care Revolution (II) “Primary Health Care”  WHO-UNICEF Joint international conference was held in 1978 in Alma-Ata (USSR).  The governments of 134 countries and many voluntary agencies called for a “revolutionary approach” to health care.  Acceptance of the WHO goal for Health for all by the year 2000 and proclaimed primary health care as a way to achieving “Health for all”.  Primary health care is a new approach to health care, which integrates at the community level all the factors required for improving the health status of the population.  It had eight elements described as “Essential health care”.  Health Care Revolution (III) “The Millennium Development Goals (MDGs)”  In Sept 2000, representatives from 189 countries met at the Millennium Summit in New York to adopt the United Nations Millennium Declaration.  Specific commitments in seven areas. The Road map established goals and targets to be reached by year 2015 in each of seven areas.  The goals in the area of development and poverty eradication are now referred as “Millennium Development Goals”- (eight goals, 18 targets and 48 indicators).  Health Care Revolution (IV) “Transforming our world: the 2030 Agenda for Sustainable Development”  This agenda is a plan of action for people, the planet and prosperity  Eradicating poverty in all its forms is a global challenge and it is requirement for sustainable development  There were 17 SDGs with 196 targets  This was building on the MDGs and achieve what all countries of the world failed to achieve. Healthcare system in Cameroon I The health care system in Cameroon is made up of 3 sectors:  Public sector: this is made up of a public hospitals and the health structures under guardianship of other department members (Departments of Defense, Department of Employment, Labor and Social Welfare, Ministry of National Education).  Private non-profit sector (religious denominations): these could be associations or non-governmental organizations) and those for-profit.  Traditional medicine: which is an important component to the system that cannot be ignored.   Historical background 1  PHC in Cameroon covers the periods before and after the Alma- Ata, conference of 1978 whose main outcome was the Alma-Ata Declaration on Primary Health Care  Before Alma-Ata, two approaches had been adopted. 1. Medical approach based on urban public hospitals and rural denominational hospitals in which good health was synonymous with absence of disease. The selected care was free of charge The community followed the health workers’ instructions. 2. Health services approach which introduced the concept of village health teams and village dispensing pharmacies managed by local health personnel through a cost recovery mechanism supported by working capital. Historical background 2 Evaluation of the system showed that; (a) community-based health activities had positive effects and stimulated demand (b) communities were willing to contribute (to some extent) to the financing of health facilities and activities, including village pharmacies.  Community involvement was mostly passive.  In the wake of the Alma-Ata conference, which enshrined the notion that health should go beyond the delivery of  care and promote community involvement in order to make a significant impact on health status, Cameroon adopted a series of health reforms in 1982. Historical background 3 However,  There had been selective implementation of PHC through vertical programmes carried out in parallel to and independent of the health system.  The system had not been restructured to integrate PHC  The use of CHWs without proper training was inefficient  Mechanisms to ensure proper community participation were non-existent  Health workers did not receive continuing professional development for supervision of CHWs Historical background of PHC in Cameroon. Source: WHO 2017  Governance 1  The health district is the operational unit for PHC, organized in a territory comprising one or more municipalities  The district by decree are being managed by a district management team.  A district health committee and a hospital management committee constitute the dialogue structures responsible for translating community participation into practice and promoting the ownership of health services by local actors  According to the 1996 Constitution and the laws and regulations on the decentralization of the State of 2004, the municipalities are responsible for public health and sociocultural development. Governance 2  The actors have not been appropriately redirected towards this new approach, which probably explains the low level of development of health districts  7% by the end of 2015  The lack of involvement of communities, despite the establishment of a number of dialogue structures by the Ministry of Public Health, including the 10 regional funds for health promotion  The Health Sector Strategy 2001–2015 had among its major objectives the decentralization of the health system, including empowerment of health districts while the central level gave direction in the areas of monitoring, control, regulation and standards.  A decrease in the number of vertical programmes was intended, while health districts developed expertise in providing integrated and comprehensive intervention packages to the population. Different levels of the health system in Cameroon References  Report by WHO on Primary Healthcare systems (PRIMASYS); Case of Cameroon  Global Strategy for Health for All by the Year 2000. Geneva: World Health Organization; 1978.  Report of the International Conference on Primary Health Care, Alma-Ata, 6–12 September 1978. Geneva: World Health Organization; 1978  Monekosso GL. The Bamako Initiative: community financing of PHC services through essential medicines procurement and cost recovery, 1987.  Conceptual framework of the D/S viable revised (MSP) Thank you