Lecture 1C Health System Management PDF

Organization of the Cameroon Health System Dr. Loveline Lum Niba PUHH 4101 Med 3 Outline 1. Introduction 2. Classification of the Hospital 3. Objectives of the hospitals 4. Hospital statistics in Cameroon 5. Historical background 6. Perspectives and Conclusion  1. The Health...

Organization of the Cameroon Health System Dr. Loveline Lum Niba PUHH 4101 Med 3 Outline 1. Introduction 2. Classification of the Hospital 3. Objectives of the hospitals 4. Hospital statistics in Cameroon 5. Historical background 6. Perspectives and Conclusion  1. The Health system in Cameroon  The health system in Cameroon is structured into three levels of health.  Each has an administrative structure, hospitals 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) 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.   Health system in Cameroon  The present health system in Cameroon is principally based on the Reorientation of Primary Health Care and centred on the Health District System is a result of a series of reforms from the inherited colonial system.  Based on the short comings of earlier strategies, the Reorientation of Primary Health Care was conceived in 1985. Its implementation was carefully developed and studied until 1989 when it was approved for field trial.  In 1990 the promulgation of the laws bearing on freedom of association and on the waiver to sell drugs, reagents and small equipment in government health units on a cost recovery basis set the pace for its effective implementation nationwide. 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  2- Classification of the hospitals A- Central Services of the Ministry of Public Health:  These services coordinate, regulate, and develop concepts, strategies and policies in the field of health.( HGY, HGD, HGOPY, CHU)  Structures of care: These are represented by: the general hospitals in reference, the Centers Hospital-Universities, the central hospitals and agencies under guardianship.(HCY etc)  Structures of SYNAME (National Essential Drugs Supply System): These structures are represented by the CENAME (National Center to supply essential drugs), wholesalers private, the central purchasing of the private non-profit sector.  Dialogue structures: There are the boards of directors or management committees.  2. Classification of the Hospitals B. Intermediate level  Administrative Structures: These structures correspond to the different provincial delegations. They provide technical support to the health districts.  Structures of care: These are represented by the provincial hospitals and assimilated.  Structures of CENAME: These structures are represented by the CAPP (Provincial Pharmaceuticals Supply Centre) and the pharmacies in general hospitals and central.  Dialogue structures: these are the management committees (COGE)  2. Classification of the hospitals C. Peripheral level  Administrative Structures: represented by the district health services, they implement the national programs.  Structures of care: These structures are represented by: the district hospitals, medical centers and district health centers.  Structures of SYNAME: These are represented by the pharmacies for health training courses of the previous levels, as well as private pharmacies.  Dialogue structures: These are the COSADI (Health District Committee), COGEDI (District Management Committee), COSA (Health Committee), and COGE (Management Committee).  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 Hospital statistics in Cameroon 3305 hospitals in the country  04 hospitals in the 1st category  04 hospitals in the 2nd category  11 hospitals in the 3rd category  166 district hospitals  194 sub-divisional hospitals  2119 integrated health centres  807 private hospitals  193 non profit making private hospitals  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  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 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. 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. Reorganisation of the National Health System  The reorganization of the health system has three objectives:  Improve the accessibility of health to the population (take the services to the people).  Increase the efficiency of health services in order to better take care of health problems.  Improve the quality of health care by paying attention to the vulnerable groups (women & children).  The reorganized health system in Cameroon has three levels viz: The Cameroonian Health Care System has undergone four major transformations: From the colonial period to 1978, the Cameroonian health care system was characterized by:  State monopoly with little or no private initiatives  Health Care (Services and Medicines) were free as the state bore the entire costs.  Irrational distribution of health structures and resources mainly concentrated in towns and major economic pools at the expense of the rural milieus.  High priority to curative activities at the expense of cost effective preventive measures.  A passive participation of the population (just recipients).  Low priority given to traditional medicine by public authorities in spite of popular glamour.  Thus with growing economic crises, this strategy became too expensive and unaffordable. Drugs and equipment could not be replenished; training of staff was a problem. Remote areas were abandoned to themselves. The system failed Conference on Primary Health Care in the East European Kazakhstan State capital, Alma Ata of 1978  The conference resolved that in many third world countries like Cameroon access to health care for the rural population was either poor or insufficient. It proposed a strategy for the promotion of health for all, termed Primary Health Care. It recognized traditional medicine and attached a lot of importance to that practice  The effective implementation of this policy in Cameroon started in 1982 where emphasis shifted from the well-known health professionals and classical health structures (hospitals and health centres) to community health workers (village health workers and traditional birth attendants) and their village health posts This vertical programme consisted of the mobilization of the community to: 1. Construct, allocate or rent a building to be used as a village health post. 2. Form village health committees for animation and communication. 3. Select a child of the soil as village health worker or traditional birth attendant. 4. Acquire a limited list of essential medicines. 5. Ensure the training of the village health workers and the birth attendants At Rica, Russia, in 1987 a global midterm evaluation showed that not the PHC concept but the so-called vertical PHC approach as outlined above had failed: 1. The approach was not sustainable 2. It lacked field coordination and offered room for the duplication of interventions. 3. It lacked supervision from the most peripheral health units with which it went into competition 4. There was no real planning resulting in irrational use of scarce resources. 5. It was difficult to retain village health workers who either deserted, or got entangled into embezzlement of the limited resources or into illegal professional activities beyond their skills and competences. 6. Generally, the population took the village health worker for health professionals whose performance was below expectation  1990, Reorientation of Primary Health Care  This was introduced in Cameroon as a natural outcome of the failure of the vertical PHC programme.  It is the result of two essentially African conferences seeking to redress the situation without necessarily changing the strategy or philosophy but simply reviewing the implementation of each concept involved.  The two conferences are the 1985 Lusaka and 1987 Bamako conference of African Ministers of Health Reorganisation of the National Health System The reorganization of the health system has three objectives: 1. Improve the accessibility of health to the population (take the services to the people). 2. Increase the efficiency of health services in order to better take care of health problems. 3. Improve the quality of health care by paying attention to the vulnerable groups (women & children). The reorganized health system in Cameroon has three levels viz: Health Levels and their corresponding health services  There is a functional relationship between these dialogue structures.  Community members who are the active members enter the dialogue structures from the bottom and contest with peers for entry into the higher structures and organs.  The lower structures and organs report to the higher structures and organs while the higher structures and organs supervise and redirect the lower ones.  At each horizontal level the general assembly of the dialogue structure is the supreme organ that supervises and enacts decisions of the management committees elected from its members  The 2001 – 2010 Health Sector Strategy  The consensual adoption in 2001 of the Health Sector Strategy (HSS) marked a turning point in the evolution of the health policy in Cameroon. It reflected the future vision and proposed a set of reforms to be conducted to face up to health problems of the population. Its objectives were:  To reduce global morbidity and mortality by one-third among the most vulnerable groups of the population,  To set up a health system delivering the Minimum Package of health activities (MPA), at one hour's walk for 90% of the population,  To practice effective and efficient resource management in 90% of the public and private health units and services at various levels of the pyramid. These objectives were set up in 17 strategic axes of which the implementation was done in 08 programs and 39 sub programs. Nomenclature of the 2001 – 2015 HSS (Health Sector Strategy)  There are 4 intervention areas (Domains) including 3 for health care delivery namely:  Health of the mother, adolescent and child,  Disease control,  Health promotion, And one for health system strengthening  Health district development. 14 health care delivery intervention classes 7 health service strengthening intervention classes 63 categories including 36 health care deliveries and 27 health service strengthening interventions; 259 types of intervention including 138 health care delivery and 121 interventions to strengthen health service. The 2016 – 2027 Health Sector Strategy The 2001 – 2015 HSS ended in 2015. An evaluation of its contents and its implementation thus guided the development of a new HSS which will cover the period 2016 - 2027. This new strategy aligns with the growth and development strategy paper and the Sustainable Development Goals (SDGs). This segmentation is shown in Figure 02. HEALTH PROMOTION DISEASE PREVENTION CASE MANAGEMENT  Living environment of  Communicable diseases.  Communicable diseases the population.   Diseases with Epidemic Maternal, Neonatal,  Acquisition of potentials. Infant and Adolescent knowledge favourable health  Vertical transmissible to health. diseases.  Non Communicable  Community interventions diseases  Non Communicable for health promotion. diseases.  Disabilities  Family Planning. Health care delivery HEALTH SYSTEM Human resource Management of medicines and other pharmaceutical products STRENGTHENING Health care financing Health Information and operational research  Conclusion  The Health system in Cameroon has greatly evolved from the concept of PHC in 1978 to the present system otherwise known as “Re-orientation of Primary Health care”.  This new system based strictly on the PHC ideology is therefore seeking to improve health care by reorganizing and rationalizing the National Health System.  Emphasis has thus shifted from hospital based care and or development of health posts to the Health District with its health service, hospital and network of integrated health centres as the operational unit.  The 2001 – 2015 HSS thus intended to strengthen the implementation of health sector reforms to translate into reality the "Health Sector Policy Statement of 1992"  With the progressive implementation of the law on decentralisation and the adoption of sustainable development goals and considering some shortcomings identified during the implementation of the 2001 – 2015 HSS, the 2016 – 2027 Health Sector Strategy has been elaborated, in order to better respond to the health needs of the population of 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