Session 1 and 2__Health Policy Development_ Introduction & Concepts CHP 326_Combined class.pdf

HEALTH POLICY DEVELOPMENT AND PLANNING Course Code: HMD 132: Credits: 3 Semester: MAY-AUG 2024 Lecturer: Dr Anastasiah Kimeu [email protected] Session 1: Introduction and Context of Health in Kenya  Course Purpose and Objectives Purpose:. Objectives...

HEALTH POLICY DEVELOPMENT AND PLANNING Course Code: HMD 132: Credits: 3 Semester: MAY-AUG 2024 Lecturer: Dr Anastasiah Kimeu [email protected] Session 1: Introduction and Context of Health in Kenya  Course Purpose and Objectives Purpose:. Objectives 1. Describe the Evolution of Facilitate students to health policy 2. Describe the health planning learn and acquire process knowledge, skills and 3. Explain the requirements attitudes for and data needs in national contributing to the health development and 4. Examine the methods used implementation of in health planning. health policies and 2 plans.  Course Content Distribution: #1 Month and Date Course content Introduction: May 16 2024 Class Introductions, Course Expectations; Norms; Course purpose and objectives, Questions and Answers Session 1: May 16 2024 Introduction; Context of healthcare and Historical development of healthcare, colonial health services bodies Session 2: May 23 2024 Introduction: Sessional papers-pre and post-independence; Concepts in public and health policy; Concepts of & types of Policy Analysis, Principles approaches to policy formation (policy triangle); Policy directions Session 3: May 30 2024 Evolution of health policy: Role of public health policy in establishing priorities and allocating health resources. Policies goals, orientations, & principles, strategies, objectives, targets, and role of stakeholders in national health policies. Planning and managing policy process (Agenda setting, policy window, policy formulation and policy implementation) June 3-7 2024 Continuous assessment 1 (CAT 1)  Course Content Distribution: #2 Month and Date Course content Session 4: June 13 2024 Evolution of health policy in Kenya before and after independence and its relationship with developmental goals, ability to plan for policies at various levels. Constitution of Kenya; Kenya Health Policy Framework 1994-2010; Kenya Vision 2030; Global policy commitments/obligations; Kenya Policy Framework 2014-2030 Session 5: June 20 2024 Health Planning Process: The relationship between health planning and national planning and development. Principles of health planning and development; Types of healthcare planning methods. Session 6: June 27 2024 Health Planning: Organization of health services in Kenya; Tiers and levels of care; National health Sector Strategic Plans; County investments and strategic plans (health components) July 1-5 2024 Continuous assessment 2 (CAT 2) Session 7: July 11 2024 Types of health plans: Centrally planned, mixed, and Laissez-faire economies. Course Content Distribution: #3 Month and Date Course content Session 8: July 18 2024 Evidence-based planning: Types & requirements of data in health planning: Demographic data, epidemiological data, socio-economic data, national demographic and health surveys, facility utilisation data and other types of data. Methods of health planning: Analytical methods, expert evaluation methods, cost-benefit analysis, ratios and proportions. Session 9: July 25 2024 Health sector reforms: Definition, Health approaches to reforms in the health sector, Types –decentralisation, financing health, health insurance, social security, pharmaceuticals, hospital autonomy. Session 10: Aug1 2024 Health sector the trend in developing countries, the Impact of health sector reforms on health policy and planning processes. 5-16 August 2024 End of Semester Examinations Educational Approach Participatory approach to learning learners are encouraged to participate to make the learning fruitful and meaningful. Group (2-3 members) activity methods that encourage active learning through ‘learning by doing’. Assessment methods; Individual assignment(contributes to the CAT 1 and 2 Marks); CAT 1&2 and End of Semester Examination Facilitation of learning modified lecture method with Brainstorms, Q&A and storytelling opportunities. Context and Background of Healthcare in Kenya Group Activity #1: Brainstorm What is health and well-being? What factors influence health? What factors determine Health? Why do we need policies for healthcare at national, regional & international levels? Health is not just the absence of disease but the complete physical, mental and social well-being (WHO 1978). Enjoyment of the highest attainable standards of health is a fundamental human right in many member states of the WHO. Governments aim to achieve good health for their citizens to spur economic growth. Why do we need policies? Cont’d #2 In Sub-Saharan Africa, the gross domestic product (GDP) per capita in 1970-2000 was very low and many countries had high poverty levels. GPD per capita is a measure of the material well-being of a population. GDP per capita influences key human development such as: ✓Life expectancy ✓Infant Mortality Rate ✓Maternal Mortality ✓Literacy rates ✓Nutritional status ✓And other determinants of health Why do we need policies? Cont’d #3 Human development indicators are directly proportional to economic development and vice versa. Economic progress activates human development by availing resources and technology, providing and financing services that strengthen the quality of human life e.g. through health care, sanitation, education and public safety. Human development and the reduction of poverty are the focus of effective health systems at national, regional and international levels. Appropriate health policies can play a major role in spurring growth and improvement of the general well-being of populations. Why do we need policies? Cont’d #4 A sound healthcare system with good health indicators produces healthy people who are capable of contributing to economic, social and political development. Industrialized nations have commensurate investments in health services (Kimalu P.K., Nafula N., N., et al 2004. Kenya Institute for Public Policy-KiPPRA Working Paper No. 11) spurring productivity in their countries. Healthcare is both a consumer good and an investment commodity. Historical Development of Health Care System in Kenya Healthcare system development in Kenya goes back to the pre- colonial period. The Imperial British East Africa Company (IBEAC) was brought into Kenya, Western Medicine in 1888 alongside its African trade ambitions. Faith-based missionary organisations established mission hospitals nationwide between 1898 and 1903. The Church Missionary Society (CMS), the Church of Scotland Mission (CSM) and the Catholic Missionary Holy Ghost Fathers began their activities in East Africa. Church of Scotland set up a station in Kikuyu Mission Hospital in 1898. Historical Development of Health Care System in Kenya 1901: Civil department of the Central colonial government administration. In 1903: The colonial government established the first State supported and controlled medical organisation and posted medical administrators to: 1. Preserve the health of the European Community 2. Keep the African and Asian labour force in good working condition 3. Prevent the spread of tropical diseases. 1950:Makere University started a medical degree for doctors for the East African Community. Historical Development of Health Care System in Kenya 1967: The University of East Africa established a faculty of Medicine at the University College, Nairobi, which in 1970 became the University of Nairobi. Continued expansion of health facilities after independence whose social goals were: 1. Elimination of Poverty 2. Elimination of Illiteracy 3. Elimination of disease. User fees for accessing medical services were abolished to ensure access to the services. User fees existed in the pre-independence era. Introduction: Historical development of the Healthcare System in Kenya Year Company/Organization Action 1888 Imperial British East Africa (IBEA) Company Western Medicine 1898-1903 Church Missionary Society (CSM )and Began church and health Catholic Missionary Holy Ghost Fathers services activities in East Africa 1898 Church of Scotland Mission (CSM) Established a church in Kikuyu which offered medical help 1901 Creation of a colonial medical department Civil department of central administration and supported by the state. 1950 Makerere University college of East Africa Medical degree course established 1967 University of East Africa, University College Faculty of Medicine in Nairobi 1970 University of Nairobi established Faculty of Medicine  Introduction: Historical Development of the Healthcare System in Kenya Year Company/Organization Activity of focus 1965 The post-colonial government expands Pursued a policy of elimination of disease, poverty and H- H-facilities illiteracy 1964 Pre-independence government abolishes Free outpatient services and hospitalization for all children in user fees public health facilities increased public health facilities Increased number of health personnel 1964 Kenya inherited a three-tier health The central government provided health services at the district, system provincial and national level Mission hospitals provided services at the sub-district levels. Local government provided services at urban areas 1970 The government established Preventive, promotive and curative health services the to comprehensive rural health services in dispensaries and health centres. date health centres and dispensaries, A pyramidal healthcare system was established with teaching and referral hospitals at the peak while the base. including improving levels of health care Level 1, Level 2, Level 3, Level 4, Level 5 and Level 6 health care complemented by teaching, referral and systems are in operation. research hospitals. The organisation of the Healthcare System in Pre- &Post independence era 1964: Kenya inherited a three-tier health system from the colonial government. Tier 1: Central government provided services at district, provincial and national levels Tier 2: Faith-based missionaries provided services at sub-district levels Tier 3: Local government-provided services in the urban centres. 1970: The government established comprehensive rural health services. Health centres were the focus of this change through: Provision of preventive, promotive, and curative services. : The pyramidal healthcare system exists with six tiers. Pyramidal Comprehensive health care system of Kenya : post independence Teaching and referral Tier 6 Tertiary care Hospitals Hospitals County Hospitals Secondary Care Hospitals Tier 5 Sub-county hospitals Primary care hospitals Tier 4 Health Centres Tier 3 Primary care facilities Dispensary/Clinics Tier 2 Community Tier 1  Sessional Paper # 6 of 1945:Source: https://kippra.or.ke/ Proposed by Key points Laid out by the It adduced that the Merging of government-led The member of Health Secretariat; On administration of public health services and those led by and local government was reorganization of health was inseparable the local government under the to Coordinate services in local government from the local government. docket of member of health and consultation with the and health local government. Director of Medical services services and local authorities as the The local government is the The member for health and technical people. agency charged with the local government was to responsibility of providing a represent the government and The Central Board of safe and hygienic the local government in the Health was to discharge environment, housing, Executive and Legislative responsibilities and water supplies, sanitation Councils in the colonial duties on health services and prevention of diseases. government. delivery. Sessional Paper # 6 of 2012: Adapted from: https://kippra.or.ke/ Proposed by Key points The Minister of A: Gives direction to ensure significant B:Obligation of F: Raises awareness and Medical Services improvement in the overall health status of health: i) ensures ownership and signed too Kenyans in alignment with Vision 2030, the Contribution to among key stakeholders. by the Ministry Constitution of 2010, the country’s long- economic of Public Health: term development agenda and global development as H: Participatory nature of On Kenya Health health commitments. envisioned in the policy by the Policy 2012-2030 C: Provides Six policy objectives and Seven V2030 government agencies, policy orientations ii) the realisation development partners D: Cognisance of the county and national of the (multilateral and bilateral) levels of governance with responsive fundamental and implementing administrative, reporting and accountability human rights as partners (faith-based, lines. enshrined in the private and civil society). G: Engagement of all actors in health for Constitution innovative and comprehensive health 2010 service delivery. Sessional Paper #10 of 1965 Adapted from:https://repository.kippra.or.ke/bitstream/handle/123456789/2345/AFRICAN-SOCIALISM- AND-ITS-APPLICATION-TO-PLANNING-IN-KENYA.pdf?sequence=6&isAllowed=y 1965; Based on a policy of non-alignment The purpose of development is not to develop an area but to develop and make better the people of the region/area by: ✓Investing in the education and training of the people whether in the area or elsewhere and investing in the health of the people ✓If the potential for expansion of the area is small, medical services, education and training will qualify people to get employment elsewhere. A National-Provided Fund and National Health Insurance Fund were to be established. ✓Skilled, trained and experienced manpower was necessary to serve in education, health facilities, forestry, water supply, irrigation schemes, road construction, agriculture, etc. 22 Individual Assignment #1: 10 points Compare two (2) sessional papers on health policy from the KIPPRA website as shown on slide # 14. 1. Indicate what each sessional paper aimed at(main subject) 2. Identify key components (focus areas) that the proponent of the sessional paper aimed to communicate to the target audience. 3. Illustrate on a table and submit to: Dr Anastasiah Kimeu: [email protected] on Monday 23rd May 2024. Thank you HEALTH POLICY DEVELOPMENT AND PLANNING Session Two: Concepts in Public and Health Policy Lecturer: Dr Anastasiah Kimeu [email protected] Session Objectives 1. Define public and health policy and their associated concepts 2. Describe the types of policy analysis 3. Describe the principle approaches to policy formulation 4. Discuss the definition, purpose and goals of health policy. Understanding the Concepts in Public and Health Policy Brainstorm: 10 mins Ask participants to brainstorm on different definitions and concepts of: 1. Public Policy 2. Policy Analysis 3. Health Policy Introduction to Public Policy and Policy Analysis National governments are responsible for developing policies that guide the mobilization, generation, allocation, spending, and impact of resources in a country. Policies have a wider impact than the areas they are developed to impact. Therefore governments collaborate with their stakeholders to develop policies. Public policies result from investigations involving various stakeholders on what, how, and why of public policies. The investigations lead to a negotiated policy framework that governs how resources are shared in a nation. Definition of Public Policy and Policy Analysis Public policy is a study of decisions and actions governments take to address a public concern (C. L. Cochran & E. F. Malone: Public Policy: Perspectives and Choices; 3rd Edition 2007, Lyne Rienner Publishers USA). Policy analysis describes the investigations that produce accurate and useful information for making decisions for policy development and implementation process. The investigations involve, among other parameters, the cause and effects of policy and values inherent in policy development and implementation. Definition of Public Policy and Policy Analysis Cont’d Public policy is also described as: A purposeful decision made by authoritative actors in a political system with the formal responsibility for making binding choices among societal goals. A form of government control usually expressed in law, regulation or order to enforce the provision of goods or services in a specific area. Types of Policy Analysis: A. Positive Policy Analysis: This is an investigation of policies based on a value-neutral position aimed at ensuring scientific objectivity in the investigation. Definition of Public Policy and Policy Analysis Cont’d Positive policy analysis is a value-free investigation. It strives to: Understand how public policy works Explain how various social and political forces change policy. Pursue truth by testing hypotheses and by measuring them against the standard of real-world experiences. Definition of Public Policy and Policy Analysis Cont’d However, the value-neutral approach was abandoned in favour of pursuing business interests and the need for: Policies to remain relevant to meet the interests of policymakers. Increasing the importance of values in policy debates e.g. preference to discuss cost-benefit analysis or the best way to test a hypothesis in policy making. Definition of Public Policy and Policy Analysis Cont’d B. Normative Policy Analysis: The normative view looks into resolving public challenges or debates and recommending decisions for action. Normative view involves value judgments about what should be such as: “The cost of health care in Kenya is too high”. This statement cannot be confirmed by referring to data. Whether the cost is too high or appropriate is based on a given criterion. Its validity depends on one’s values and ethical views. Individuals may agree on the facts of health costs but disagree over their ethical judgements regarding the implications of “the cost of health care”. However it is important to be aware of the distinction between positive and normative policy analysis and not to substitute the goals or methods of one method to that of another. Definition of Public Policy and Policy Analysis Cont’d The Value of policy analysis is determined by an accurate observation of the critical variables/parameters in the external environment during a negative value in policy analysis. This renders factual relationships empirically derived, useful in indicating how best to achieve normative(value) goals that meet the needs of policymakers and the populations. The study of public policy has an implicit ethical view that people and their welfare are important. Other Concepts in Public Policy Global Public Goods: These are all the resources, structures, systems, and processes, in the public domain that foster interdependence of the global community i.e. knowledge and ideas in the public domain, mitigating climate change, identifying and containing diseases with a global reach, identifying and preventing international financial crises, maintaining international peace, fostering cybersecurity etc (UNDP 2023/2024 Health Development Index Report). Scarcity: Scarcity is a condition of limited resources. A combination of scarcity and unlimited wants requires making choices among goods and services to be produced and in what quantities. Other Concepts in Public and health Policy Health: In addition to the WHO (1978 definition), health is the extent to which an individual or group can realize aspirations satisfy needs and cope with the interpersonal, social, biological, spiritual and physical environments. Social Choice: Due to the scarcity of or inequities in health resources, mechanisms for aggregating individual choices to arrive at collective decisions are democratically created to arrive at social choices. Social justice: This is a lack of or exclusion from the full citizenry (low income, poor housing, inaccessible to education etc). Equal worth is a principle that aims to guarantee social justice and therefore social inclusion. Other Concepts in Public and health Policy Accessibility of health services: Access of health services means the aspects of the structure of health services or health facilities that enhance the ability of people to reach a health care practitioner, in terms of location, time, and ease of approach. Access to health is the perception and experience of people as to the ease with which they reach health services or health facilities in terms of location, time, and ease of approach. Equity in health: This is the absence of systematic differences in one or more aspects of health status across socially, demographically, or geographically defined population groups. Other Concepts in Public and health Policy Population Health: This is not merely the sum of the health of the individuals but also a consideration of the nature of the distribution of health throughout the population. Community: A unit, generally geographically defined, which is the locus of basic political and social responsibility and in which everyday social interactions involving all or most of the spectrum of life activities of the people within it take place. Determinants of Health: The wide variety of interacting current and past influences on the health of individuals and populations, including but not limited to political contexts, policies, distribution of power and wealth, social and physical environments, health systems and services, as well as genetic, biological, and historic-cultural characteristics. Other Concepts in Public and health Policy Processes of Health: Aspects of the behaviour or performance of the health care system or health facility and the nature of participation on the part of the people it serves. Guidelines: These are recommendations or suggestions for organizing or delivering services of various types. Guidelines are distinguished from regulations by their voluntary nature, but adherence is generally facilitated by professional expectations rather than formal requirements. Guidelines for public health activities, such as those for laboratory standards, are distinguished from clinical guidelines because they describe interventions that are indicated (or not indicated) in the diagnosis and the management of specific diseases or conditions. Other Concepts in Public and health Policy Outcomes of health care: Those aspects of health that result from the interventions provided by the health system, the facilities and personnel that provide or recommend them and the actions of those who are the targets of the interventions. Health Status: All aspects of physical, social and mental well-being and their manifestations in daily living, including impairment, disability, and handicap. Sometimes other aspects related to vulnerabilities and resiliencies are also included under this definition. Prevention: An intervention or intervention that interrupts the web of causality leading to one or more aspects of ill health. Other Concepts in Public and health Policy Primary care: That aspect of a health services system that assures person- focused care over time to a defined population, accessibility to facilitate receipt of care when it is first needed, comprehensiveness of care in the sense that only rare or unusual manifestations of ill health are referred elsewhere, and coordination of care such that all facets of care (wherever received) are integrated. Health Promotion: Activities, usually directed at individuals, to maximize the development of resilience to a threat or threats to health. Health Protection: Activities undertaken to reduce the likelihood of occurrence of situations or events that are health threats and organized on a population level by a societal action (such as a law or regulation) rather than at an individual level. Health iniquity: This is the presence of unfair, unavoidable, remediable differences in health services and outcomes, among groups of people. Other Concepts in Public and health Policy Health System (WHO definition): consists of all the organizations, people and actions whose primary intent is to promote, protect, restore, and maintain health. The healthcare system is the way the industry is organized to provide health services that people need. Health Systems Governance: refers to the processes, and structures that are in place to oversee and manage a country’s healthcare system. Health Systems Structures: Aspects of the design of health systems and services that influence how services are delivered. Processes of Healthcare: Aspects of the behaviour or performance of the health care system or health facility and the nature of participation on the part of people its serves.