Introduction to Public Health Care systems
- 1. INTRODUCTION TO PUBLIC HEALTH CARE SYSTEM By James
- 2. DEFINITIONS OF PUBLIC HEALTH The science and art of : 1) preventing disease 2) prolonging life and 3) promoting health and efficiency through organized community effort. (1920)
- 3. CONT’ • Public health care systems are commonly defined as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction.” This concept ensures that all entities’ contributions to the health and well- being of the community or state are recognized in assessing the provision of public health services.
- 4. Cont’ The public health system includes; • Public health agencies at state and local levels • Healthcare providers • Public safety agencies • Human service and charity organizations • Education and youth development organizations • Recreation and arts-related organizations • Environmental agencies and organizations
- 5. THE CONTENT OF PUBLIC HEALTH PRACTICE • Focus on primary prevention. • Community protection through monitoring and surveillance for infectious and toxic agents. • Response to unanticipated natural and human- generated disasters. • Health promotion through programs to notify and educate the community about risks and protective measures. • Target hard-to-reach populations with clinical services.
- 6. PUBLIC HEALTH WORKS BY: • Defining a health problem • Identifying risk factors associated with the problem • Developing and testing community-level interventions to control or prevent the causes of the problem • Implementing interventions to improve the health of the population; and • Monitoring those interventions to assess their effectiveness
- 7. DEFINITIONS OF DISEASE • MULTIPLE DEFINITIONS (E.G.): • An abnormal condition of an organism or part, especially as a consequence of infection, inherent weakness or environment stress, that impairs physiological functioning. (1973)
- 8. • Literally, DIS-EASE, the opposite of ease, when something is wrong with a bodily function. • The words “disease”, “illness” and “sickness” are loosely interchangeable, but are better regarded as not wholly synonymous.
- 9. • Thus, M.W. Susser has suggested that they be used as follows: - Disease is a physiological/psychological dysfunction. - Illness is a subjective state of the person who feels aware of not being well. - Sickness is a state of social dysfunction, i.e., a role that the individual assumes when ill. (1995)
- 10. PRACTICAL DEFINITION OF DISEASE AND EXPOSURE Disease: broad array of health conditions that we seek to understand and ultimately modify, including physiologic states, mental health, and the entire spectrum of human diseases (synonym: outcome variable). Exposure: a catch-all term for agents, interventions, conditions, policies, and anything that might affect health (synonym: predictor/explanatory variable).
- 11. DEFINITIONS OF HEALTH • WHO: A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (1948) • The word “health” is derived from the old English “HAL” meaning hale, whole, sound in wind and limb. • The state of an organism functioning normally without disease or abnormality. (1973)
- 12. Cont’ Objective/Goals • Health: making health of population as good as possible for the entire population over a lifecycle. Conventional measures here include infant and under-five mortality rates, life expectancy, measures of disability, quality of life, etc.
- 13. Cont.’ • Responsiveness: How do health systems perform in regard to non-health aspects of population expectations. Assessing this can be challenging. • The notion of responsiveness can be noticed in many ways: Respect for persons(subjective) and meeting expressed concerns of patients and their caretakers.
- 14. Respect for persons: • -Respect for dignity (cant lock people up for diseases) • -confidentiality (who has access to my file as a patient) • -Autonomy to participate in ones health (choice)
- 15. Cont’ Client Orientation: • -Prompt attention especially for emergencies • -Amenities of adequate quality • -Access to social support networks-Family &Friends • -Choice of provider
- 16. Fair Financing Fair distribution of risks from health financing. Ensuring financial protection for everyone. Ensuring progressivity (Advancement toward better conditions, policies or methods) rather than regressivity (opposing progress). Payment based on ability to pay.
- 17. Core Functions of Public Health There are three core functions of public health and these include ---Assessment (monitor health, diagnose and investigate) – Policy development – Assurance
- 18. Purpose of Public Health – Prevent epidemics and spread of disease – Protect against environmental hazards – Prevent injuries – Promote and encourage healthy behaviors – Respond to disasters and assist communities in recovery – Assure the quality and accessibility of services
- 19. Essential Service (ES) 1 – Monitor Health to Identify and Solve Community Health Problems This can be achieved through; Accurate, periodic assessment of the community’s health status Identification of health risks Attention to vital statistics and disparities Identification of assets and resources Use of methods and technology (e.g., mapping technology) to interpret and communicate data Maintenance of population health registries
- 20. ES 2 – Diagnose and Investigate Health Problems and Hazards in the Community Timely identification and investigation of health threats Availability of diagnostic services, including laboratory capacity Response plans to address major health threats
- 21. ES 3 – Inform, Educate, and Empower People About Health Issues • Initiatives using health education and communication sciences to Build knowledge and shape attitudes Inform decision-making choices Develop skills and behaviors for healthy living • Health education and health promotion partnerships within the community to support healthy living • Media advocacy and social marketing
- 22. ES 4 – Mobilize Community Partnerships to Identify and Solve Health Problems • Constituency development • Identification of system partners and stakeholders • Coalition development • Formal and informal partnerships to promote health improvement
- 23. ES 5 – Develop Policies and Plans That Support Individual and Community Health Efforts • Policy development to protect health and guide public health practice • Emergency response planning • Alignment of resources to assure successful planning
- 24. ES 6 – Enforce Laws and Regulations That Protect Health and Ensure Safety • Review, evaluation, and revision of legal authority, laws, and regulations • Education about laws and regulations • Advocating for regulations needed to protect and promote health • Support of compliance efforts and enforcement as needed
- 25. ES 7 – Link People to Needed Personal Health Services and Assure the Provision of Health Care When Otherwise Unavailable • Identification of populations with barriers to care • Effective entry into a coordinated system of clinical care • Ongoing care management • Culturally appropriate and targeted health information for at risk population groups • Transportation and other enabling services
- 26. ES 8 – Assure a Competent Public and Personal Healthcare Workforce • Assessing the public health and personal health workforce • Maintaining public health workforce standards Efficient processes for licensing /credentialing requirements Use of public health competencies • Continuing education and life-long learning Leadership development Cultural competence
- 27. ES 9 – Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services Evaluation must be ongoing and should examine: Personal health services Population based services The public health system Quality Improvement Performance Management
- 28. ES 10 – Research for New Insights and Innovative Solutions to Health Problems Identification and monitoring of innovative solutions and cutting-edge research to advance public health Linkages between public health practice and academic/research settings Epidemiological studies, health policy analyses and public health systems research
- 29. THE HEALTH SYSTEM BUILDING BLOCKS In order to achieve the goals of health systems, six interconnected pillars or building blocks are identified Governance: policy guidance, coordination and regulation of actors, ensuring optimal allocations of resources and accountability towards all stakeholders. Governance/stewardship must ensure equity, efficiency and sustainability of the health system. This is the role of MOH
- 30. Financing: Acquisition, pooling and allocation of financial resources, but taking into account equity, accountability and sustainability. Note that the way health services are financed and how different providers are paid influences service delivery
- 31. Health workforce: Availability, competence, and right skills mix. These are what can ensure better performance of the health system. But also, are they well remunerated or incentivized? Information and knowledge: for monitoring, evaluation and research, decision making and planning, and for communication assessment of health system performance.
- 32. Medicines, medical products and technologies: Well equipped and maintained medical infrastructure and equipment, insulating the system against stock-outs, adequate prescription and ensuring quality control in drug management and distribution.
- 33. Service delivery: This is closely linked with all other elements including availability of resources, qualified staff, and organization of their use, optimal delivery models for different health services in society, how to steer and motivate providers to behave accordingly
- 34. Service delivery • -requires well maintained health facilities (the infrastructure) • -well trained and paid health work force • -Reliable health information system on which to base decisions and policies • -Medical technologies, vaccines and drugs adequate to deliver quality health care • -Robust health financing mechanism that is sustainable • -Leadership and Governance
- 35. • The people participate in Health systems as actors as well as beneficiaries
- 36. UGANDA’s HEALTH CARE SYSTEM Demographic and socio-economic statistics • Population 34.8 M (2014) • Annual population growth rate 3.03% dropping from 3.2(2014) • Male to female population is 16.9 million males as compared to 17.9 million females (2014) • Total Fertility rate (children per woman) 6.7 (UDHS,2013) • Adult literacy rate 68.9% • Infant mortality rate 54 • Maternal Mortality ratio 438 • National per capita income (US $) 1,520 • Population living below poverty line 21% (2013)
- 37. Factors Accounting for Uganda’s high population growth rates •High fertility rate •Short birth intervals •High teenage pregnancies •Cultures related to families (and religion) • ETC
- 38. Leading causes of death in Uganda • Malaria is leading cause of death in Uganda (37%) followed by HIV/AIDS, and Pneumonia. • Other causes include, lower respiratory infections, Diarrheal diseases, Perinatal conditions ,Tuberculosis, Injuries, etc
- 39. The ratio of health workers to patients in Uganda • The Ratio of health workers to Patients • in Uganda • Doctor is 1:24,000 • Nurse is 1: 1,700 • Midwives 1: 9,000 • Dentists 1: 77,000 • Lab technician 1: 16,000
- 40. THE ROLE OF THE PUBLIC SECTOR IN HEALTH CARE Almost all countries have health-care systems in which there is a high level of public-sector involvement. Some of the arguments for public-sector involvement in health care include; • Social justice; this applies to situations in which the provision of health services to one person is advantageous for other members of society. For example, the treatment of an infectious disease provides a broad societal benefit. When the price of a service is determined privately, it may not incorporate the positive external social benefits of delivering it.
- 41. Cont’ • As a result, the price may be higher when it is determined privately. If the price exceeds what people can afford, or are willing, to pay, they will forego the treatment. This may have undesirable social consequences. For example, an infectious disease may spread to a broad segment of society.
- 42. Cont’ Restriction of monopolies; Government involvement in health care prevents health-care providers from exercising a monopoly. In a health-care monopoly, the medical profession is able to control access to training or impose restrictions on medical substitutes. This can restrict the availability of services.
- 43. Cont’ • Redistribution; Public-sector involvement permits the redistribution of funds from people who are in good health to people who are in poor health. Individuals are not equally afflicted with health problems. People with unhealthy lifestyles or dangerous jobs, have a higher risk of developing health problems. In a private insurance system, these people would pay a higher premium, but in a public health system, the risks are pooled and everyone pays the same premium, regardless of the risk for filing a claim.
- 44. Cont’ • In the public model, insurance must be mandatory; otherwise those at low risk would almost certainly opt out. In the private model, insurance is voluntary and insurers may choose who they wish to insure. In some cases, people in poor health may have difficulty finding an insurer who is willing to cover them.
- 45. Cont’ • Public goods; this suggests that health care is a public good in the sense that it “cannot be managed by market mechanisms because it is impossible to exclude people who have not paid from consuming it. Clean air and military defence are examples of public goods. There is a consensus that governments have a legitimate economic role and responsibility to fund and deliver public goods.
- 46. Private Involvement • For various reasons or concerns such as, quality, accessibility and Availability of health services necessitates private sector involvement as a means of addressing these concerns. public-sector involvement in health care has decreased, permitting increased involvement of private sector in many countries. The impotence of the private- sector involvement in health-care systems include the following
- 47. Private Involvement (cont) Encourages; • Greater efficiency, (using appropriately the time and energy to produce desirable results) • Innovation, • Consumer choice, • Client responsiveness • Etc.
- 48. The National Health Policy To ensure cost-effective service delivery, The ministry of health developed a National Health Policy which Seeks to enhance the health status of the population thru the following approaches: • A) A minimum package of services comprising the most cost-effective interventions that address the major causes of burden of disease. The package known as the Uganda Minimum Health Care Package (UMHCP) is intended at bring the cardinal reference in determining the allocation of public funds and other essential inputs. The UMHCP includes
- 49. • (1) health promotion, environmental health, disease prevention, and community health initiatives, including epidemic and disaster preparedness and response; • (2) maternal and child health (MCH); • (3) prevention, management, and control of communicable and non-communicable diseases
- 50. • The UNMHCP has, however, been consistently underfinanced through the years, and receives only about 30 percent of the total funding required for its full provision. • B) Sustainable broad-based national Health Financing Strategy (HFS) geared towards efficient, effective and equitable allocation and utilization of resources in the Health Sector, Stronger Donor Co-ordination institutionalized through the Sector Wide Approach (SWAp) for health development.
- 51. • C) The basic principles of equity: fair play and justice are expected to be at the forefront. • D) Empowering Communities to take responsibility for their own health and participate actively in the management of their local health services. • E) Enacting a Public Private Partnership for Health Policy: The recognition that the Private Sector has specific advantages in health care delivery which need to be recognized and harnessed – Public Private Partnership for Health