Health systems Flashcards
What is a good health system according to the WHO definition?
Delivers quality services to all people
- when and where they need them
What are the three requirements to have a good health system?
- Well-trained and adequately paid workforce
- Reliable info. in which to base decisions and policies
- Well-maintained facilities and logistics to deliver quality medicines and technologies
What is the state of health systems in LMICs?
> Mental health services often absent or available only in large cities
> Low proportion of health budget spent mental health
> Healthcare workers not trained in mental healthcare
> Lack of health management information systems
> Continuity and supply issues
What is the idea behind ‘system thinking’ approaches in global mental; health?
Alter the research planning and expectation of translation of results into clinical practice
to more realistically reflect the complexity of health systems = context of GMH work
- > from linear isolated process towards multilevel
- taking into account complexity of mutual interactions between different components and their effects on system as a whole
What is the type of research emerging from the systems thinking approach?
It multilevel and mixed methods
What do researchers try to do in the systems thinking approach to GMH research?
Close the gap between what happens in study context and what happens in real-life health systems
What is the stepped care model?
Currently, all care is stepped care
- aiming to match needs of people, population and patients to most appropriate level of care, depending on illness and social characteristics
- > we treat most people in lower pyramid
- > fewer people with most severe conditions require the most complex services (top of pyramid)
What is the difference between the effectiveness of packages of care across LMIC and HIC?
- Effectiveness of packages of care for depression is similar across LMIC and HIC settings
- Evidence suggests this is similar across disorders BUT adaptations are needed to ensure components are appropriate for particular health system contexts
What characterises the mismatch between burden and resources in LMICs?
> Lack of some resources for delivering stepped care
> Lack of MH services overall, particularly community-based
> Lack of specialists but pyramid is top-heavy (need of specialist services)
> Traditional / faith healer fill the gap
- BUT weak evidence of their effectiveness
- absence of evidence
- remain often expensive and unregulated
What is the problem of task-sharing in the scale-up of mental health services in LMICs?
How do we assess feasibility and acceptability of task-shared care in the context of lack of experience of mental health care?
What did the TaSCs trial in Ethiopia consist of?
- Non-inferiority trial
- Intervention group: primary healthcare service
- TAU was the existing service at Butajira hospital
- > moving from hospital -based care by psychiatric nurses to local primary care service delivered by non-specialists
What were the two steps of the TaSCs trial in Ethiopia?
> Step 1: Consultation meetings carried out with
- healthcare admins
- healthcare workers
- community leaders
- caregivers
- service users
> Step 2:
- Focus group discussions with caregivers and healthcare workers
- In-depth interviews with service-users
What did the results of the TaSCs trial in Ethiopia show?
> Transformative effect from treatment received, on the lives of services users and caregivers
-> Lack of disruption to the service was perceived as utmost priority
> From no treatment to treatment, build up trust and reliance on service
In the TaSCs trial in Ethiopia, why were the service users often more reticent to express their opinions than the other stakeholder groups?
> Perceived that possible changes to the service were outside of their area of expertise and control
> It was the responsibility of care providers / researchers to make decisions about changes
What are the consensus points across stakeholder groups generally supportive of primary care delivered service within the community?
- Ease of access (follow-up)
- Reduced costs
- notably of transportation - Reduced caregiver burden
- no need to travel to clinical appointments - Healthcare workers addressing unmet needs
- not turning people away for being ill-equipped to deal with mental health problems
