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Global Health BSc 2018/19 - GHG > Health Systems - 2.2-3, 2.8, 2.9-10, 2.16 > Flashcards

Health Systems - 2.2-3, 2.8, 2.9-10, 2.16 Flashcards

1
Q

What is the definition of a health system?

A

The sum total of all the organisations, institutions + resources whose primary purpose is to improve health

‘The essence of a satisfactory health services is that the rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged’ (Aneurin Bevan)

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2
Q

What are the fundamental objectives of a health system? (x5)

A

Improve health status of indiv, families + communities
Defend population against what threatens its health e.g. outbreaks
Protect people against the financial consequences of ill-health
Provide equitable access to people-centred care
Enable people to participate in decisions affecting their health and the health system

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3
Q

What are the 6 building blocks of the WHO health system framework?

A 
FILMS H
Finance
Information
Leadership/governance
Medical vaccines, devices + technology
Service delivery
Health workforce
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4
Q

What are the 4 outcomes of the WHO health system?

A 
SIRI
Social + financial risk protection
Improved efficiency
Responsiveness
Improved health (level + equity)
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5
Q

What 4 things allow the WHO building blocks of a health system to achieve the outcomes?

A

Access
Coverage
Quality
Safety

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6
Q

What is important about the building blocks that enable an effective health system?

A

It is not the building blocks alone that make a health system. It is the multiple relationships and interactions between the blocks and what converts it into a health system

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7
Q

What are the 4 different types of health system financing models?

A

Beveridge
Bismarck
National Health Insurance Model
Out-of-pocket model

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8
Q

What is the Beveridge model?

A

Healthcare provided + financed by government through tax payments
Not all hospitals owned by government though
Insurer is state
Low costs per capita

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9
Q

What countries adopt the Beveridge model?

A

Great Britain, Spain, most of Scandinavia + New Zealand

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10
Q

What is the Bismarck model?

A

Private provider and private payer
Entitlement bases - contribution
Wages = funding base
Occupational ‘insurer’ - sickness funds from employee AND employer

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11
Q

What countries adopt a Bismarck model?

A

Germany, France, Belgium, Japan, Switzerland

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12
Q

What is the National Health Insurance Model?

A 
Private provider
Public/government payer
Citizenship/residence funding base
Occupational 'insurer'
Public funding accounted for an estimated 70% of total health expenditure
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13
Q

What countries adopt the National Health Insurance model?

A

Canada, Taiwan, South Korea

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14
Q

What is the out-of-pocket model?

A

Private provider + private payer

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15
Q

What countries adopt the out-of-pocket model?

A

LICs

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16
Q

Which is the best health system finance model?

A

Context-dependent
Each country has a different starting point + context, so the right “next steps” to improve efficiency + sustain performance will differ - principle/impact driven

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17
Q

What are the negative impacts of conflict on public health and health systems? (x5)

A 
Loss of lives
Worsening malnutrition
Internally displaced people and refugees
Communicable disease spread and may become life threatening 
Chronic illnesses aren't treated
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18
Q

What do governments of a fragile state lead to? (x4)

A

Governments cannot provide basic services for citizens
Lots of mistrust exist
No economic opportunity for citizens
Hard to rebuild

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19
Q

What are the key principles of post-conflict rehabilitation of the health sector?

A

(Refer to the star diagram)
Bottom left quadrant indicates immediate help is needed - bypass government + service delivery
Top right quadrant refers that government partnership + system strengthening is needed for sustainable development

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20
Q

What are the 3 key phases to rebuild a healthcare system?

A

1) Initial response to immediate health needs e.g. urgent aid, data collection, emergency care
2) Restoration/establishment of a package of essential health services e.g. EML, antenatal care, vaccines, HIV/TB services
3) Rebuilding health system itself e.g. WHO 6 building blocks of health system (FILMSH SIRI)

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21
Q

Name 4 frameworks + tools for Health System evaluation (+ monitoring)

A

The Health System Function Approach (WHO 6 Building blocks)
The ‘control knobs’ framework - Roberts et al., 2004
SWOT analysis
Logical Framework approach

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22
Q

Give a case study whereby a health system had to be rebuilt.

A

Libya 2012

WHO Collaborating Centre was asked to carry out an in-depth assessment of Libya’s health system

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23
Q

What were the aims of the assessment of Libya’s health system in 2012?

A

Identify gaps + shortages
Identify challenges + opportunities for health system reform
Identify future directions

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24
Q

What did the 2012 Libya health system review involve?

A

In-depth desk review
Field visit
Interview with key informants + stakeholders
Led to 2 reports

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25
Q

What were the main challenges found in the Libya health system review in 2012?

A 
Lack of data + evidence
Low quality of care
Shortage of primary health care facilities
Chronic need for maternal + antenatal care
Need for mental health services
High numbers of 'treatment abroad'
Prevalence of HIV drug-injecting users
Ambiguous MoH policy
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26
Q

What were the strengths found in the Libya 2012 health system review?

A 
Commitment
Drive for development
Finance availability
Workforce (production at lower end)
Support of international community
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27
Q

What were the ‘quick wins’ - results that will build credibility with key stakeholders - found in the Libya 2012 health system review?

A

Primary health care
Medicines - availability + distribution
Income incentives - salaries to work in rural areas
Communication strategy - public’s confidence in health services was at its lowest

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28
Q

What were the ‘must do’ actions the Libyan government was advised to take in 2012?

A

Create a Public Health body at MoH
Focus on leadership training
Establish updated Public Laws + Regulations
Develop a Master Plan - all stakeholders should operate within its frame

29
Q

What is universal coverage?

A

Ensure that all people have access to needed health services (promotive, preventive, curative + rehabilitative) of good quality without the risk of financial hardship linked to paying for care

Worldwide ideal advocated by WHO

30
Q

What are the 4 main goals of a health system?

A

Improve health
Provide financial protection
Support fair financing (ability to pay vs risk of ill health)
Responsive to people’s legitimate expectations

31
Q

Describe the inequities in health care access between rural + urban populations

A

WHO report 2000: Major urban hospitals receive around 2/3 government budgets but only serve 10-20% population
Isolated communities have fragmented + under-resourced care
Urban populations have better continuum of care
Depends on population movement in countries e.g. Canada is huge so rural is poor but there is trend of urbanisation

32
Q

What are the reasons for good access to health care in urban areas?

A

Hospital dominated/specialist care
Diverse care services/good referral services
High levels of private care services (unregulated fee charging)

33
Q

What are the reasons for poor access to healthcare in rural areas?

A

Regional + cottage hospitals + health centres
Fragmented care approach based on individual disease control
Limited resources, no continuum of care

34
Q

What are the 4 components of effective access to healthcare?

A

4 A’s
Affordability - ability vs willingness to pay

Accessibility - convenience to access, waiting times, appointments, time to travel

Acceptability - needs for minority groups e.g. LGBTQ+

Awareness - increasing knowledge about services available +/- changing behaviour

35
Q

What are the 3 types of barriers to access of health care in isolated indigenous populations such as in Guyana, S America?

A

Health system
Physical
Economic

36
Q

What are the health system barriers of access to healthcare in Guyana?

A

Shortage of healthcare providers
Poor facilities + limited supplies
Lack of emergency response services
Fragmented service + no continuum of care
Overlapping personal + professional roles

37
Q

What are the physical barriers of access to healthcare in Guyana?

A

Long travel distances/impassable roads in rainy seasons
Lack of public transport/expensive
Limited telephone + internet services
User’s fees

38
Q

What are the economic barriers of access to healthcare in Guyana?

A

Limited economic resources - income + insurance
Adverse + unpredictable weather conditions
Threats to confidentiality + privacy
Local values + beliefs

39
Q

What are the current strategies in remote areas?

A 
District/cottage hospitals
Static health centres
Outreach clinics
Health huts/posts
Community Development Workers (CDWs)
Mobile units (single disease control)
40
Q

What is the definition of globalisation?

A

Historical process characterised by changes in nature of human interaction across range of social spheres incl economic, political, technological, cultural + environmental. Dodgson et al, 2002

41
Q

What diagram depicts the contextual, distal + proximal determinants of health and the globalisation process?

A

The conceptual framework by Huynen et al., 2005

42
Q

What are the contextual determinants of health?

A

Institutional - global governance structures
Economic - Global markets
Social-cultural - global communication + diffusion of information global mobility; cross-cultural interaction
Environmental - global environmental change

43
Q

What are the distal determinants of health?

A

Institutional - health policy; health-related policy
Economic - economic development, trade
Social-cultural - Knowledge, social interactions
Environmental - ecosystem goods + services

44
Q

What are the proximal determinants of health?

A

Institutional - health services
Social-cultural - social environment, lifestyle
Environmental - food + water; physical environment

45
Q

What is the double burden of disease?

A

NCDs are imposing a growing burden upon LMICs - limited resources + still struggling to meet challenges of existing problems with CDs (WHO)

NCDs kill 38 million people each year
Almost 3/4s of NCD deaths occur in LMICs
16million NCD deaths occur before age of 70; 82% LMICs

46
Q

What are the implications of globalization for health?

A

Intensified transborder health risks
Growth in number + influence of non state actors e.g. civil society, private companies
Decline in the capacity of nation-states

47
Q

What is the global health governance landscape increasingly adopting?

A

A contested, increasingly unstructured playing field but it is also a restricted one featuring new players with new power dynamics

48
Q

What is the difference between global governance for health and national?

A

Borders are not present in global health terms - global public goods
Governance is more fluid in global and has more actors with increased complexity
Government used to be the central player but no longer the case as there is a myriad of actors

49
Q

Why should health system performance be measured?

A

To ensure that it is of a good + sufficient quality
To identify any areas that need improving
To measure the effectiveness + value of any intervention

50
Q

Name 4 frameworks + tools for health system evaluation

A

The Health System Function Approach (WHO’s BB framework)
SWOT analysis
‘Control knobs’ framework
Logical Framework approach

51
Q

What is the definition of primary care?

A

A clinical healthcare service that is frontline/first point of call e.g. GP, family doctor, community health worker

52
Q

What are the key principles of primary care?

A 
First-contact
Continuity
Coordinating - integrates care over different providers
Comprehensive - wide range of services
Accessible - few barriers of access
53
Q

How does primary care achieve wider health-improving actions?

A

Addressing the wider social determinants of health
Intersectoral action for health
Equity + social justice - a right to health
Community empowerment

54
Q

What was the first declaration that defined primary healthcare and when?

A

Alma-Ata Declaration 1978
Defined primary healthcare as a right; community participation; wider determinants of health;intersectoral action; equity
Doesn’t JUST encompass primary care - a wider vision for health + well-being and includes a range of movements + agendas which are all interlinked + essential

55
Q

What is the newest renewed global commitment to primary healthcare?

A

Global Conference on Primary Health Care in Kazakhstan, 2018

56
Q

What did the Global Conference on PHC in Kazakhstan 2018 cover?

A

PHC as a way of managing healthcare costs
Expand coverage of basic healthcare
Address wider social determinants of health
Person-centred + community-orientated care
‘Whole of society’ approach
Equity + social justice

57
Q

What is different between the Alma-Ata Declaration 1978 to the Global Conference on PHC in Kazakhstan 2018?

A

Better evidence and understanding of ways to improve health now
Primary healthcare is central to many of those

58
Q

Name a case study to be used to illustrate the effects of Primary Healthcare

A

Brazil, Family Health Strategy

Health Reform began in 1980s as weak PHC + over centralised system

59
Q

Give a brief background of the history + economic background of Brazil

A

MIC
7th largest economy in the world
200 million people

60
Q

What are the health challenges in Brazil?

A

Ageing population
Poverty
Obesity
Inequality - slums in Rio

61
Q

What were the main findings from the Family Health Strategy, Brazil?

A

ESF coverage greater in the lowest income groups - population that is most disadvantaged benefit most from primary healthcare

62
Q

What are the challenges that face the Family Health Strategy, Brazil?

A

Uptake in urban areas still low
Variable administrative capacity to manage local health services
Challenges for access - lack of Drs in public system; availability of appointments; wait times

63
Q

What are the issues with the overall evidence on primary care?

A

Mostly from HICs
Variability in definitions
Selective health outcomes considered
Variation in exposure

64
Q

What does the overall evidence on PHC show?

A

Reduction in mortality - children, CVD + resp illnesses
Lower hospitalisations from ACSCs
Lower costs
Improved equity

65
Q

What is the difference between primary care and primary healthcare?

A

Primary care = service

Primary healthcare = societal vision

66
Q

What are the social determinants of health?

A

The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power + resources at a global, national and local levels

67
Q

What model illustrates the wider determinants of health?

A

Dahlgren and Whitehead, 1991 (rainbow)

68
Q

What did Dahlgren and Whitehead’s model show?

A

The wider determinants of health

Age, sex + constitutional factors
Individual lifestyle factors
Social + community networks
Living and working conditions
General socio-economic, cultural and environmental conditions

Global Health BSc 2018/19 - GHG (6 decks)

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