Lecture 11: Health systems

Question 1

Alma-Ata Declaration

Answer 1

emerged as a major milestone of the twentieth century in the field of public health, and it identified primary health care as they key to the attainment of the goal of health for all

Highlighted multiple stakeholders need to make a commitment in order to make this work

First international declaration underlining the importance of primary healthcare

Question 2

International Conference of Primary Health Care

Answer 2

When it comes to primary health care they highlight that essential health care should be based on practical, scientifically sound and socially acceptable methods of care

Also highlight:
o Bring healthcare as close as possible to the people
o Governments have a primary responsibility for the health of their people
o People have both the right and duty to participate individually and collectively to participate in the planning and implementation of healthcare

Question 3

Health for All

Answer 3

Strong relationship between health systems, health, wealth and social well being
o Healthy people are more likely to be employed, and less likely to take sick days, more likely to be more productive, and less likely to retire early

Generally speaking lower income countries will see great benefit from investing in very basic interventions, such as hygiene sanitation issues, immunization, bug nets

How we share advanced knowledge

How we share health information online

Question 4

Primary care

Answer 4

Generally speaking, we are speaking about first contact care

Primary healthcare is the level of healthcare the provides entry into the health system for all other needs and problems that might arise

Primary healthcare: first contact care as well as health promotion and prevention seen in public health initiative
o More basic level of healthcare
o Deals with the majority of healthcare related issues
o If you don’t feel well do you have access to a doctor?

Question 5

Strong primary healthcare includes

Answer 5

Diagnosis and treatment

Management of healthcare problems

Providing ongoing support

Includes things such as health prevention and promotion

Question 6

Characteristics of Primary healthcare

Answer 6

Based on evidence based medicine

Are universally available

Should be affordable

Should address the actual needs of the community

Provide preventative care, curative care as well as retaliatory services

Should be linked to more advanced levels of healthcare through a referral system

Question 7

Secondary care

Answer 7

Medical care provided by a specialised or facility upon referral by a primary care physician

Question 8

Tertiary care

Answer 8

Specialized consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment
o Example: cancer care centers

Question 9

WHO 5 elements to provide primary care for all

Answer 9

Reducing exclusion and social disparities in health

Organizing health services around people’s needs and expectations

Integrating health into all sectors

Pursuing collaborative models of policy dialogue

Increasing stakeholder participation

Question 10

Cuba’s life expectancy

Answer 10

79

Question 11

Why is Cuba doing so well

Answer 11

They do make a lot of investments, its prioritized
Healthcare system is based on a term called Poly-clinics
o A place where a range of healthcare services are administered
o Diagnostic centers
o Family care
o Internal medicine
o Pediatrics
o Gynecology is apart of it
o X-rays and ultra sounds
o Emergency services
o Family planning

Question 12

Health Systems

Answer 12

All activities whose primary purpose is to promote, restore or maintain health

Agencies that plan, fund and regulate health care

The money that finances healthcare

Those who provide preventative health services

Those who provide clinical services

Those who provide specialized inputs, such as the education of the healthcare professionals

Production of drugs and medical devices

Question 13

Vertical Approach

Answer 13

Public health initiatives targeted at addressing a single disease/health condition at a time

Ultimate goal to eradicate or reduce the prevalence of the disease

Vertical approaches are not as beneficial as if a specific thing is included in a horizontal approach

Question 14

When is vertical approach used

Answer 14

Vertical programs are necessary if primary health care is not sufficient and it’s a temporary solution
o If you want to address the needs a specific target group that is hard to reach
o If it needs to be a quick fix
o When you need very high skilled people to do a couple of things

Question 15

Horizontal approach

Answer 15

Public health initiatives focused on integrated delivery of general health services and tackling overall health problems

Aim is to develop health networks that cater to people’s day-to-day health issues

Question 16

Changing nature of healthcare globally

Answer 16

Development of pharmaceuticals

Technological advancements

Surgical advances

Treatment of non-communicable diseases

Question 17

Global Health System

Answer 17

The group of actors whose primary intent is to improve health, along with the rules and norms governing their interactions

Organized social response to health conditions at the global level
WHO is the only real actor in global health systems, because of its universal memberships

Question 18

Other global health system organizations

Answer 18

UNICEF

World bank

Question 19

Global governance for health

Answer 19

The way in which the global health system is managed; no government at the global level

Example: formal decision-making processes of the UN; voluntary codes of conduct or organizations

Question 20

Key stakeholders for global health

Answer 20

UN systems 
US is a key player in a lot of things
National governments
Philanthropic organizations
Academic organizations

Question 21

4 essential functions of the global health system

Answer 21

1. Production of global public goods
   o Referring a lot to knowledge related goods
   o Any tools that your using to standardize the language when talking about health and disease (international classifications)
2. Management of externalities across countries
   o Trying to prevent negative effects of ill health
   o Surveillance systems to monitor progression of disease
   o What response mechanisms are set in place
   o Coordination mechanisms with other countries
3. Mobilization of global solidarity
   o Mostly provided through the provision of aid
   o Donor aid
   o Technical cooperation and capacity is also involved here
   o Humanitarian assistance during disasters
4. Stewardship
   o Ontario ministry of health and long-term care: provide overall strategic direction

Question 22

Importance of health systems

Answer 22

Improving the health status of individuals, families and communities
Defending the population against what threatens its health
Protecting people against the financial consequences of ill health
Providing equitable access to people-centred care
Making it possible for people to participate in decisions affecting their health and health system

Question 23

3 measures of health system performance

Answer 23

attainment of good health
 looking at both at how the health system can improve or protect peoples health
 concerned with how long you could live in good health (disability and disease free)

Responsiveness to the expectations of the population
 Referring to goals of the health system to reduce inequalities in a way that improves the situation for the people who are the worst off
 Client oriented? Is it responsive to their expectations

Fairness of financing
 Ways in which you pay for health care
 Does the healthcare system do anything for reducing the burden of out of pocket expensive for health care

Question 24

4 functions of health systems

Answer 24

Providing health services
Generating human/physical resources for service delivery
Raising/pooling resources to pay for health services
Stewardship (govern and regulate the health system)

Question 25

Responsibility of health care

Answer 25

Performance of the country’s health system lies with the government

• Need a responsible government to oversee the healthcare of people
• Continuous, sustainable involvement of the government
• Looking at primary healthcare

Not always just about how much money governments are investing in healthcare

• Rather efficiency
• Wasteful of resources

Question 26

Canada’s Health System

Answer 26

Will vary from province to province
Provide overall strategic direction
30% coming from private sector 70% from public sector
hospital drugs and physicians is where most of our money is going
spending into these areas has been slowed
prescription drugs
o generally speaking people support with covering drug costs in taxation

Question 27

Ontario Ministry of Health and Long-term Care

Answer 27

Local health integration networks: have a better way of plan, fund and implement more efficient healthcare services
Local authorities are more capable of knowing what’s going on in a region or sub region
Make sure healthcare is patient focused,
Investing in things you need in a specific region

Question 28

Local Health Integration Networks

Answer 28

LHIN
Ontario created 14 LHINs in 2006 with the mandate to plan, fund, and integrate health services for more efficient care in their regions
Authority of governance of health care has been moved to regional authorities, based in the belief that local authorities can better integrate and coordinate services and contain costs
Non-profit organizations funded by the Ministry of Health and Long-Term care

Question 29

Problem with US healthcare

Answer 29

The US has the most expensive healthcare system
US spends the most on healthcare,
US has the highest technology of healthcare services however millions of people don’t have access
Using taxation is not the only way to pay for public health
People who are better off need to subsidize costs for those less off

Question 30

Health System Building Blocks

Answer 30

Service delivery 
Health workforce
Information 
Medical products, vaccines and technologies 
Financing 
Leadership/governance

Question 31

What is public sector responsible for

Answer 31

stewardship of the system
raising funds
making decisions on how to allocate those funds
establishing approaches to health insurance

Question 32

Private sector responsibilities (for profit)

Answer 32

provision of services including non-licensed medical practitioners
operation of health clinics, hospitals, services and laboratories
can partner with public sector or work under contract to the public sector
involved in all countries

Question 33

Private sector responsibilities (not for profit)

Answer 33

involved in community-based efforts to promote better health through education improved water sanitation
often carry out health services
can partner with the public sector or work under contract to the public sector

Question 34

Allopathic or Conventional medicine

Answer 34

western medicine 
physician to population ratio: 
•	low income: 2.8/ 10 000 
•	lower middle: 10.1/10 000
•	upper middle: 22.4/10 000
•	higher: 28.6/10 000

Question 35

Complementary and Alternative Medicine (CAM)

Answer 35

complementary and alternative or traditional medicine is very common in many developing countries
a group of desperate methods of healing and healthcare, which incorporate herbal medicines, spiritual practices, use of animal parts and manual treatments
80% of the population in Africa and India will use CAM, 40% of the population will rely on CAM (complimentary and alternative medicine)
in lower income countries both high and low income populations are likely to use CAM
in higher income countries women are more likely to use it

Question 36

Health services organization: low income countries

Answer 36

fragmented health system that include both public and private providers

Question 37

Health services organization: middle-income countries

Answer 37

system organized around a national insurance scheme

Question 38

Health services organization: high-income countries

Answer 38

national health insurance

Question 39

Universal health coverage

Answer 39

ensures that all people obtain the health services they need without suffering financial hardship when paying for them

Question 40

Universal health coverage requires…

Answer 40

strong, efficient health system
system for financing health services
access to essential medicines and technologies
sufficient capacity of well-trained motivated health workers

Question 41

User fees

Answer 41

are bad, should not have people who are already in a compromised situation paying for services. Drop service fees
o if you cant eliminate them: reduce them to a point where it is not a huge burden on the people using the service

Question 42

Sliding scale arrangements

Answer 42

pay based on SES

o however, healthcare providers would need to know something about peoples SES

Question 43

Out of pocket payments

Answer 43

you should try and keep them to a minimal level
are regressive in nature
may be considered neutral or progressive if they don’t pose a huge burden on people

Question 44

Free of Charge Services

Answer 44

free of charge services wont translate into unjustified and over utilized services
in lower income countries: there will still be barriers
• transportation
• gender
• cultural barriers
• lack of awareness of services
• health literacy

Question 45

Triple burden of disease

Answer 45

triple burden of disease: communicable, non-communicable and injuries

Question 46

Health sector concerns

Answer 46

demographic and epidemiologic change: high cost of treated NCDs
inaccessible/Inequitable care: inefficient care, lack of coverage
Quality of care/Unsafe care: unsanitary conditions, medical errors
Misdirected care: emphasis on secondary and tertiary care
Fragmented care: excessive specialisation threaten routine care
Inverse care: richest consume greatest amount of healthcare
Stewardship: lack of clear rules and regulations
Human Resources: weak management of HR, absenteeism

Question 47

Health Sector Reform

Answer 47

Improving performance of civil services 
Decentralization 
Improving function of health ministries
Building the health financing options
Introducing managed competition 
Working with the private sector