1 dr. babar t shaikh the aga khan university, karachi society, culture & health care system
TRANSCRIPT
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Dr. Babar T Shaikh
The Aga Khan University, Karachi
Society, Culture & Health Care system
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“ New doctors advise that colostrum should be given. It is essential.
Our elders say that colostrum should be disposed off, therefore, we practice what our elders advise us to do”.
Mothers’ focus group Rural Sindh, Pakistan.
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Health System• a set of cultural beliefs and practices;
• the institutional arrangements; and
• the socio-economic, political & physical context
Health system includes environmental conditions, nutrition, water supply, education, housing, status of women, social structures, economic and political system
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Factors influencing health service utilization
•Age/sex of child
•Family size/ parity
•Education
•Occupation
Socio-demographic factors
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•Possession of household items
•Possession of cattle
•Possession of agriculture land
•Type of residential house
Economic factors
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•Availability of the transport
•Physical distance for Health Facility/Health Care Provider
•Time taken to reach Health Facility/Health Care Provider
Physical accessibility factor
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•Fare spent for one round trip to Health Facility/Health Care Provider
•Total amount spent for treatment of last illness (excluding fare)
Financial accessibility factors
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•Attitudes of health provider
•Satisfaction with the treatment
•Received medicines from Health Facility/Health Care Provider
•Received prescription for medicines
to be purchased from bazaar
Health service factors
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•Freedom to visit HF alone
•Permission to spend money on health
•Decision power in emergency situation
Mother’s autonomy
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Conceptual framework of KroegerSocio-demographic factors
•Age/sex of child
•Family size/ parity
•Education
•Occupation
Economic factors
•Possession of household items
•Possession of cattle
•Possession of agriculture land
•Type of residential house
Physical accessibility factor
•Availability of the transport
•Physical distance for HF/HCP
•Time taken to reach HF/HCP
Financial accessibility factors
•Fare spent for one round trip to HF/HCP
•Total amount spent for treatment of last illness (excluding fare)
Health service factors
•Attitudes of health provider
•Satisfaction with the treatment
•Received medicines from HF/HCP
•Received prescription for medicines
to be purchased from bazaar
Govt./ Private HF/HCP
Mother’s autonomy
•Freedom to visit HF alone
•Permission to spend money on health
•Decision power in emergency situation
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Challenges
Knowledge of illness/wellness and of services available
Perceptions of services/service providers
Risk/symptoms assessment
Cultural “prescriptions”
Social barriers/social pathways to care
Etc…
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Health SectorChange Agents
Changing disease patters
Advances in biomedical/ clinical sciences
Health Sector Reform
Global perspectives on health and health care
New specializations/ professions
Ethical issues: New dimensions
Information/ Communication revolution
Globalization
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PROVISION OF HEALTH CARE
PRODUCING HEALTH
Focus on Life-styles
Focus on the Environment
Shift focus from individuals to populations
Cost-effective health care
Evidence-based decision/ policy
Resources to sector that contribute to health
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HEALTH CARE SYSTEM: TYPES AND COMPONENTSTRADITIONAL
MODERN
PRIVATE
PUBLIC
PRIMARY
Physicians’ office Dispensaries NGO/Community Groups BHU/RHC
SECONDARY
Clinics/Maternity homes Tehsil Hospitals NGO-run clinics/hospitals
TERTIARY
Distric Hospitals Large Urban Hospitals
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GOVT. (PUBLIC)HEALTH DELIVERY SYSTEM (4 TIERS)
Outreach/Community-based activities [Immunization, malaria control, MCH, FP]
PHC Facilities (OPD)
TEHSIL & DISTRICT HQ. Hospitals
Tertiary Care Hospitals
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PUBLIC HEALTHDELIVERY SYSTEM
DISTRICT HQ HOSPITAL (80 - 100 Beds)
TEHSIL HQ HOSPITAL (40 - 50 Beds)
RURAL HEALTH CLINICS (Extensive OPD; 10-20 Beds)
BASIC HEALTH UNITS (Preventive & Curative; mostly OPD)
10-20,000 Pop
25-50,000 Pop
50,000-1 ml. Pop
1 - 2 Million Pop
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PREVENTIVE HEALTH SERVICES
IMMUNIZATION PROGRAM
MCH SERVICES
FP SERVICES
LHW PROGRAM [45,000 LHW /2000; Target 1:1,000 Pop]
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GOVT. HEALTHSERVICES:
WEAKNESSES
Insufficient focus on Prevention/Promotion
Gender Imbalances
Excessive centralization of management
Political Interference
Lack of openness
Weak human resource development
Lack of integration
Lack of Healthy Public Policy
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PROBLEM AREAS
POVERTY
ILLITERACY
LOW STATUS OF WOMEN
INADEQUATE SANITATION & WATER SUPPLIES
POOR QUALITY OF HEALTH SERVICES
Problem areas
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Income influences health
• People in the top income bracket are healthier than middle income earners
• Middle income earners are, in turn, healthier than people with low income
• This means that the poorer people are, the less healthy they are likely to be.
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Social status affects health
• It affects health by determining the degree of control people have over life circumstances
• It affects their capacity to act and make choices for themselves
• Higher social position and income somehow act as a shield against disease.
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Gender influences health
Gender is linked more to the roles, power and influence society gives to men and women, than it is to their biological differences.
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Culture influences healthCulture and ethnicity influence how people link with health system, their access to health information and their lifestyle choices.
‘Dominant’ cultural values largely determine the social and economic environment of communities.
Result:Marginalization
Loss/devaluation of culture and language
Lack of access to culturally appropriate health services
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Health Caresystem 25%
Biologicalendowment 15%
Physicalenvironment 10%
Socio-economicenvironment 50%
Estimated Health Impact of Determinants of Health on Population health Status: CIAR 1997
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• Focuses on the entire range of individual and collective factors (income and social status, education, employment and working conditions, social environment, physical environment, gender, culture, personal health and coping skills, healthy child development, health services)
• The interaction among these factors
Population Health Approach
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Population Health Approach• Health is determined by the complex interactions between individual characteristics, social and economic
• Strategies to improve population health must address the entire range of factors that determine health
• Important health gains can be achieved by focusing interventions on the health of the entire population/significant sub-populations rather than individuals
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Population Health Approach
• Improving health is shared responsibility that requires the development of healthy public policies in areas outside the traditional health system
• The health of a population is closely linked to the distribution of wealth across the population
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Creating a Healthy Community
Community
Economy
Environment
Based on a model from: Hancock, Trevor. 1993, “heath, human development and community ecosystem: three ecological models”
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Health Services
• move towards ‘broader resources’ to support well-being
• the design: services to maintain and promote health, to prevent disease, and to restore health system functioning to contribute towards population health.
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