THE HUBERT KAIRUKI MEMORIAL UNIVERSITYFACULTY OF

MEDICINEBEHAVIOURAL

SCIENCES AND ETHICS

TOPIC: ISSUES IN HEALTH CARE DELIVERY

DATE: 13TH May 2015

FACILITATOR: DR. LIWA

PRESENTERS: BONAVENTURE NYAKI BUKOMBE BULOLE DORAH MOLLEL LYDIA BARNABAS SOSPETER MANDAMANO

TABLE OF CONTENTSINTRODUCTIONOBJECTIVESDEFINITION OF TERMSMAIN PRESENTATIONCONCLUSIONSUMMARYRECOMMENDATIONSREFERENCES

Introduction

Health care delivery is a diagnosis treatment and prevention of disease, illness, injury and other physical and mental impairment in human beings, in which the services are rendered by members of the health professionals for the benefit of a patient.

• Issues in health care delivery refers to problems or obstacles facing health professionals in delivering or providing health care to patients.

• This presentation is about the issues in health care delivery generally, our presentation will depict the issues and solutions .

OBJECTIVES

At the end of this presentation we should all be able to:

Define Health and Health care

Know the levels of health care

Know the issues in health care delivery

Understand how the government and community based organizations participates in healthcare delivery

Know the problems and solutions in health care delivery

Apply the solutions in our medical field

DEFINITION OF TERMS. Health: Is the state of complete

physical, mental and social well-being and not merely absence of disease or infirmity.

Health care: Is a diagnosis treatment and prevention of disease, illness, injury and other physical and mental impairment in human beings.

Heath care delivery: Are services rendered/provided by members of the health professionals for the benefit of a patient.

Cont………..

Issues in Health care delivery: refers to problems or obstacles facing health professionals in delivering or providing health care to patients.

Main presentationLEVELS OF HEALTH CARE

Primary health care:-It refers to the work health professional who act as a first point of consultation for all patients within the health care system. E.g. General practitioner, Family physician.

Secondary health care:- Is the health care that is provided by medical specialists and other health professional's who do not have first contact with patients. E.g. Cardiologist, Dermatologist.

Cont.……

Tertiary care:-Is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment such as tertiary referral hospital. E.g. Cancer management, Cardiac surgery and Plastic surgery

Cont…….GOVERNMENT METHODS OF

PAYMENT FOR SERVICES.

MEDICARE: Federal government program that makes health care payments to those on social security.

i) Pays cost for the:

Elderly age (>65)DisabledDependents of disabled

Cont…..ii) Covered services include:

HospitalsLaboratory work-upsNon self administered drugsAmbulance transport

iii) Non-covered services:Eye/Ear examination for glasses/hearing

aidsMost self administered drugsRoutine foot care

Main presentationB) MEDICAID: Health care payment for those on welfare.

i) Covers all care including:Hospital staysPhysician servicesMedication Nursing home

Main Presentationii) Poor and over 65 years of age, Medicare is first used the Medicaid.

C) DIAGNOSTIC RELATED GROUPS(DRGs): Payment categories used to classify patients(medicare patients) for the purpose of refunding hospitals for each case in a given category. DRGs are assigned based on diagnosis, procedure, age, sex and discharge status.

Cont…..COMMUNITY BASED ORGANIZATIONS

IN HEALTH CARE DELIVERY

Community based organizations in their role of health care delivery have started insurance organizations such as the National Health insurance Fund (NHIF), Changamka Microhealth Limited, MicroEnsure , Tanzania’s National Social Security Fund and Assurances Générales du Laos(AGL).

Cont…..National Health Insurance Fund

(NHIF) Enrolment in the national health insurance fund is mandatory for formal sector employees and voluntary for all informal sector workers. The scheme offers wide range of preventative and curative medical care benefit.

The benefits of the government driven scheme includes diagnostic test, out-patients services, dental services physiotherapy, glasses and minor surgery. Services are provided by the accredited health facilities and pharmacies.

Cont….. The premium for formal sector

employees is 6% of the employees salary. The employer contributes 3% and the employees pays the remaining 3%. The informal sector workers pays a flat fee.

In 2010 the membership size increased to 373,326 from 332,650 in 2009 and to 1,971,251 beneficiaries from 1,830,375 in 2009.

Tanzania’s National Social Security Fund It began in 1997 to replace the National provident Fund and to compliment the National Health Insurance Fund. The goal was to enroll 85% of the employees in the informal and 85% of individual living……

Cont…..in rural areas. This program covers out-patients services including consultations, basic and specialized investigations, simple and specialized procedures, Drugs in the national drug lists, Referrals to higher levels and special hospitals. 3.9% of the Tanzanian population was covered in 2009 and 2010.

Cont…BIGGEST PROBLEMS IN HEALTH CARE TODAY

INCLUDE:

Lack of medical personnel.

Inadequate medical equipment's.

Usage of expired drugs.

Bad government policy.

Ignorance.

Centralization of health care centers.

Limited Knowledge and skills among staff and counselor's in planning health care delivery.

Cont…

Cont… Corruption and misuse of resources

Brain drain ( Continuous loss of personnel to foreign countries)

Eruption of new diseases due to change in environment.eg Malaria, Rift Valley fever, Bird flue and Dengue.

Overpopulation

Poor infrastructure

Cont…SOLUTIONS IN HEALTH CARE DELIVERY

INCLUDE: To motivate people into the medical field.

Health care centers should be built around all areas.

Invest more in the health sector.

Management of all resources in health facilities.

Modified working conditions to prevent brain drain.

Policies formulated should be implemented.

There is need to discuss the professional socialization of nurses, physicians, and other members of the health care delivery system in relations to scheme of services and benefits, especially the opportunity to pursue higher degrees after the primary degree in an area of specialization.

There is need to describe the “culture” of the health care providers.

Cont…

Comparing the growth of the Gross Domestic Product and National Health Care Expenditures over time, in Tanzania, East Africa and Africa in general, medical personell is somehow left out, that means the is a challenege of not getting effective motivation, not effective payments, and recognition for the services they render compared to politicians, and other rare professions.

Cont…

We also need to recognize the interrelationships and trends of sociocultural, public health, and medical events that have produced the crises in today’s modern health care system.

We then have to break down the complex web of factors that impede a given person’s passage through the health care system.

Issues in health care delivery call for a description of barriers to health care to all, including medical and health care professionals.

Cont…

It is h

appier to give

than to

rece

ive

SUMMARYHealth care delivery

applies in the government and in the community. In some areas there are poor facilities so health delivery is not appropriately administered for example in remote areas.

CONCLUSIONUltimately, medical personnel

must be willing to collaborate with all members of the health care team in order to provide the best possible care for patients. With thorough knowledge of health care delivery models and leadership skills, they can provide their patients with the highest quality care that only a good leader can provide.

The government should enable electronic financial management to ensure effective collection allocation and use of health financial resources at all levels in accordance with health plan priorities, this includes comprehensive planning, budgeting and reporting between central levels and recipients(District, Region and National).

Recommendations .

REFERENCES

www.en.m.wikipedia.org/wiki/Health_care

Tanzania eHealth startegies.pdf

Behavioral Science 5th edition by, Barbara Fadem

Kaplan USMLE-1(2003)-Behavioral Sciences

Bond J. & Bond S. (1994). Sociology and Health Care. Churchill Livingstone.

Johns Hopkins Medicine. Patient Care: Tertiary Care Definition. 2011.

Simmons J. Primary Care Needs New Innovations to Meet Growing Demands. HealthLeaders Media, 2009.

Tulenko et al., "Framework and measurement issues for monitoring entry into the health workforce." Handbook on monitoring and evaluation of human resources for health. Geneva, World Health Organization, 2012.

World Health Organization. International Classification of Primary Care, Second edition (ICPC-2).Geneva. 2011.

REFERENCES

Nothing unreal exists; Nothing real can be threatened; Herein lies the peace of God.Our true essence is love, all else is an illusion. Teach only Love because that is what you really are.