HUBERT KAIRUKI MEMORIAL UNIVERSITYFACULT OF MEDICINE

DEPARTMENT OF BEHAVIOURAL SCIENCES

TOPIC: PROVISION OF HEALTH SERVICES

FACILITATOR: PROF. MASALAKULANGWAPRESENTERS: JOHN MBILINYI

FILOMENA GILEAD MISANA MSHOLLA

ZAITUNI CHEGAMILA

DATE: 1 APRIL, 2015

TABLE OF CONTENTS

• Objectives• Definition of terms• General discussion• Introduction• Summary• Conclusions• Recommendations• References

INTRODUCTION• A good health system delivers quality services to all people, when

and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies.

• Health services are the most visible functions of any health system, both to users and the general public. Improving access, coverage and quality of services depends on these key resources being available; on the ways services are organized and managed, and on incentives influencing providers and users

OBJECTIVES.

• To understand what is a health system and how it operates

• Promotion of health services by WHO• To understand the provision of health services in

India, South Africa and England.• To understand the provision of service in

Tanzania• General practitioner services• Social services.

DEFINITION OF TERMS.• Health services: include all services dealing with the diagnosis and treatment of

disease, or the promotion, maintenance and restoration of health. They include personal and non-personal health services.

• Service provision: refers to the way inputs such as money, staff, equipment and drugs are combined to allow the delivery of health interventions.

• General Practitioner: A physician whose practice is not oriented to a specific medical specialty but instead covers a variety of medical problems in patients of all ages.

• Inception: The beginning of something, such as an undertaking; a commencement

• Social service: organized effort to advance human welfare. It’s a professional and academic discipline committed to the pursuit of social welfare, social change and social justice

• Authorities: The power to enforce laws, exact obedience, command, or judge

GENERAL DISCUSSION• WHO is supporting countries in implementing people centered and

integrated health services by way of developing policy options, reform strategies, evidence-based guidelines and best practices that can be tailored to various country settings.

• Promoting health Health promotion strategies are not limited to a specific health

problem, nor to a specific set of behaviors. WHO as a whole applies the principles of, and strategies for, health promotion to a variety of population groups, risk factors, diseases, and in various settings. Health promotions, and the associated efforts put into education, community development, policy, legislation and regulation, are equally valid for prevention of communicable diseases, injury and violence, and mental problems, as they are for prevention of non communicable diseases.

cont...• Areas of Work The programmes of the Health Promotion Unit cover the following

areas:

1.About the health Promotion Unit cover the following areas:

Global health promotion, guidance and capacity building• Promotion and supporting capacity building activities, training, review

and evaluation research, information and knowledge sharing, developing and strengthening of WHO collaborating centres for health promotion, in support of national and community-based demonstration programmes.

Global evidence base for health promotion• The rationale of the Global Program on Health Promotion Effectiveness

is to focus on the principles, models and methods that relate to best health promotion practice, taking regional and cultural diversity into consideration.

cont...

2.Global Programme on Health Promotion Effectiveness (GPHPE)

Methods for financing health promotion, strengthing capacity for health promotion and NCD prevention

• The International Network of Health Promotion Foundations was established in 1999 to enhance the performance of existing Health Promotion Foundations andto assist the development of new Foundations.

cont...

3.Network of Health Promotion Foundations

Support to regions and countries in health promotion, strengthening national and community capacity

• Cooperation with Member States, particularly in developing countries, in strengthening their capacity and infrastructure for health promotion and population-based NCD prevention, and incorporating it into national and community plans with emphasis on well planned implementation and evaluation.

Networks on chronic disease prevention and health promotion

• Support networks and partnerships, at local, national and inter-country levels, in developing and implementing related policies and programmes, including most populous countries, and a global forum for health promotion dialogue

PROVISON OF HEALTH SERVICES IN INDIA

• India has a universal health care system run by the constituent states and territories in India. The Constitution charges every state with "raising the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties". The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002.

• Parallel to the public health sector, and indeed more popular than it, is the private medical sector in India. Both urban and rural Indian households tend to use the private medical sector more frequently than the public sector, as reflected in surveys.

• India has a life expectancy of 64/67 years (m/f), and an infant mortality rate of 46 per 1000 live births.

cont...

Health care system Public and private sector• According to National Family Health Survey-3, the private medical

sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. Reliance on public and private health care sector varies significantly between states. Several reasons are cited for relying on private rather than public sector; the main reason at the national level is poor quality of care in the public sector, with more than 57% of households pointing to this as the reason for a preference for private health care. Other major reasons are distance of the public sector facility, long wait times, and inconvenient hours of operation. The study conducted by IMS Institute for Healthcare Informatics in 2013, across 12 states in over 14,000 households indicated a steady increase in the usage of private healthcare facilities over the last 25 years for both Out Patient and In Patient services, across rural and urban areas.

cont...

National Health Mission (former National Rural Health Mission.

• The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India. The goal of the NRHM was to provide effective healthcare to rural people with a focus on 18 states which have poor public health indicators and/or weak infrastructure. Lack of political, economic and administrative decentralization of health care is being chronically ignored by NHM.

PROVISON OF SERVICES IN SOUTH AFRICA.

• Health care in South Africa varies from the most basic primary health care, offered free by the state, to highly specialized, hi-tech health services available in the both the public and private sector.

• However, the public sector is stretched and under-resourced in places. While the state contributes about 40% of all expenditure on health, the public health sector is under pressure to deliver services to about 80% of the population.

cont...

• The private sector, on the other hand, is run largely on commercial lines and caters to middle- and high-income earners who tend to be members of medical schemes. It also attracts most of the country's health professionals.

• This two-tiered system is not only inequitable and inaccessible to a large portion of South Africans, but institutions in the public sector have suffered poor management, underfunding and deteriorating infrastructure. While access has improved, the quality of health care has fallen.

• The situation is compounded by public health challenges, including the burden of diseases such as HIV and tuberculosis (TB), and a shortage of key medical personnel.

PROVISION OF HEALTH SERVICES IN ENGLAND

• In Britain the present organizational structure of Health services grew out of war-time report (1942). Of the committee headed by William Beveridge the report envisaged a comprehensive health and rehabilitation service. For the prevention and cure of diseases and restoration of capacity to work, available to all members of the community at the time of need.

cont... After much discussion and many attempts to accommodate the competing of interested parties, the 1946 National Health Services art proposed a tripartite structure. Responsibility was to be shared between three statutory authorities: the regional Hospital board, the local authority, and local executive council. The National Health Service (NHS) was born on 5th July, 1948. The head of the hierarchical structure of organization is the minister and his ministry:

Cont...

• The department of Health and Social Security. England is then divided into fourteen Regional Health Authorities (RHSs). Most of the members of a RHA are not professionally involved in health service. This committee is augmented by five full-time mangers who constitute the regional team of officers The next level of organization is the District Health Authority,(DHA). A part time paid chair person is appointed by the secretary of the state. The DHA has four full time chief officers who together with one consultant and general practitioner. The general practitioner are self employed contractors to the NHS paid on nationally agreed scale of capitation fees

cont...

• Local authorities are in control of social work, non-medical residential care and other community services. In order to facilitate the integration of services joint consultative committees exist to plan collaboration between the hospital based and local authority community-based services.

PROVISION OF HEALTH SERVICES IN TANZANIA

• In 1977 private health services for profit was banned under the Private Hospitals (Regulation) Act and the practice of medicine and dentistry prohibited as a commercial service

• After a series of major economic and social changes, the Government adopted a different approach to the role of private sector.

• Private sector in health care delivery was further recognized with an amendment to the Private Hospitals (Regulatory) Act, 1977 which resulted into the establishment of the Private Hospitals (Regulation) (Amendment) Act, 1991

cont...Health Services System (Structure) The health system and especially the Governments referral system assumes a pyramidal pattern of a referral system recommended by health planners, that is from dispensary to Consultant Hospital (Better Health In Africa, 1993).

Village Health ServiceVillage Health Service

Cont..

The structure of health services at various levels in the country is as follows:

1. Village Health Service(Community service)• This is the lowest level of health care delivery in the

country. They essentially provide preventive services which can be offered in homes. Usually each village Health post have two village health workers chosen by the village government amongst the villagers and be given a short training before they start providing services.

2. Dispensary Services• This is the second stage of health services. The

dispensary cater for between 6,000 to 10,000 people and supervise all the village health posts in its ward.

cont...

3. Health Centre Services• A health Centre is expected to cater for 50,000 people

which is approximately the pop. of one administrative division.

4. District Hospitals• The district is a very important level in the provision of

health services in the country each district is supposed to have a district hospital. For those districts which donate have Government normally negotiates with religious organizations to designate voluntary hospitals get subventions from the Government to contract terms.

cont...

5. Regional Hospitals Every region is supposed to have a hospital. Regional

Hospital offer similar services like those agreed at district level, however regional hospitals have specialists in various fields and offer additional services which are not provided at district hospitals.

6. Referral/Consultant Hospitals This is the highest level of hospital services in the country

presently there are four referral hospitals namely, the Muhimbili National Hospital which cater the eastern zone; Kilimanjaro Christian Medical Centre (KCMC) which cater for the northern zone, Bugando Hospital which cater for the western zone; and Mbeya Hospital which serves the southern Highlands.

GENERAL PRACTITIONERS SERVICES.About 50% of doctors who qualify enter general practice.24500 general practitioners gives services to an average 2307 patient each; theTrend since 1948; has been away from single practitioner {18% in 1975}.They have been replaced by group practice, some in purpose built health centre {800 in 1975} 45% of practices have two or three doctors, whilst 37% have four or more.

cont...The secretary of state establishes a national medical practices

committee the task of which is to assessThe numbers of doctors practice to an area relative to populationThese are assigned to one of four categories 1.Designated area. 2.Open area. 3.Intermediate area 4.Restricted area.When the number of patients per doctor exceeds 2005, special

encouragement to move into that area by means of financial inducement is given.

On the other hand in the restricted area, where the average number of the patients per doctor drops below 1800, entry is only allowed when vacancy become available through death or retirement.

cont... COMMUNITY HEALTH COUNCILS• Community Health Councils were established, following the 1974

reorganization of health services with the task of representing the views of the local users of health services to the health authorities.

• The councils range in size from eighteen to thirty six members one third by voluntary organization and one six by the Regional Health Authority. Councils have varied in the way they interpret their brief but they must examine the health care needs of the local population, to examine the existing services to see how they meet them, publicized the service offered and give advice about how complaint may be made.

• Communities’ healths have contributed to shift in resources away from hospitals to community services and creation of better balance of service within an area.

cont... COST• At its inception optimist anticipated that the new health service

would actually decrease the number of cases there by keeping cost down .Infact the number of cases has been continued to increase and the cost of both treatment and maintaining people particularly elders has increased enormously. Health services are expensive largely because they are so labor intensive.

SOCIAL SERVICE• Social services are defined as welfare activities designed by the

state or local authority and are carried out by trained personnel.• They too have been subjected to reorganization and may be see to

fall into three category. i.Local authorities’ social services department. ii.Probation and after care services. iii.Voluntary agencies.

cont... I.Local authorities social services department

Their work must be divided into four parts:

1.Residential services. Old people accommodation {part three homes} Homes for physically and mentally handicapped; Children, homes, reception centers; residential nurseries.

2.Field work services Child care, social work support and counseling, to parents and

children oversee of children at risk, particularly for non accidental injury. Provision of services such as day nurseries and child minding.

Adoption, fostering etc Counseling; aids and advice to elderly disabled and mental ill.

cont....

3.Support services Day centre for elderly, physical and mental disabled Home helps Visiting warden services: particularly with regards to

discharge and adjusting to the return home. iv.Meals on wheels

4.Hospital services Counseling patients and relatives; Environmental assistance particularly with the regards to

discharge and adjusting to the return home Financial and practical help Liaison with other agencies to facilitate the continuity of

care.

cont...Probation and after care services This service is responsible to home office, and it involved

with a variety of largely court based work. This includes, supervision of probation orders, prepare social enquiry reports for the court prison after care, parole orders .etc

Voluntary agencies Inspire of the development of statutory services many

voluntary agencies continue to flourish, often serving particular interest groups .In many cases they enable non professionals to make a contribution to the care and wellbeing of others and to provide personalized services.

CONCLUSIONS.

Provision of social services faces problems financialy this hinders it’s function and some countries have low technology hence poor provision of health services.

RECOMMENDATIONS.

The government should setup the budget so That different health institution can be create for undertaking medical education so As to reduce the tendency of providing health services to large population of people by few medical personnel.

REFERENCES.

• A.C.P Sims&W.I Hume,Lecture notes on Behaviour Science.

• WWW.Who.int/topic/health_services/en/

• http/en.wikipedia.org/wiki/health_in Tanzania

• http/en.wikipedia.org/wiki/health_in India

Thank you