Lecture 4

Health System in Saudi Arabia

Proposed Health Reforms 1] Sectoral coordination:(National Health Services Council )2] Health

manpower(Labor Force Council )

3] Financing health care

Future changes in the Saudi Health System Strategy

Health System in Saudi Arabia

Proposed Health Reforms 4] The function of the Ministry of Health 5] Relevant Data and Statistics

6] Improve the Pharmaceutical Sector

Future changes in the Saudi Health System Strategy

Health System in Saudi Arabia

Proposed Health Reforms

Future changes in the Saudi Health System Strategy 1] Sectoral coordination:

(National Health Services Council ) 1- Coordinating and integrating all health system elements

2- Optimal utilization of facilities and resources

3- Alternatives for the operation and financing services .

4- Specific criteria for new health facilities.

5- Ensuring regional balance

6- Selecting adequate health insurance alternatives.

7- Health services studies and research.

Health System in Saudi Arabia

Proposed Health Reforms

Future changes in the Saudi Health System Strategy

1- Private colleges. 2- Hospitals own training centers. 3- Expand on the postgraduate 4- Strengthen the role of the SCFHS

2] Health manpower(Labor Force Council )

3] Financing health care1 -Cooperative HIS .

2- Private sector :financing, construction and management

3- Better coordination and integration between government health agencies

Health System in Saudi Arabia

Proposed Health Reforms

Future changes in the Saudi Health System Strategy 4] The function of the Ministry of Health

5] Relevant Data and Statistics All Sectors should :

1 -Promote evidence based policy-making .2- Combining/coordinating the multiple systems and the

private.3- Quality : facilities and manpower.

1 -Regulations and control rules.2- Public health services and PHC

3- Disadvantaged access to health care.4- Strategies and general plans..

Health System in Saudi Arabia

Proposed Health Reforms

Future changes in the Saudi Health System Strategy 6] Improve the Pharmaceutical Sector 1 -List of essential medicines.

2- Substitute or generic medicine .3- Training physicians on logical use of medicines 4- Develop medicine-pricing system5- Storage and distribution.

Lecture 5

Health EducationHealth Promotion

or health education

“Health Promotion is any combination of educational,

organizational, economic and environmental support for

behaviors and conditions of living conducive to health .”

Health Promotion is broader

than Health Education

Health EducationHealth Promotion

or health education

Health Promotion is used to encompass various activities eg. :

Behavior & lifestyle, Preventive health services, Health protection directed at environment, Health related public policy, Economic & regulatory measures.

)Health Education is the primary and dominant

measure in Health Promotion .(

Health Education

.1Interest..2Participation.

.3Proceed from known to unknown..4Comprehension.

.5Reinforcement by repetition..6Motivation

Principles of health education

Health Education

7 .Learning by doing

“If I hear, I forget

If I see, I remember

If I do, I know.” 8 .Good human relations

9 .Leaders

Principles of health education

Health Education

Communication

•Communicator: the person or the team who give the message (Educator) .

•Message: the contents (materials) of health education

•Channel: method of carrying the message

•Audience: the receivers (users or targets) of the message

Health Education

Good communication Good communication techniquetechnique

•Source credibility.•Clear message.

•Good channel: individual, group & mass education.

•Receiver: ready, interested, not occupied.

•Feed back.•Observe non-verbal cues.

•Active listing.•Establishing good relationship.

Health Education

Educator

•Personnel of health services.•Medical students, nursing & social

work.•School personnel.

•Community leaders & the influential.Requirements:

•Personality: popular, influential and interested in work.

•Efficiently trained and prepared. •Must show good example.

Health Education

Message

What information to be communicated.

•Simple, at the level of understanding.•Culturally accepted.

•Interesting.•Meet a felt need.

•Free of technical jargon.•Use audiovisual aids .

Health EducationWhere Does Health Education Happen?

Everywhere!•Schools

•Communities

•Worksites

•Health Care Sites

•Homes

•Consumer Marketplace

Health Education

Practice

1-Individual

Face to face Education through spoken word.A- Occasions of health appraisal.

B- Home visitsNurses Health visitor Social workers

Health Education

2-Groupa. Lessons and lectures in schools.

.bLectures in work places e.g. factories ..cDemonstration and training

3 -Mass media.a. Broadcasting: radio & TV.

b. Written word: newspapers, posters, booklets.c. Others e.g. theaters .

Practice

Lecture 6

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MENTAL HEALTH and types of Mental

Illness

Classification

Serious Mental IllnessSchizophrenia

Criteria for SchizophreniaDelusions

HallucinationsDisorganized Speech

Disorganized Behavior

Social/Occupational Dysfunction

•Flat Affect•Lack of Motivation

Negative Symptoms

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MENTAL HEALTH and types of Mental

Illness

Classification

Serious Mental IllnessMajor Depression

Criteria for Major DepressionDepressed Mood

Diminished InterestWeight Loss or Gain

Sleep DisturbanceRestlessness or

Being Slowed DownFatigue & Loss of

EnergyThoughts of Death

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MENTAL HEALTH and types of Mental

Illness

Classification

Serious Mental IllnessMajor Depression

Criteria for Major DepressionFeelings of Worthlessness

or Excessive GuiltDifficulty Thinking &

Concentrating Symptoms Occur

Almost Every Day Significant Distress &

Impairment

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MENTAL HEALTH and types of Mental

Illness

Classification

Serious Mental IllnessBipolar Disorder

Criteria for Bipolar DisorderManic Episodes

•Grandiosity •Decreased need

for sleep•Talkativeness

•Racing thoughts

•Elevated mood

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MENTAL HEALTH and types of Mental

Illness

Classification

Serious Mental IllnessBipolar Disorder

Criteria for Bipolar DisorderMarked Impairment

•Occupation •Social relationships

May Alternate with Depressive Episodes

Lecture 7

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SCHOOL HEALTH

Components of school Environment:

1. Site and area: - easily reached. - Located in quiet area. - 10 – 15 square m. / pupil

2. School building: - Damp, fire and rat proof. - 2 – 3 floors - > 1 stair case.

- Governmental design

) E, T, L types.(

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SCHOOL HEALTH

3. Class rooms: - Rectangular 6x8 = 48 m2 - 1.0-1.5m2 of floor area for primary school pupils, - 1.5-2.0m2 for intermediate & high

school students. - Windows on left side - Allow best illumination. - White ceiling.

Components of school Environment:

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SCHOOL HEALTH

4. School furniture: - Suitably suspended writing board, - Height & slope of desks ( 150 angle ), - Size of seats in relation to students age & built, - Distance between columns of desks ( 60 cm.).

Components of school Environment:

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SCHOOL HEALTH

- Proper illumination & ventilation, - Rat & insect proof, - Washable walls & floors, - Cold & hot water taps, - Refrigerators ,

Components of school Environment:

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5. Kitchen and Dining:

- Sanitary refuse baskets , - > one door

- Proper control of food handlers.

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SCHOOL HEALTH

- one toilet / 30 students,- Soap & ? Paper towels

Components of school Environment:

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6. Water, Sewage and refuse disposal:

- Drinking fountains,- one tap / 40 students,

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SCHOOL HEALTH

Health Appraisal

Case-finding, specially of unapparent disease , Assessment of health status of school children,

Baseline for follow-up of health status. Health education and guidance of students,

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Objectives

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SCHOOL HEALTH

1- comprehensive medical examination

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Health Appraisal

Components

3 -Clinical (curative) service

4 -Survey studies.

2 -Screening tests,

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SCHOOL HEALTH

1- comprehensive

medical

examination

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Health Appraisal

Components

- Beginning of each level

- Entry - Intermediate- Secondary

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SCHOOL HEALTH

2. Screening Tests:

They are simple tests which can be carried out frequently :

- obesity (BMI)

- visual acuity,

- acuity of hearing,

- IQ testing, and

- dental examination.

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Health Appraisal

Components

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SCHOOL HEALTH

3. Clinical Service:School health units,referrals to specialized clinics,referrals to hospitals for diagnosis and treatment .some cases may need specialized diagnosis or/and management.

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Health Appraisal

Components

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SCHOOL HEALTH

4. Survey Studies:

Occasionally required, specially when

precise data are not available

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Health Appraisal

Components

nutritional deficiency parasitic diseases handicapping conditions

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SCHOOL HEALTH

• May be congenital or acquired.

• Children with minor or mild cases of disability can attend regular schools,

• Severe forms (e.g. the deaf, blind, or mentally retarded) would attend special institutes.

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Health Appraisal

Components

Handicapping conditions:

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SCHOOL HEALTH

Some forms in regular school:

Heart disease

Musculoskeletal deformities Impaired vision

Impaired hearing

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Health Appraisal

Components

Handicapping conditions:

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SCHOOL HEALTH

Each child should have his own health record

Contents of Record: - Personal and social data. - Results of health appraisal. - Immunizations/date/age. - Any morbidity, and management data.

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Health Appraisal

Components

School Health Record

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SCHOOL HEALTH

• For reference whenever health data are needed;

(e.g. past medical history to assist diagnosis of

existing disease.)• Allows follow-up of chronic disease.• Collecting statistical data and indices of school

children, ( for future planning and evaluation

of health services).

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Health Appraisal

Components

School Health Record

Value of Health Record:

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SCHOOL HEALTH

- Spotting suspected cases

through supervision of the

students in the classrooms.-Participation in health

education program.-Supporting mental health

promotion.

- First aid

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Role of Teacher:

Health Appraisal

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SCHOOL HEALTH

• Health appraisal.• First aid and emergency service.• Participation in prevention and control

of communicable diseases.• Inspection of the school environment.• Participation in health education. • Supervising preparation of statistical

indices and health reports.

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Health Appraisal

Role of School Health Physician:

Lecture 7

A) Nutrition:

PERIODS OF MATERNAL CARE:MCH

)> 15 yrs (.for physical and psychological preparation

to bear responsibility.

The nutritional status

strongly influencesFoetal growth

Birth weight (newborn)

Nutrition during infancy

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I. Before pregnancy:

•Maternal immunization against rubella

protects the outcome of pregnancy.

•Tuberculosis severely affects nutritional

status of mothers

MCH

B) Infections:

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• Maternal Abs passive immunization

PERIODS OF MATERNAL CARE: I. Before

pregnancy:

MCH

II. During pregnancy:

Promote, protect and maintain health.

Detect high risk.

Relieve fear and anxiety .

Health Education: ( elements of child care, nutrition, hygiene ……

etc(

)Antenatal Care(

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Aims-:

PERIODS OF MATERNAL CARE:

-Well nourished preg. good birth wt.

MCH

-Common -Affects newborn

infant -Preventable

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A) Nutrition:

-Anaemia during pregnancy

II. During pregnancy:

PERIODS OF MATERNAL CARE:

MCH

B) Infection: -

RubellaCongenital deformitiesAbortio

n -Syphilis

IUFD

Stillbirt

h -

Malaria Low birth wtAmnioniti

s -UTI

Placentitis

Low birth wt

IUFD

IUFD

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II. During pregnancy:

PERIODS OF MATERNAL CARE:

MCHgy

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C) Chronic Diseases

StillbirthAbortionLow birth weight

High perinatalmortality

D) Smoking

II. During pregnancy:

PERIODS OF MATERNAL CARE:

E) Heavy work and stress in late pregnancy leads to low birth wt

F) Psychological stress

Good ANTENATAL care can provide for all of

this and more.

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II. During pregnancy:

PERIODS OF MATERNAL CARE:

First visit………

Beyond 16 weeks

Second visit..…

Between 24 and 28 weeksThird

visit...……Fourth visit……

Between 30 and 32 weeksBetween 36 and 40 weeks

(key family practices(

MCH

)Intra-natal Care( AIMS:

Asepsis

(prolonged labor – ante partum hemorrhage – convulsions (

Care of baby at delivery.

Preparedness to deal with complications.

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Minimum injury to mother and newborn.

III. During labour:

PERIODS OF MATERNAL CARE:

b) Care during labour

MCH

a( Antenatal Care (Risk assessment(

-Infection

ophthalmia neonatorumtetanus

neonatorum -Bleeding

-Trauma

MotherNewbor

n -Asphyxia

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III. During labour:

PERIODS OF MATERNAL CARE:

V. Post lactation: spacing?

MCH

IV. Post-Natal Care

Aims:

Restoration of health. Check adequacy of breast

feeding. Provide basic health education.

) Evaluate effect of antenatal Care!?(

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PERIODS OF MATERNAL CARE:

SAFE MOTHERHOOD

FP ANC SD EOC

E Q U I T Y F O R W O M E N

PRIMARY HEALTH CARE

BASIC MATERNITY CARE

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THE RIGHTS OF WOMEN! MCH

-Malnutrition

- Anaemia- Infection

Pregnancy

- Bleeding- Infection

- Bleeding- Infection

-Lack of awareness- Lack of health services

-Lack of utilization of health services

Labour

Postpartum

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MCHMaternal Mortality

Infancy and Early Childhood:

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MCH

Rapid growthDevelopment

Learning -Period of

-Vulnerabilit

y

InfectionMalnutritio

nEnvironmental hazards

-Infants: 4% of population: 25% of deaths

“ -1 -4 ”years: 13% of pop: 20% of deaths

Child Welfare

Objectives of child care:Safe entry to life

Reduction in perinatal and neonatal deaths

Reaching a healthy adulthood

Promotion, protection and maintenance of health

(Overcome genetic factor?)

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MCHChild

WelfareChild Care Program

Genetics

Family history

Feeding plans (Br. F)

Home preparation for baby care

Answering questions

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MCHChild

WelfareChild Care Program 1 .Prenatal Care ( Ideally before

conception ) Parental guidance and discussion

involving:

-Work of mothers

- Nutrition

- Smoking

- Drugs

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MCHChild

WelfareChild Care Program 1 .Prenatal Care ( Ideally before

conception ) Parental guidance and discussion

involving:Obstetric

-Early evaluation -Encourage breast feeding

-Face parents’ concern -Developmental problems

-Anxiety -Sleep

-Overfeeding -Active immunization

-Monitoring of growth and development

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MCHChild

WelfareChild Care Program2 .Infant

Care

Mortality in and around infancy

28th weekof

gestation

Birth

7 Days

28 Days

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MCH

I N F A N T

FOETUS

N E O N A T E

PERINATALPERIOD

1 Year

VERY IMPORTANT

Mortality in and around infancy

Infant Mortality

Perinatal death

Post-neonatal death

Neonatal death

Lateneonatal

death

Early neo-natal deat

h

Still birth

Birth

7 Days

28 Days 1 Year

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MCH

28th weekof

gestation

3 .Second year of life -Rapid development

-Increased parental concern4 .Pre-school years (< 5 years)

-Accident prevention5 .School years

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MCHChild

WelfareChild Care Program

6 .Adolescent Care -Rapid physical growth

-Marked emotional changes -Personality development

CONCLUSIONgy

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Addressing mortality in and around infancy

Integrated Management of Childhood Illness (IMCI)

Child care starts ideally before conception

Antenatal care is the key to modification of outcome to the mother and the newborn

Prevention and management of bleeding and infection during and after labour