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Capacity Building Workshop On Health Systems Development for Country & Regional Office Staff 20-24 May 2007 Alexand

Capacity Building Workshop On Health Systems Development for Country & Regional Office Staff 20-24 May 2007 Alexandria , Egypt Health Services Delivery Ahmed Ali Abdullatif Coordinator, Health Systems WHO/EMRO. Outline Typology Evolution Framework Agenda.

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Capacity Building Workshop On Health Systems Development for Country & Regional Office Staff 20-24 May 2007 Alexand

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  1. Capacity Building Workshop On Health Systems Development for Country & Regional Office Staff 20-24 May 2007 Alexandria , Egypt Health Services Delivery Ahmed Ali Abdullatif Coordinator, Health Systems WHO/EMRO

  2. Outline Typology Evolution Framework Agenda

  3. Health Services Delivery Typology Levels Primary: Secondary: Tertiary Content: Curative: Preventive: Promotive: Rehabilitative Essential Care : Sophisticated Care (Medical Tourism) Individual/ Personal : Public Health Network Hierarchial; Solos Owner Public : Private Institution Ambulatory care : Hospital Care Western/ Formal : Traditional / Alternative Care Setting Rural : Urban Self Care : HHC: Facility based care Continuity Episodic/Vertical Care: Integrated care: LifeTime

  4. Evolution of HealthCare Concept WHERE WE ARE GOING WHERE WE ARE 3. Helping people make healthier lifestyle choices complexity 2. PersonalisingCare – responding to individuals 1. Universal Services = investment and reform 19801990200520102015

  5. WELLNESS HEALTH PROMOTION-ORIENTED RISK Reduction-ORIENTED DISEASE-ORIENTED ILLNESS Strategic Intent/ Approaches of Health care

  6. Health Service Delivery has a Role to: • create conditions that lead to longer, healthier lives for all; • eliminate health disparities; • protect communities from avoidable health hazards and • help them to address their own health problems.

  7. Health Services Delivery Framework COVERAGE GAP UTILIZATION POLICIES, ORGANIZATION, & MANAGEMENT ACCESSIBILITY AVAILABILITY

  8. Availability 1)Proximity: Average Distance to the nearest healthcare facility primary, specialist, emergency, preventive, curative (local services range 50 - 100) 2)Distribution of Services & Resources: Provider/Patient ( user) ratios by Districts (range 1.8 - 27.2 physicians per 10,000 population) Beds ( General& Specific ie Emergency) / populations ( range 4.2 - 36 per 10,000 population) 3)Time-Based Availability After- hours Care Average Waiting Time between Referral & assessment Waiting Lists for.. diagnostics, specialist, elective 4) Essential Resources etc, Medicines, diagnostics…

  9. Accessibility (Financial) % population with Health Insurance Low in low & middle income EMR countries % out of pocket payment (OOP) of Total health Expenditure High in low & middle income EMR countries

  10. Utilization Care seeking behaviour Awareness, Expectations, Decision, Choice Creation of Demand ( low for preventive & promotive) Ability to pay Segmentation: Age ( elderly) , Gender, Socioeconomic chronic, acute Ambulatory: Inpatient Annual per capita visits range <1-6 Differential between Gender ; urban rural, socioeconomics Example Egypt Annual per capita visits 3.51 Rural ( 2.7 ) : Urban ( 4.8)

  11. Coverage The right service at the right time, in the right place or context ( right target group) When needed Where needed ( Different settings including community, HHC) Appropriate: culture & Evidence based Quality standards:…compliance, consultation time, satisfaction

  12. 50% 41% 50% 66% 99% 70 % 97% 100% Ante Natal Care Coverage in 4 EMR countries

  13. 50% 41% Visit= 2 Visit= 1 OOP=63% OOP=70% 50% 66% 99% 70 % Visit= 4.3 Visit= 3.51 OOP=10% OOP=60% 97% 100% Ante Natal Care Coverage in 4 EMR countries

  14. Health Services Delivery Agenda • Strategize • Organize • Manage processes

  15. Defined Strategic Health Goals To develop the health services to improve the health of the people especially underserved Ensuring equitable, accessible, quality health care through strategic planning, coverage plans, institutional capacity building and development programmes, health financing frameworks and Regulatory frameworks

  16. ORGANIZING Health Care Delivery Values: HFA; Accountability, User Centredness…. Decentralization : working unit, Hospital autonomy; District Health System Integration Delegation to Primary care Programmes Family Practice : Gatekeeping ( 8/1000) Continuity of care Public Private Partnership

  17. Management: Stratification of Population: Risk Approach Utilization Patterns & Care seeking Behaviour Prioritized / Essential Care Quality/ Safety: standards setting; Accreditation, Risk management Competence Tools: Problem Solving, SOPs; Clinical Pathways Management of Change; EB Practice Performance Assessment & Reward

  18. Fully Operational Service delivery point User Provider Available Accessible Credible Effective

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