Overview of Health services

1. Overview of Health Services
6/13 May 2016

2. Health Service
A health service, also sometimes
referred to as health system or health
care service or health care system is the
organization of people, institutions, and
resources to deliver health care services
to meet the health needs of target
populations.

3. WHO’s Definition
A health system consists of all organizations, people and
actions whose primary intent is to promote, restore or
maintain health. This includes efforts to influence
determinants of health as well as more direct health-
improving activities. A health system is therefore more
than the pyramid of publicly owned facilities that deliver
personal health services. It includes, for example, a
mother caring for a sick child at home; private providers;
behaviour change programmes; vector-control
campaigns; health insurance organizations; occupational
health and safety legislation. It includes inter-sectoral
action by health staff, for example, encouraging the
ministry of education to promote female education, a well
known determinant of better health.

4. WHO’s Health System Building Blocks
1. Service Delivery
2. Health Workforce
3. Information
4. Medical Products, Vaccines and
Technology
5. Financing
6. Governance

5. Service Delivery: Key Characteristics
1. Comprehensiveness: Promotive, Preventive,
Curative, Rehabilitative, Palliative
2. Accessibility: No Barriers; Routine point of
entry of the service network at Primary Health
Care
3. Coverage: Universal – All Universal Health
Coverage (UHC)
4. Continuity of Care: Levels of Care, Life-cycle
5. Quality: Timely, safe, effective, patient-
centered
6. Person-centered: Around Person, Not
Diseases or Financing

6. Service Delivery: Key Characteristics contd
7. Coordination: Across types of care,
provider
8. Accountability and Efficiency:
Accountable for overall performance and
results

7. Health Workforce
1. Health worker density: Number of health
workers per 10,000 population
2. Distribution of health workers: by
occupation/ specialization, region, place
of work, sex
3. Annual number of graduate of health
professions educational institutions per
100,000 population- by level and field of
education

8. Health Information System
1. Health Survey
• Bangladesh Demographic and Health Surveys
• Bangladesh Urban Health Surveys
• Bangladesh Maternal Mortality Surveys
2. Birth and Death Registration
3. Census
4. Health Facility Reporting
5. Health System Resource Tracking
6. Human Resources Information System

9. Medical Products, Vaccines and
Technology
Access to Essential Medicines
1. Average availability of 14 selected
essential medicines in public and private
health facilities
2. Median consumer price ratio of 14
selected essential medicines in public
and private health facilities

10. Health System Financing
1. Total expenditure on health
2. General government expenditure on
health as a proportion of general
government expenditure (GGHE/GGE)
3. The ratio of household out-of-pocket
payments for health to total
expenditure on health

11. Governance
1. Existence of national policies/strategies
• National Health Policy 2011
• National Population Policy 2012
• National Nutrition Policy 2015
• Bangladesh Health Workforce Strategy 2015
• Health Care Financing Strategy 2012
2. Governance structure
• Centralized
• Decentralized

12. Governance
3. Stewardship role of the Government
4. Participation
5. Voice and Accountability
6. Access to Information
7. Budgetary provision
8. Distribution of Facilities
9. Distribution of Health Workforce
10. Special attention for excluded

13. World Bank’s Health System Components
1. Financing
2. Payment
3. Organization and Service Delivery
4. Regulation
5. Persuasion
6. Politics
7. Ethics and Values

14. Financing
Health financing mechanisms such as:
1. General Revenue
2. Social Health Insurance
3. Private Health Insurance
4. Community Financing
5. Out-of-Pocket Spending
6. External Aid

15. Payment
• Facilities
• Fee for service
• Capitation
• Salary
• Salary plus Bonus
• Case based
• Per diem
• Per admission

16. Organization of Service Delivery
There are four key characteristics in the
organization of service delivery:
1. The mix of organizations that provide health-
care services;
2. The division of activities among these
organizations;
3. The interactions among these organizations
and their relationship with the rest of the
political and economic environment—especially
how they get the resources they need to
continue to exist; and
4. The internal administrative and management
structures and processes of these
organizations.

17. Regulation
Regulation serves four key purposes:
1) To ensure that exchanges and transactions in the
market are done in a transparent and open manner
2) To promote more equal access to health care and to
improve the distribution of health status
3) To correct market failures, such as information
inequalities, and monopolies that hinder reasonably
effective competition and reduce the benefits it might
bring.
4) To advance health improving individual behaviors and
moral norms that markets do not foster.

18. Persuasion
1) Treatment seeking behaviors- consumer decisions on
when, where, and how to seek treatment; what kind of
health professional, what level of health facility, which
facility, and Western versus traditional medicine
2) Health professional behaviors- provider decisions
about treatment, including the nature of the treatment,
the amount of attention given to preventive care; the
location of treatment; and referral of patients to other
providers
3) Patient compliance behaviors- patient decisions on
whether to follow the treatment instructions of health
professionals, including the use of pharmaceutical
prescriptions, pursuing referrals other providers, and
other treatment-following behaviors.
4) Lifestyle and prevention behaviors- consumer
decisions on lifestyle habits that affect their health,
regarding exercise patterns, food consumption, smoking,
sexual relations, and contraceptive usage

19. Politics
The following are some key factors that determine public attention to
issues in the agenda-setting process:
1) the role of mass media in shaping the cycle of issues for public
debate
2) the availability of proposed solutions, often supported by policy
entrepreneurs
3) the emergence of a crisis, such as a natural disaster or an
economic crisis
4) political cycles and timing—the window of opportunity for policy
change is often limited and subject to unanticipated events
5) the entrance of new actors into the political system
6) the beliefs and values of the policy entrepreneurs, which are
shaped by experiences, ideology and professional training
7) sudden changes in government
8) the general culture of a society, based on local traditions
9) political feasibility, which often relates to the commitment and
leadership capacity of the advocates of reform

20. Ethics and values
How do national health systems reflect the
country's and community's values?

21. Plurality of Health Services
• Physical and Mental Health
• Promotive, Preventive, Curative, Diagnostic,
Rehabilitative, Palliative
• Preventive – Primary and Secondary
• Curative – Primary, Secondary, Tertiary and
Quaternary
• Curative – Outdoor, Indoor, Emergency
• Support Service – Security, Reception, Waiting
space and time, Tidiness, Toilet, Diet, Drug,
Nursing Care, Hotel Service, Ambulance, other
common service – canteen, flower shop,
newspaper/book stall, Cloth store etc.

22. Plurality of Health Services contd.
• Allopathy, Hoemopathy, Unani, Ayurved,
Acupuncture, Spiritual, Traditional
• Formal and Informal Sector
• Public, Private, NGO, Mission, Charity
• Public – Ministry of Health and Family
Welfare, Ministry of Local Government,
Rural Development and Cooperatives,
Ministry of Chittagong Hill Tract Affairs,
other Ministries and Departments

23. Plurality of Health Services contd.
• Field based and Facility based
• Facility – Satellite, Mobile, Fixed
• Fixed – Centre, Hospital of varied beds
• Segments of health – Family Planning,
Nutrition
• Reproductive health, Maternal health,
Neonatal health, Infant health, Child
health, Adolescent health, Geriatric health

24. Plurality of Health Services contd.
• Location – Community health, School
health, Occupational health
• Public health interventions –
Immunization, TB, Malaria, Kala azar,
Filaria, Dengue, Nipah virus, HIV/AIDS,
Integrated Management of Childhood
Illness, Eye
• Communicable and Non-communicable
diseases

25. Plurality of Health Services contd.
• Blood Transfusion
• Determinants of Health
Water and Sanitation
Transportation
Education – Female
Female Employment
Microfinance
Violence

26. Plurality of Health Services contd.
• Determinants of Health
Environment
Social Security
Housing
Food security
Food safety
Clothing
Commerce
Electricity

27. Plurality of Health Services contd.
• Systems supporting health service
delivery
Planning, Monitoring, Evaluation
Management Information System
Research
Surveillance
Financing and Financial Management
Human Resources for Health
 Training – Pre-service; In-service; Types
Recruitment, Deployment, Retention,

28. Plurality of Health Services contd.
Procurement and Supply Chain
Management
Physical Facilities Management –
Construction, Repair and Maintenance
• Emergency Preparedness and Response
• Regulatory role of Government
• Quality of Care
• Health Rights
• Health Ethics
• Conflicting understanding of service
providers and recipients

29. Health Service
• Vast
• Complex
• Unless very careful, many apparent
positive decision will affect other
negatively