case study e
LeahD
9.2-Healthsystems-Keysectorissues.pptxExam Study Guide Topics
Know what each of the 7 health sector issues means, plus:
A specific example
A strategy to address issues related to that Key Sector Issue
Use this understanding to do research for part III of your country papers
Before next slide: what would a demographic change be? Epidemiologic change?
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| Definition | Examples | Strategies to address concerns |
| Changes in the population or changes in the patterns of disease. A health system needs to be able to respond to these. | Longer life expectancy or immigration, the increase in non-communicable diseases or the emergence of a new disease like HIV or Zika. A health system needs to be able to respond to these issues. | If non-communicable disease are on the rise, then need initiatives to address lack of physical activity, cigarette usage, etc. If HIV is on rise, need effective treatment and prevention. If population is aging, need to address NCDs such as CVD, dementia, and if the country can financially support aging population. |
1. Demographic & Epidemiologic Change
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| Definition | Examples | Strategies to address concerns |
| Quality of governance—is it open/transparent? Clear rules/ regulations? Are rules enforced? | Staff hired because of connections rather than skill. New staff may have to pay off hiring managers. Staff high absenteeism without losing job. Buying products without best prices because of corruption. Staff getting kickbacks. This happens because of lack of governance—not just individual choice. | Nat’l anticorruption campaigns with strong political will. Reforming supply procurement systems & making transparent. Auditing health system & enforcing penalties. |
2. Stewardship and governance
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| Definition | Examples | Strategies to address concerns |
| Issues related to health system staff members (includes having sufficient staff, well-trained staff, distributed throughout country where needed, salaries to keep people, high quality work conditions, not losing top skilled workers to other countries/settings). | Shortages of docs, nurses, lab techs, unqualified managers. Deficient skills due to poor training. More staff in cities; more shortages rural areas. Public sector salaries < private sector. Lack financial incentive to do quality work. Poor working conditions prompt them to leave country. | Countries & their dev’ment partners more support for education, training, plans for retention. Wealthy countries more shared global responsibility so workers won’t leave resource poor areas. |
3. Human Resources
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Human Resources Sector issue example
2003 survey of over 1400 public health centers across India
Surveyors verified the attendance of providers during unannounced visits
nearly 40% of doctors and medical service providers are absent from work on a typical day.
the absence problem is quite widely distributed and not concentrated among a few doctors.
“Doctors posted at remote facilities and at facilities with poor infrastructure and equipment were absent at significantly higher rates, as were those with longer commutes.”
Muralidharan, Karthik, Nazmul Chaudhury, Jeffrey Hammer, Michael Kremer, and Halsey Rogers. 2011. “Is There a Doctor in the House? Medical Worker Absence in India”. (working paper, Harvard University)
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| Definition | Examples | Strategies to address concerns |
| Safe, effective, patient-centered, timely, efficient, equitable | Not using evidence-based guidelines. Don’t know correct diagnosis or treatment for a disease. Inappropriate use of antibiotics, fluids, feeding, oxygen. [Note: High quality can be achieved in low-resource settings.] | Need assessments to identify quality gaps. Better oversight & training. Use clear guidelines & algorithms. Link payments to NGOs with performance. |
4. Quality of care
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| Definition | Examples | Strategies to address concerns |
| How to fund sufficiently, how to find funding to cover more or to keep covering what system is supposed to cover with changing costs (new tech, drugs, aging pop increase costs) | New technologies drive up cost of care, how to fund to reduce wait times, govt not funding health system enough to ensure decent care regardless of ability to pay. | Shift some $ from another part of economy to health. Shift to most cost effective interventions. Gather data, monitor outcomes. Increase efficiency. |
5. Financing of Health System
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| Definition | Examples | Strategies to address concerns |
| Financing the system without denying healthcare coverage to poor & without making people go bankrupt. Goal: universal coverage for basic package of health services | In India spending $ on health is a primary reason why families fall below poverty line & cause of family selling assets. People use less health care (ie hospital deliveries of babies) when charged. | Raising $ for health, improving efficiency, less out-of-pocket. Providing universal health ins. Targeting free basic package of services to those most in need |
6. Financial Protection & the Provision of Universal Coverage
More example of solutions: Allocate more proportionately to basic packages to people & places with most need. Subsidize care for poor. govts encourage NGOs to provide services to poor.
Before next slide: what’s access and equity?
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| Definition | Examples | Strategies to address concerns |
| Any disparities by sex, age, ethnicity, income, education, location? | Lack of coverage in areas where poor, rural & minorities live. Fewer trained people, equipment & drugs in those areas. Services like vaccines more available in urban areas & areas with higher income & educ. Richer people get the more expensive services. | Govts need to gather data and use it to look at where inequalities exist. Then target services there. Best if paired with improved water, sanitation, nutrition, hygiene, health behaviors (via increased knowledge) |
7. Access and Equity
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Part III of your country papers: Health System
Organization, financing, coverage – previous lecture.
Key Sector Issues: Analyze the ability of your country’s health system to tackle its health issues by researching and describing each of the following issues discussed in class (a few sentences for each issue, or a short paragraph on each, is sufficient):
demographic and epidemiologic changes
health workforce concerns (human resources)
access and equity
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