Transcript Society, Culture & Health Care system II

Society, Culture &
Health Care system
Dr. Babar T Shaikh
The Aga Khan University,
Karachi
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“ New doctors advise that colostrum should be
given. It is essential.
Our elders say that colostrum should be
disposed off, therefore, we practice what our
elders advise us to do”.
Mothers’ focus group
Rural Sindh, Pakistan.
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Health System
• a set of cultural beliefs and practices;
• the institutional arrangements; and
• the socio-economic, political & physical context
Health system includes environmental
conditions, nutrition, water supply, education,
housing, status of women, social structures,
economic and political system
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Factors influencing health
service utilization
Socio-demographic factors
•Age/sex of child
•Family size/ parity
•Education
•Occupation
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Economic factors
•Possession of household items
•Possession of cattle
•Possession of agriculture land
•Type of residential house
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Physical accessibility factor
•Availability of the transport
•Physical distance for Health
Facility/Health Care Provider
•Time taken to reach Health
Facility/Health Care Provider
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Financial accessibility factors
•Fare spent for one round trip to
Health Facility/Health Care Provider
•Total amount spent for treatment of
last illness (excluding fare)
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Health service factors
•Attitudes of health provider
•Satisfaction with the treatment
•Received medicines from Health
Facility/Health Care Provider
•Received prescription for medicines
to be purchased from bazaar
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Mother’s autonomy
•Freedom to visit HF alone
•Permission to spend money on
health
•Decision power in emergency
situation
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Conceptual framework of Kroeger
Financial accessibility factors
Socio-demographic factors
•Fare spent for one round trip to HF/HCP
•Age/sex of child
•Total amount spent for treatment of last
illness (excluding fare)
•Family size/ parity
•Education
•Occupation
Economic factors
•Possession of household items
•Possession of cattle
Mother’s autonomy
•Freedom to visit HF alone
Govt./ Private
HF/HCP
•Permission to spend money on health
•Decision power in emergency
situation
•Possession of agriculture land
•Type of residential house
Health service factors
•Attitudes of health provider
Physical accessibility factor
•Availability of the transport
•Physical distance for HF/HCP
•Time taken to reach HF/HCP
•Satisfaction with the treatment
•Received medicines from HF/HCP
•Received prescription for medicines
to be purchased from bazaar 10
Challenges
Knowledge of illness/wellness and of
services available
Perceptions of services/service
providers
Risk/symptoms assessment
Cultural “prescriptions”
Social barriers/social pathways to care
Etc…
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Changing disease patters
Advances in biomedical/
clinical sciences
Health Sector Reform
Health Sector
Change Agents
Global perspectives on
health and health care
New specializations/
professions
Ethical issues: New
dimensions
Information/
Communication revolution
Globalization
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PROVISION OF HEALTH CARE
Focus on Life-styles
Focus on the Environment
Shift focus from
individuals to populations
Cost-effective health care
PRODUCING
HEALTH
Evidence-based decision/
policy
Resources to sector that
contribute to health
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HEALTH CARE SYSTEM: TYPES AND COMPONENTS
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PRIMARY
Physicians’ office
Dispensaries
NGO/Community Groups
BHU/RHC
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SECONDARY
Clinics/Maternity homes
Tehsil Hospitals
NGO-run clinics/hospitals
TERTIARY
Distric Hospitals
Large Urban Hospitals
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Outreach/Communitybased activities
[Immunization, malaria
control, MCH, FP]
GOVT. (PUBLIC)
HEALTH DELIVERY
SYSTEM (4 TIERS)
PHC Facilities (OPD)
TEHSIL & DISTRICT
HQ. Hospitals
Tertiary Care Hospitals
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1 - 2 Million Pop
DISTRICT HQ HOSPITAL
(80 - 100 Beds)
50,000-1 ml. Pop
TEHSIL HQ HOSPITAL (40
- 50 Beds)
PUBLIC HEALTH
DELIVERY SYSTEM
25-50,000 Pop
10-20,000 Pop
RURAL HEALTH CLINICS
(Extensive OPD; 10-20 Beds)
BASIC HEALTH UNITS
(Preventive & Curative;
mostly OPD)
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IMMUNIZATION
PROGRAM
MCH SERVICES
PREVENTIVE HEALTH
SERVICES
FP SERVICES
LHW PROGRAM
[45,000 LHW /2000;
Target 1:1,000 Pop]
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Insufficient focus on
Prevention/Promotion
Gender Imbalances
GOVT. HEALTH
SERVICES:
WEAKNESSES
Excessive centralization of
management
Political Interference
Lack of openness
Weak human resource
development
Lack of integration
Lack of Healthy Public Policy
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Problem areas
POVERTY
ILLITERACY
PROBLEM AREAS
LOW STATUS OF WOMEN
INADEQUATE SANITATION
& WATER SUPPLIES
POOR QUALITY OF
HEALTH SERVICES
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Income influences health
•
People in the top income bracket are
healthier than middle income earners
• Middle income earners are, in turn,
healthier than people with low income
• This means that the poorer people are,
the less healthy they are likely to be.
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Social status affects health
• It affects health by determining the
degree of control people have over life
circumstances
• It affects their capacity to act and
make choices for themselves
• Higher social position and income
somehow act as a shield against disease.
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Gender influences health
Gender is linked more to the roles, power
and influence society gives to men and
women, than it is to their biological
differences.
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Culture influences health
Culture and ethnicity influence how people
link with health system, their access to health
information and their lifestyle choices.
‘Dominant’ cultural values largely determine the
social and economic environment of communities.
Result:
Marginalization
Loss/devaluation of culture and language
Lack of access to culturally appropriate
health services
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Health Care
system 25%
Biological
endowment 15%
Physical
environment 10%
Socio-economic
environment 50%
Estimated Health Impact of Determinants of Health on
Population health Status: CIAR 1997
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Population Health Approach
•
Focuses on the entire range of individual
and collective factors (income and social
status, education, employment and
working conditions, social environment,
physical environment, gender, culture,
personal health and coping skills, healthy
child development, health services)
• The interaction among these factors
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Population Health Approach
• Health is determined by the complex
interactions between individual
characteristics, social and economic
• Strategies to improve population health must
address the entire range of factors that
determine health
• Important health gains can be achieved by
focusing interventions on the health of the
entire population/significant sub-populations
rather than individuals
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Population Health Approach
• Improving health is shared responsibility
that requires the development of healthy
public policies in areas outside the traditional
health system
• The health of a population is closely
linked to the distribution of wealth across
the population
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Creating a Healthy Community
Community
Economy
Environment
Based on a model from: Hancock, Trevor. 1993,
“heath, human development and community
ecosystem: three ecological models”
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Health Services
move towards ‘broader resources’ to
support well-being
•
• the design: services to maintain and
promote health, to prevent disease, and
to restore health system functioning to
contribute towards population health.
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