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By the end of this session students should be able to • Define health care , health care system, doctor, nurse, hospital and health resources. • Describe the health care system in Public sector of Pakistan. • Describe other sectors involved in health care delivery in Pakistan • Discuss the Problems in health care system in Pakistan
HEALTH CARE SYSTEM
Definition Health care is the Prevention, treatment, and management of illness and the preservation of mental and physical wellbeing through the services offered by the medical, nursing, and allied health professions. The organized provision of such services may constitute a health care system ,Weather it is directed to individuals or to populations.
• According to WHO, the health care embraces all the goods and services designed to promote health, including • Preventive • Curative • Palliative interventions
The word doctor comes from the Latin “docere” meaning to teach. A doctor is a person who possesses a certain minimum medical qualification to practice medicine and surgery at minimum required level under the lisence / registeration of a health authority like Pakistan medical and dental council (PMDC) in Pakistan.
• Nurse is a health professional, an important component of Paramedical staff, who assist individuals, families and communities in attaining , maintaining, and recovering optimal health and functioning. • Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people.
• Has important role in the country’s health system
• Hospital role include provision of curative, preventive & promotive health care. • WHO defines hospital as follows, “The hospital is an integral part of a social and medical organization, the function of which is to provide for the population, complete health care, both curative and preventive, and whose out patient services reach out to the family and its home environment; the hospital is also centre for the training of health workers and for social research”.
Health resources involved in health sector • Man (Doctors , Paramedical staff, supportive staff and administeration) • Money (finances) • Material ( Facilities,Utilities,Equipment machines, medicines ect)
Health care delivery system of Pakistan
• • •
Mainly five sectors Public or Government sector Semi Government and special institutions. Non Governmental or voluntary organizations Private sector Traditional healers
(Government) • Federal
Policy making Assistance and guidance Planning and programming Coordination with provincial government Evaluation
Independent delivery of health care to the people
Organizations involved at central level • Ministry of health • Division of population welfare • Kashmir affairs division • Frontier division Provincial Health Administration • Ministry of health (controls health secretariat) • Director General of health ( chief technical advisor to secretary health and responsible for all activities of health establishment) Operates ,implements and supervises through the District health officer.
District health System (Devolution plan)
• The principal unit of health administration is the district. • A health district is well defined part of a country, province, administrative division or a district in which primary health care is delivered to all individuals in that area. • A health authority responsible for community based services, clinics, centers and district hospitals. • Decisions made at local level with community a real say.
Hierarchical structure of health system in Pakistan Public health sector
Tertiary Hospitals District head quarters Hospital Tehsil head quarters & civil Hospitals Rural health centers Basic health units Lady health workers The community s
A fundamental and necessary function of health care system is to provide a sound referral system. It must be two way exchange of information and returning patients to those who sent them for follow up care. Presently this aspact of the system is very weak.
District Health management team
• Plan , co-ordinate and manage the complete public health services for the geographical area for which it is responsible . • Promotes appropriate community participation in health care delivery . • It prioritize problem at the local level according to the need of the population and the available resources .
District Health management team
It includes • District administrator • Executive District health officer (EDO) • Nursing Officer • Health inspector and administrator • Councilor from district health committee • Representative from each hospital • Representative of clinics and medical assistants • Local government promotion officer
Health care system problems
Crucial issues • Equity • Effectiveness (1) Poor statistical records (2) Under utilization of primary health facilities (3) Problems of malnutrition (4) Persistence of preventable diseases
Persistence of preventable diseases
• Meager efforts for health education, MCH and other promotive and preventive measures. • Curative focus of private health sector • Problems limiting female access to the health facilities
• Inadequate medical audit and poor records • Absence of institutionalized supply • Performance monitoring and compliance procedures • Problems of inventary control and quality control • Low motivation of staff • Absence of sewage and sanitation • Lack of safe water supply
• Financial Problems a) Insufficient resources for planned health services. b) Low salaries Organizationl Problems 1) Poor frame work 2)Lack of effective health manpower planning both in terms of number and content of training programmes 3)Lack of evaluation of traditional medical sectors
New Approaches of Health Care System
1.Comprehensive and Primary health care 2.Quality of care It includes Quality of health care delivery (content of care provided) and quality management of health care workers. Achieved by • Appropriate training of health workers • Defining norms and standards relared to health programmes e.g MCH, Family planning and immunization programmes
• Defined as an association or organization which is made by either lay person or professionals and is administered by autonomous board which holds meeting, collect funds from private sources and spend money, with or without paid workers in conducting a programme directed primarily towards public health by providing health services, or health education or by advancing research. • NGOs can be Local, regional, National, International
• Maternity and child welfare association of Pakistan. • Red Crescent society of Pakistan. • TB Assocaiation • Blind Welfare organization • Society of deaf and dumb Edhi welfare trust • Agha khan foundation • Fatmid foundation
Semi Government and Special Institutions
• • • • • Social security Institutions WAPDA Railway Pak Armed Forces PIA
• • • • • • It Consist of General practitioners (GPs) more than 2000 Medium sized hospitals Maternity homes Small dispenaries Diagnostic labs
• Unani • Ayurvedic • Homeopathic These systems are granted recognition by Government of Pakistan These people provide health care to rural people , about 90% serve in rural area.