HEALTH SYSTEMS

Unified Body Systems

Individual Body Systems
SYSTEMS APPROACH
 Leadership and governance

Health Information System

Health Financing

Human resources for Health

Essential medical products and
Technologies

Service delivery
 Health Systems
 Leadership and governance
 Health information systems
 Health financing
 Human resources for health
 Essential medical products and technologies
 Service delivery
 Health systems research
 Health system beneficiaries
 Health governance
 Board structure/ policy making/Constitution
 CEO/ Leadership/Framing rules and
regulations/ defining plans and programmes
 Implementation/ Carrying out activities and
programmes/HRM
 Monitoring including supervision and support
 Evaluation
 Modifying policies/Amending constitution
Applying Health systems
 What is given in the previous slides is the WHO
Systems for health.
 This is general template that could be applied in
organisations and countries.
 Each organisation and or country has its own
governance structure.
 You need to study and understand how each
governance works
 I am giving separately, the leadership and governance
of the Indian health delivery system
 An Example
 Recently when there was a large number of deaths due
to dengue disease in Tamilnadu, the State health
Minister had to come forward, take actions and
respond to questions from the media and the
politicians.
 When it appeared that the state was not able to
effectively control the spread within a short time, a
Central team visited the state and advised on the
measures to be taken.
 Health Information System
 A well-functioning health information system is
one that ensures the production, analysis,
dissemination and use of reliable and timely
information on health determinants, health systems
performance and health status.
 Key indicators of HMIS
 Child mortality
 Maternal mortality
 Key health interventions
 Nutritional status
 Percentage of births registered
 Percentage of deaths registered
 Census data
 Population projections
 Key indicators of HMIS
 Percentage of institutional deliveries
 HIV Prevalence
 Percentage of districts submitting timely reports
 Data base of health workers
 Data base of health facilities
 A burden of disease study
 Study of health systems performance
 Official annual health status report
 Sources of HMIS
 1. Census
2. Registration of Vital Events
3. Sample Registration System (SRS)
4. Notification of Diseases
5. Hospital Records
6. Disease Registers
7. Record Linkage
8. Epidemiological Surveillance
9. Other Health Service Records
10. Environmental Health Data
11. Health Manpower Statistics
12. Population Surveys
 Health financing
 Health financing is the “function of a health system
concerned with the. mobilization, accumulation and
allocation of money to cover the health needs of the
people, individually and collectively, in
the health system.”
 Health Financing – India’s Health
Budget
Health spending under PM Narendra Modi government
Ministry of Health & Family
Share of total Central Budget (In
Year Welfare Budget (In Rs Total Central Budget (In Rs crore)
percent)
crore)

2014-15 33121.42 1794891.96 1.8

2015-16 30626.39 1777477.04 1.7
2016-17 37671.3 1978060.45 1.9
2017-18* 51550.85 2146734.78 2.4
2018-
52800 2442213.3 2.1
19**
 Health financing
 It would be preferable if it is 4 or more % of the total
budet
 The budget itself is low
 They may further reduce during mid year review
 All states do not fully utilize the budgeted amounts
 Indicators of Health Financing
 General government health expenditure as a
proportion of total government expenditure
(GGHE/GGE).
 Around 4% GDP
 Around $40 per capita GDP
 The ratio of household out-of-pocket payments for
health to total health expenditures.
 Health financing governance
 Good governance requires
 Oversight,
 Clear standards
 Ability to hold providers and payers accountable.
• Turning a blind eye to corruption is a clear example of bad
governance
 Types of health financing
 Not for profit-Government
 Not for profit-Voluntary and charitable
 For profit-Corporates
 For Profit-Private practitioners
 Health Financing

Planning
Budgeting
Spending
Auditing
 Ayushman Bharat
 Very important current health financing in India.
 Will be discussed under health care delivery syatem in
India.
 Health financing
Country Health budget as %of GDP

United States 8.28

United Kingdom 7.58
South Africa 4.24
Turkey 4.19
Brazil 3.83
Russia 3.69
Saudi Arabia 3.49
Mexico 3.26
China 3.1
Argentina 2.65
Nepal 2.4
Srilanka 2.0
India 1.41
Indonesia 1.08
 Human Resources for Health
 Human Resources for Health (HRH) are defined as
“the stock of all individuals engaged in the promotion,
protection or improvement of population health”. This
includes both public and private sectors and different
domains of health systems, such as personal curative
and preventive care, non-personal public health
interventions, disease prevention, health promotion
services, research, management and support services
(WHO, 2007)
 Categories of HHR personnel
 Physicians,
 Nursing professionals,
 Midwives,
 Dentists,
 Allied health professions,
 Community health workers,
 Social health workers and
 Other healthcare providers
 Health management and support personnel
 HHR Indicators
 1: Number of health workers per 10 000 population
 Distribution of health workers – by occupation /
specialization, region, place of work and sex
 3: Annual number of graduates of health professions
educational institutions per 100 000 population – by
level and field of education
 Rate of retention of health service providers at primary
health-care facilities in the past 12 months
 % of HRH positions that have not been filled
 Human Resources for Health

 Job description
 Selection
 Human resource Development
 Human Resource Management
 Monitoring-supervision and support
 Performance appraisal/evaluation
 Remuneration/Incentives
 Health Human resources
Countr Physici Nurses Midwiv Dentist Pharma
y ans es s cists
China 1.06 1.05 0.03 o.11 0.28
India 0.6 0.8 0.47 0.06 0.56
Japan 1.98 7.79 0.19 0.71 1.21
Sri 0.55 1.58 0.16 0.06 0.06
Lanka
Thailan 0.37 2.82 0.01 0.17 0.25
d
UK 2.3 12.12 0.63 1.01 0.51
USA 2.56 9.37 NA 1.63 0.88
 Essential medical products and
Technologies
 World Health Organization (WHO) defines essential
drugs or medicines as “those drugs that satisfy the
healthcare needs of majority of the population; they
should therefore be available at all times in adequate
amounts and in appropriate dosage forms, at a price
the community can afford”.
Essential medical products and
technologies
 Improved supply and access of drugs
 More rational prescribing and use of drugs
 Price control of essential drugs
 Jan-aushadi or promoting of generic drugs
 Lower drug costs.
 Price control on devices and accessories
 Health Services Provided
 Antenatal care for pregnant women
 Delivery care for pregnant women
 Immunization for children
 Programme for adolescent girls
 Outpatient clinics in PHC/Hospitals
 Implementing national programmes in health
 108 National ambulance service
Government and Private Medical Industry

 The government has made concession to the

private medical industry hoping to receive
provision of medical care for the poor.
 However the private medical industry has
not given as much services for the poor to
the extent they have received benefits from
the government.
Private Medical Care and Medical Tourism
 Many private medical care institutions have
promised high level care of international
standards.
 Many times they say that the patient is their
first concern.
 In reality it is the share holders who are
important and not the patients.
 The standards are so high that medical
tourism has found an important place in the
private medical care.
 Health care
 Appropriate
 Comprehensive
 Adequate
 Available
 Accessible
 Affordable
 Feasible
 Equitable- Pulimood principle
 Private medical care and the poor
 Often only the government planned health care delivery is
described in detail.
 However private health care delivery plays an important
role in the country.
 Increasingly they cover primarily those who can afford their
services.
 The cost of care by private medical care is increasingly
becoming out of reach of the poor.
 Besides they provide more of curative medical care and less
of preventive and rehabilitative care.
 Catastrophic illness and the poor
 The beneficiaries
 The focus of this is on Behaviour Change
Communication.
 This will be handled as a separate session
Thanks