Health Care System: By: Mohammed Seid (BSC, MSC)

Health care system
By: Mohammed Seid(BSc, MSc)

Outline
 Different perspectives in health
 Health care system
 Ethiopian health care system
▪ Organization
▪ Policy
 Health care approach
 Primary health care
 Delivery of eye care model
 Primary eye care
Set by Mohammed Seid 2

Objectives
 At the end of this section, you all be able to:

▪ Describe different perspectives in health
▪ Describe a health care system in terms of policy
and arrangements
▪ Define PHC
▪ List principles and components of PHC
▪ Explain delivery of eye care model
▪ Define and list activities of PEC

Different perspectives in health
 Health as
 Right
 Goods
 Investment

Health care system
 A health system, also sometimes referred to

as health care system or as health care system, is
the organization of people, institutions, and
resources that deliver health care services to meet
the health needs of target populations.

Cont…
 There is a wide variety of health systems around the

world.
 Common elements in all health systems are

primary healthcare and public health measures

Organization of health service
 Health care service consisted of a mixture of

health care sectors:
▪ Public
▪ Private
▪ Nongovernmental

Ethiopian Health care system organization
 Period : from 1885-up to early 199os
 Structure: six-tier system.
 It was organized after Alma-Ata declaration

Cont…
 Period : started in early 1990s
 Structure: Four-tier system

Cont…
 Why reorganization is needed?

▪ it was centralized/undemocratic .
▪ Fragmented and donor reliance
▪ It was vertical
▪ Little collaboration b/n public and private sectors

Cont…
 Current health care system of Ethiopia

▪ Structure: three-tier health care
▪ Implemented by BPR

Ethiopian health care policy
 In the past, Ethiopian health policy:

–Focused on curative and urban-centred health
services
 The new health policy:

 Focused on prevention and the health promotion
 Expand healthcare delivery at the grass roots level
(rural community at family level).
▪ Through the implementation of the Health Service
Extension Programme(HSEP).

Health care approach/programmms
 Vertical program
 Horizontal program

Historical development of health care
approaches
 In 1948, WHO was established.
 Major objective: The attainment by all people of the

highest possible level of health.

Cont…
 Strategies used by WHO

 In the 1950s, the vertical health service strategy for
selected communicable diseases, such as control
of malaria, tuberculosis.
 But it was found to be expensive and

unsuccessful.

Cont…
 In the mid 1950s

 The concept/strategy of Basic Health Service
 This approach gave more attention to rural areas
through construction of health centers and health
stations providing both preventive and curative
care.
 In the early 1970s
 Integration of the specialized disease control
programs with the basic health services was
emphasized.

Cont…
The evaluation of these strategies(1950s and

1970s):
The health status of millions of people in the

world was unacceptable.
The health status of the majority of people

in disadvantaged areas of most countries of
the world were remained low.
Cont…
 It was not inter-sectoral collaborative and

community participatory.
 Overall, due to political and socio economic

factors the various health care approaches
implemented in different countries between 1948
and 1978 did not enable WHO to meet the stated
objectives.

Cont…
 All these approaches were disease oriented based on

high cost health institutions requiring advanced
technology to solve the health needs of the people,
and thus ultimately failed to reach the desired goal.

Cont…
 So, What health care approach is important

to address health needs of the majority?
 Therefore, the magnitude of health problems

and inadequate distribution of health
resources called for a new approach and the
Concept of PHC was born.

Cont…
In 1977, the WHO set a goal of providing “Health for All by
the year 2000” which aims at achieving a level of health that
enables every citizen of the world to lead a socially and
economically productive life.
The
strategy to meet this goal was later defined in the 1978
WHO/UNICEF joints meeting at Alma-Ata.
In this meeting,it was declared that the PHC strategy is the
key to meet the goal of “Health for all by the Year 2000”.

PRIMARY HEALTH CARE
 PHC defined as essential health care on practical,

scientifically sound, and socially acceptable
methods, and technology made universally
accessible to individual and families in the
community through their full participation and at
a cost that the community and country can
afford to maintain at every stage of their
development in the spirit of self-reliance and
self-determination.

PHC Definition cont…
 It forms an integral part of both the community’s

health system and the overall social and economic
development of the community.
 It forms the first level of contact of individuals, the

family and the community with the national health
system, bringing health care as close as possible to
where people live.

Terms in the definition:
 Essential health care
 Scientifically sound: should be explainable
 Socially acceptable: with respect to their value,
culture and belief.
 Universally accessible: The PHC approach is to
bring health care as close as possible to where
people live and work in order to guarantee
universal accessibility to the individuals, family
and community.

PHC Components/ELEMENTS
Essential H/care: At least 8 elements:

o Health Education
o Provision of Essential Drugs
o Immunization
o MCH/FP (Family Health)
o Treatment of common diseases & injuries
o Adequate supply of safe water & basic sanitations
o Communicable diseases control
o Food supply and proper nutrition

"Elements" of PHC
 Education for health

 Locally endemic disease control
 Expanded program of immunization
 Maternal and child health
 Essential drugs
 Nutrition
 Treatment of communicable disease
 Safe water and sanitation

Cont…
Additional elements incorporated in the Ethiopian

context after Alma-Ata
1. Oral health
2. Mental health
3. The use of Traditional Medicine
4. Occupational health
5. HIV/AIDS
6. ARI (Acute Respiratory Infection)

 Community involvement
 Self-reliance and Self-determination: able

to support yourself, being independent
understanding your own needs and trying to
minimize problems.

Principles of PHC
 Active community participation
 Intra and inter-sectoral collaboration
 Appropriate technology
 Focus on prevention
 Decentralization
 Equity

PHC PRINCIPLES
Community participation
 Emphasis is on strengthening the capacity of

communities to determine their own needs and
take appropriate action.
 Should not be passive recipients of services.

In what circumstance can the community
participate?
The communities should be actively involved:

 In the assessment of the situation
 Problem identification
 Priority settings and making decisions
 Sharing responsibilities in the planning
 Implementing, monitoring, and evaluation.

Small group discussion
 Discuss advantages of community

participation
 Types of participation

Cont…
Advantages:
 Extend service/better coverage.
 Programs are affordable and acceptable.
 Promote self reliance and confidence.
 Create sense of responsibilities.
 Consider real needs and demands.
 Promote local community initiatives and technology.
 Reduce dependency on technical personnel.
 Build the community’s capacity to deal with
problems.
 Help to choose appropriate strategy.

Cont…
Types of Participation
 The cheap labor concept of participation
 The cost-sharing concept of participation
 Contractual Obligation concept of participation
 Decision making concept of participation

Cont…
Skills for enhancing community participation

 Belief in community’s potential.
 Skills in participatory approach: look, listen and
learn.
 Motivate.
 Awareness creation.
 Understanding community’s culture.
 Identify/create structure.

Cont…
APPROPRIATE TECHNOLOGY
Criteria for appropriateness:
 Effective: must work and fulfill its purpose
 Culturally acceptable and valuable.
 Affordable, i.e. cost-effective.
 Locally sustainable.
 Possessive of an evolutionary capacity: if its
introduction and acceptance can lead to further
benefits.

 Environmentally accountable: harmless or at
least minimally harmful.
 Measurable: need proper and continuing

evaluation if it is to be widely recommended.
 Politically responsible

Small group discussion
 Equality vs. equity?

Cont…
EQUITY
 This is to close the gap between the ‘have’s’ and the
‘have not’s’.
 To achieve more equitable distribution of health
resources.

Thank you

Health Care System: By: Mohammed Seid (BSC, MSC)

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Health care system

By: Mohammed Seid(BSc, MSc)

Set by Mohammed Seid 2

 At the end of this section, you all be able to:

Set by Mohammed Seid 3

Set by Mohammed Seid 4

 A health system, also sometimes referred to

Set by Mohammed Seid 5

 There is a wide variety of health systems around the

 Common elements in all health systems are

Set by Mohammed Seid 6

 Health care service consisted of a mixture of

Set by Mohammed Seid 7

 Period : from 1885-up to early 199os

 Structure: six-tier system.

 It was organized after Alma-Ata declaration

Set by Mohammed Seid 8

 Period : started in early 1990s

 Structure: Four-tier system

Set by Mohammed Seid 10

 Why reorganization is needed?

Set by Mohammed Seid 11

 Current health care system of Ethiopia

Set by Mohammed Seid 13

 In the past, Ethiopian health policy:

 The new health policy:

Set by Mohammed Seid 15

Set by Mohammed Seid 16

 In 1948, WHO was established.

 Major objective: The attainment by all people of the

Set by Mohammed Seid 17

 Strategies used by WHO

 But it was found to be expensive and

Set by Mohammed Seid 18

 In the mid 1950s

Set by Mohammed Seid 19

The evaluation of these strategies(1950s and

The health status of millions of people in the

The health status of the majority of people

 It was not inter-sectoral collaborative and

 Overall, due to political and socio economic

Set by Mohammed Seid 21

 All these approaches were disease oriented based on

Set by Mohammed Seid 22

 So, What health care approach is important

 Therefore, the magnitude of health problems

Set by Mohammed Seid 23

Set by Mohammed Seid 24

 PHC defined as essential health care on practical,

Set by Mohammed Seid 25

 It forms an integral part of both the community’s

 It forms the first level of contact of individuals, the

Set by Mohammed Seid 26

Set by Mohammed Seid 27

Essential H/care: At least 8 elements:

Set by Mohammed Seid 28

 Education for health

Set by Mohammed Seid 29

Additional elements incorporated in the Ethiopian

Set by Mohammed Seid 30

 Self-reliance and Self-determination: able

Set by Mohammed Seid 31