CHARACTERISTICS OF

HEALTH SERVICE
SETTINGS
Dr Seun Esan
 Objectives of the lecture
• Know what is expected of an ideal health service
setting

• Identify the current Nigerian health service settings

Outline
• Definition of the health systems
• What are health service settings
• Health service settings in the Nigerian context
• Types of health service settings
• How should the health services be organized
• According to the National Health Policies
 Why study health services
• Health is of primary importance to most people
• Health services contribute to maintaining and improving
people’s health
• Uncertainty as to the effectiveness, humanity, equity and
efficiency of many interventions
• Need to make health care professionals and services more
accountable to the people
• Huge expenditure on health
• Health services are major employers
What do you understand by a health service setting?

• A place where the following can be offered:

• Health promotion activities
• Disease prevention activities
• Curative services
• Long term care
• Rehabilitative care
 The health service setting as a systems
• What is a system
• Use the biological system to explain a health
system?
• Class activity as groups
• Consider the transport system in your country, list
its constituent parts, how do they relate to one
another
• Consider the objectives, the means of achieving it
and the processes involved
 What is a system
• A systems is “a set of interdependent elements
which can be seen as a purposeful whole”.
• The perception of a single element cannot account
for understanding the whole
• Understanding the interdependence in a system
helps us to understand how things are organized
and how the whole responds to change if one of its
parts changes
 In a system, there is…
• A purpose or mission
• Decision making processes that are themselves
systems- these interact so that the effects can be
transmitted throughout the system
• Resources that can be used by the decision making
processes
• Some guarantee of continuity
• Its performance can be measured
• It exists in a wider system/ and or environments with
which it can interact but from which it is separated
 Definition of a health system
• A health system consists of all organizations, people and actions
whose primary intent is to promote, restore or maintain health .
(WHO)
• This includes:
• Efforts to influence determinants of health
• Direct health-improving activities.
• Examples
• a mother caring for a sick child at home
• private providers
• behavior change programs
• vector-control campaigns;
• health insurance organizations;
• occupational health and safety legislation.
• Inter-sectoral collaborations
 Definitions of health systems
• A health system is an organizational framework for
the distribution or servicing of the health care needs
of a given community. (Prof Asuzu)

• It is a fairly complex system of inter-related elements

that contribute to the health of people - in their
homes, educational institutions, in work places, the
public (social or recreational) and the psychological
environments as well as the directly health and
health-related sectors.
 The systems approach to health service settings
• What is the main aim of a health service system
• The results of care
• Changes in patient survival or quality of life
• Other intermediate changes
• How does the health service system achieve this
• Provides health services
• Makes available resources like finance, staff, land,
buildings, medical knowledge, drugs, patients
• Therapeutic processes, organizational processes,
patient- provider interactions
 Therapeutic processes
• Therapeutic processes are all that ensues for the
client or patient’s needs to be met
Dimensions of need Therapeutic processes

Felt need- Health education,

Expressed need- Community Mobilization, provision of
health services,
Awareness creation
Normative need Diagnostic procedures, clinical
examination, interrogations
Met need Availability of drugs, health
providers, services to meet needs
Unmet need Failure of service delivery at all
levels
 Organizational processes
• Processes that will help make service provision
possible
• Supervision- Supportive or implicating supervision?
• Feedback (work not person, standard not behavior,
immediate not delayed, specific not vague, educational and
constructive) Feedback from clients, community, providers)
• Rewards for good work and consequences for bad work
• Administrative bureaucracies and managerial activities
• Regular monitoring and evaluation of services
Client/ Patient Provider Interactions
• This entails the:
• Need to assess the full spectrum of patients’ concerns
• Failure to develop and maintain therapeutic relations
like empathy
• Failure in delivering information to clients
 How does the health service setting
provide services
• The Scope
• Preventive
• Health Promotional activities
• Disease prevention activities
• Curative
• Screening services
• Therapeutic services
• Rehabilitative care
• Long term care
• Custody Public
• Responsible organizations Private
How does the health service setting
provide services
• The Levels
• Primary care: A formal care
• Usually general services
• Provided in the home, community
• Providers include General practitioners; Community
nurses; Community Health Extension Workers
• Secondary Care: Formal care
• Expected to be specialized care
• Usually offered in facilities
• Tertiary care
• More advanced specialized care
Informal care
• Health care extends beyond the formal care
• There is also lay care
• Note:
• 80% of care are provided by lay people
• They influenced people’s health seeking
behavior
• Incorporating the lay perspective emphasizes
community participation and sense of
ownership
 ti
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Secondary
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Primary care

Lay care
 Formal Care versus Lay Care
Formal care Lay care

Usually takes place in a formal Informal persons like people’s

setting houses
Formally trained with some No training or unstructured
certification training
Usually paid Not paid or receive incentives

Lay Carers:
1. Provide information and advice
2. Provide emotional support
3. Practical assistance in providing health and social care
4. A major determinant of the amount of formal health care that
is consumed
5. Are TBAs formal care or lay care?
Perspectives of the formal carers to the
lay carers
• A range of activities should only be performed by the formal
care. So formal care needs to expand and take over the lay
care.
• However,
• A vibrant lay sector may lead to a cut in funds to formal care
• Lay carers should be trained by the formal carers
• So, the extent of lay care is determined by the formal care
• Lay carers should be encouraged and supported by the formal
care
• Formal sector cannot cope without alliance with the lay care
• Lay carers are an opportunity and not threats
Challenges facing the health service setting
• There are two sources of pressure on health service
managers in the health service setting
• These are:
• Internal pressures
• External pressures

• Class activity:
• Identify five sources of internal and external
pressures in an organization you know or have ever
worked in
Challenges facing the health service setting

• Health care setting is highly complex

• Limits the standardization of care provided
• The complexity is ever changing
• Some employees exercise enormous influence
• Pressures from Government/ Funders
• Pressure from Local Interests
• Organizations representing the staff’s interests
• Medical- industrial complex
 How would you describe a high quality service
• What would a health service provide that will make it one
of very high quality
• It is effective
• The benefits outweigh the harm
• Provided in a humane way
• Treat people with respect and timely
• It is equitable
• Available to everyone in need regardless of their sex,
age, ethnicity, and so on.
• It is efficient
• Good quality care delivered at reasonable cost
•Thank you for listening