Chapter 3:

Health Care Systems

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 Health Care Systems
What is a health system?
- A health system consists of all the organizations, institutions,
resources and people whose primary purpose is to improve
health.
- A health system needs:
- staff,
- funds,
- information,
- supplies,
- transport,
- communications and
- overall guidance and direction.
- It needs to provide services that are responsive and financially
fair, while treating people decently.
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- A good health system delivers quality services
to all people, when and where they need them.

- These services requires:

1. Financing mechanism;
2. A well-trained & adequately paid
workforce;
3. Reliable information;
4. Well maintained facilities and logistics to
deliver quality medicines and technologies
Sec. 3 19.4.2022
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 Elements of Health Care Systems
- The elements of health care system are:
1. Personal health care services for individuals
and families, available at hospitals, clinics, and
in the clients' own homes.
2. The public health services needed to maintain
a healthy environment, such as control of
water and food supplies, and safety
regulations.
3. Teaching and research activities related to
prevention, detection, and treatment of disease.
4. Health insurance.
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 Patient safety
- Patient safety is a fundamental principle of health care.
- Every point in the process of care-giving contains a
certain degree of unsafety.
- Patient safety improvements demand a wide range of
actions including:
 infection control,
 safe use of medicines,
 equipment safety,
 safe clinical practice and
 safe environment of care.

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 The Need for Health Care:
Who needs medical care ‫متى يحتاج المريض للرعاية‬
‫?الصحية‬
1. People who have a problem which needs expert
help ‫بحاجة الى استشارة من مختص‬.
2. People who can be assisted by medical
intervention ‫بحاجة الى تدخل طبي‬.
3. People who look for long lasting recovery.
‫بحاجة الى الشفاء التام‬
4. People who need reasonably priced services.
‫بحاجة الى خدمة بسعر مناسب‬
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 Levels & Types of Health Care:
Health care services are divided into two main types of
services:
- Curative and
- Preventive.
- These services can be provided at three levels of health
care:
- Primary ‫رعاية صحية اولية‬
- Secondary ‫رعاية صحية من المستوى الثاني‬
- Tertiary ‫رعاية صحية من المستوى الثالث‬

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 Levels & Types of Health Care:
A. Curative Services:
1- Primary: the first medical services the patient get in the
clinics and health centers, usually by the general
practitioner (GP).

2- Secondary: the patient get the services at the hospital

level.

3-Tertiary: include advance medical services like coronary

surgery and cancer treatment.

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 Levels & Types of Health Care:
-B. Preventive Services:
1- Primary: include immunization ‫التطعيم‬, health education
and promotion ‫التوعية والتثقيف الصحي‬.

2- Secondary: include screening for specific diseases like

cancer, routine check up for non-sick persons, and
management of chronic diseases like diabetes mellitus.

3- Tertiary: include different types of rehabilitation

services like physical, social and psychological
rehabilitation.
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 I. Primary Health Care
-Primary care is defined as: " the first contact,
continuous, comprehensive, and coordinated care provided
to populations undifferentiated by gender, disease or organ
system.
-Who provide these services?
1. The general practitioner (GP);
2. The practical nurses;
3. Community health workers like nurses, physiotherapists
and occupational therapists.
4. Health services centers like child health services, family
planning , women's health clinics and accident and
emergency departments.
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Elements of Primary Health Care
1- Education on health problems and how to prevent and
control them.
2- Development of effective food supply and proper
nutrition.
3- Maternal & child healthcare, including family planning.
4- Adequate and safe water supply and basic sanitation.
5- Immunization against major infectious diseases.
6- Control Local endemic diseases.
7- Appropriate treatment of common diseases & injuries.
8- Provision of essential basic medication
Sec. 3. 26.4. 2022
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 Primary Health Care In Palestine:
- Primary health care centers in Palestine are distributed
into:
1- Ministry of Health (MOH) with a high percentage

2- UNRWA
3- Non-governmental Organizations (NGOs).

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 Primary Health Care In Palestine:
The primary health care activities can be summarized as
follows:
1. Environmental health :
The central public health laboratory is a specialized in
public health issues like;
1- food and water examinations.
2- infectious diseases screening,
3- Screening for neonatal phenylketonuria disease (PKU),
Thyroid-stimulating Hormone (TSH).

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A. Food control activities, which include:
1. Food Microbiology; & Food Chemistry;
2. Bacteriological & Chemical Poisoning;

B. Water control activities, which include:

1. Drinking water chemical examination;
2. Control of seawater and swimming pools:
3. Control of Waste water, and medical waste

C. Vector control: vector is a living agent like insects &

rodents that transmit a disease like control of sand fly that
transmit Leishmania.
Sec 1 9.5.2022 health care systems 15
Leishmania
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2. School Health Program:
- School health program include a comprehensive primary
medical, mental health care, with preventive and
psychosocial services.

- The services included in this area include:

Medical services, Oral and dental health, Vaccination,
School Health Education and promotion program.

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3. Child Health:
A- Child health Immunization:
The immunization of Palestinian children is the major success of
Palestinian health care system where the services are available,
accessible and affordable almost in all the Primary health Care
(PHC) centers.

B- child health problems in Palestine:

1. Phenylketoneurea: genetic disease caused by lack of an enzyme
needed to convert the amino acid phenylalanine to tyrosine thus
cause mental and physical disability.

2. Congenital hypothyroidism: lack of the production of thyroid

gland hormones so lead to mental and physical retardation.

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3. Child Health:
3. Rickets: a bone disease that can affect children due to deficiency
of vitamin D and/or calcium.

4. Failure to thrive: is a medical term which means poor weight

gain and physical growth failure over an extended period of time in
infancy.

5. Anemia:

The WHO defined anemia as Hemoglobin (HB) less than 11

gram/dl.

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Endemic cretinism :Four inhabitants aged 15-20 years : a normal male and
three females with severe longstanding hypothyroidism with dwarfism,
retarded sexual development, puffy features, dry skin and hair and severe
mental retardation
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Rickets :Bowed legs due vitamin D Deficiency

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4. Women's Health:
1. Family planning services: health education and promotion
programs about methods of family planning like the use of
contraceptive pills
2. Prenatal services: these services to women during pregnancy
period. Like physical check up, weight measurements, and
management of pregnancy complications.
3. Delivery services: through general and maternity hospitals.
4. Postnatal (after delivery) services: health education and
promotion about breast feeding, nutrition counseling for the
mother and the baby and physical check up for the baby like
measuring weight, height

Sec 2 5.5.2022
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 II. Secondary Health Care
-Secondary care is that care which is given as a result of a referral
from the primary care provider.

- Most commonly this is a specialized service referred to by a GP,

and other primary care professionals like nurses.

- The most costly part of health services is the hospital service.

-Entry into the system at this level is either by direct admission to a

health care facility or by referral.

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 Hospital Departments & services :
1-Accident and emergency (A&E): provide services for
injured people, accidents, trauma and emergent cases.

Patients may be referred for inpatient department for

further services like surgery or medical supervision or they
may leave to home.

2- Admissions (‫ )االدخال‬- the patient will be required to

provide personal information and sign consent forms
before being taken to the hospital unit or ward. If the
individual is critically ill, then, this information is usually
obtained from a family member.
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 Hospital Departments & services :
3- Out-patient clinics: different medical specialties
provide curative services to the patients without need to be
hospitalized like orthopedic, and internal medicine clinics.

4- Anaesthetics (‫)التخدير‬- Doctors in this department give

anaesthetic for operations and procedures.
An anaesthetic is a drug or agent that produces a complete
or partial loss of feeling.
There are three kinds of anaesthetic: general, regional and
local.

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 Hospital Departments & services :
5- Critical Care (‫)العناية المركزة‬- Also called intensive care,
this department is for seriously ill patients.

6-General Surgery - Covers a wide range of types of

surgery and procedures on patients.

7- Maternity (‫ االمومة‬/ ‫ )النسائية‬- Maternity wards provide

antenatal care, delivery of babies and care during
childbirth, and postnatal support.
8- Neonatal – (‫ )حديثي الوالدة‬provides care and support for
babies and their families.
Sec. 3. 9.5. 2022
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 Hospital Departments & services :
9 - Radiology – The application of imaging technology
like x-ray and radiation to diagnosing and treating disease.

10-Laboratory- provide different diagnostic services like

hematology, microbiology, and clinical chemistry.

11- Nutrition and Dietetics - Dieticians and nutritionists

provide specialist advice on diet for hospital wards and
outpatient clinics.
.

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 Types of Hospitals:
1. General Hospitals: provide general curative and
preventive services that may include outpatient, inpatient
and emergency services.

2. Specialized Hospitals: like mental hospitals, maternity

hospitals and ophthalmic hospitals.

3. Educational Hospitals: in addition to the medical

services, some hospitals may have accreditation to provide
educational services for various medical specialties.

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 Admission and referral to hospital:
‫االدخال والتحويل للمستشفيات‬
- The majority of people going into hospital do not need
admission and stay at hospital.

- Patients will be satisfied with the hospital services when

they feel:
1· The comfort of surroundings ‫راحة في المكان‬
2· Easy to get to the unit or service
3· The courtesy of staff ‫لباقة الطاقم الطبي‬
4 ·The speed and seriousness of health services
- The main referral professionals are the GPs.
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 III. Tertiary Health Care
Characteristics of tertiary services:
1- includes highly technical services for the treatment of complex or
complicated health needs.

2- Providers of tertiary health care are specialized health

professionals in a particular clinical area as psychiatric hospitals
and clinics, chronic disease centers, and highly specialized units of
general hospitals, for example, a coronary care unit.

3- Entry into the tertiary services is by referral from either the

primary or secondary level.

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 III. Tertiary Health Care
Services provided by tertiary level could be:
A. Curative:
•Advanced surgery like heart surgery.
•Advance medical treatment like treatment of cancer.
• Research and education.

B. Preventive:
•Physical rehabilitation.
•Mental rehabilitation.
•Psychological rehabilitation.

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 IV. Continuing Health care:
- Persons who need continuing care are:
1. Physically or mentally handicapped,
2. Elderly and suffering from a chronic and incapacitating
illness, or
3. Mentally retarded.

- Services can be provided in:

- personal care homes,
- inpatient health facilities,
- nursing homes,
- geriatric day care centers
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