COMPONENTS OF THE

HEALTH CARE SYSTEM

Ms. Mavis Nyarko
Components of the health care system

 Formal health care system

 Informal health care system
 Social structure
Formal health care system

 Organized in both curative and preventive system

 Curative health service are provided by:
 Government institutions
 Quasi government institutions
 Teaching hospitals
 Private institutions
Preventive health care
 Polyclinics
 Health centers
 Community-based clinics(CHPS zone)
Public Health Programmes

 The Ministry of Health is focusing on a number of

health priorities in Ghana.
 Specific health programmes have been developed
to address these health priorities.
Reproductive and Child Health

 The GHS has sanctioned the existence and free

unfettered operation of the Reproductive and Child
Health Unit.
 This unit has active branches at all levels
throughout the country.
The components of the reproductive health programme

 Safe motherhood, including antenatal, safe delivery, and

postnatal care, especially breast-feeding, infant health,
and women’s health
 Family planning
 Prevention and treatment of unsafe abortions and post
abortion care
 Prevention and treatment of reproductive tract infections,
including sexually transmitted diseases and HIV/AIDS
 Prevention and treatment of infertility
 Management of cancer, including prevention and
management of cervical cancers
 Responding to concerns about menopause
 Discouragement of harmful traditional practices
that affect the reproductive health of men and
women, such as female genital mutilation
 Information and counselling on human sexuality,
responsible sexual behaviour, responsible
parenthood, preconception care, and sexual health.
 Family planning services are designed to assist
couples and individuals in their reproductive ages
to space or limit the number of births, prevent
unwanted pregnancies, manage infertility, and
improve reproductive health.
 Services provided at delivery points include the
provision of short-term methods (condoms,
spermicides, injectables, LAM, oral contraceptives,
and natural family planning methods), reversible
long-term methods (IUDs, jadelle, and implants),
and permanent methods (minilap tubal ligation, and
vasectomy).
 Currently, the reproductive health care system,
which was designed for adults, is being modified to
meet the needs of adolescents as well.
The child health programme
 The child health programme constitutes all child
health activities aimed at promoting and
maintaining the optimal growth and development
of children age 0-18 years.
 For programmatic purposes, it has been subdivided
into three groups:
 Children under 5 years (0-4 years)
 School-age children (5-15 years)
 Adolescents (10-18 years).
The components of the child health

 Neonatal health care

 Antenatal care services
 Postnatal care services
Child welfare services
 Promotion of exclusive breastfeeding for the first
six months and timely introduction of
complementary feeding
 Immunization
 Growth promotion and nutrition rehabilitation
 Curative care for minor ailments and injuries
School health services
 Screening and examination of school children and
food vendors
 Immunization
 Health education on current public health issues
 Management of minor ailments and injuries
 Maintenance of a hygienic school environment
 Referrals
Adolescent health
 Identification and management of common health
problems affecting adolescents
 Provision of services focused on adolescents, including
counseling; information, education, and
communication (IEC); and reproductive health issues
in general
 Referrals
Expanded Programme on Immunization

 In Ghana, the Expanded Programme on Immunization (EPI) was

introduced in 1978 as a strategy to improve child health.
 Since 1985, the programme has been operational in all 16 regions
and over 216 districts.
 The programme’s focus was on childhood immunizations against
tuberculosis (TB), diphtheria, neonatal tetanus, pertussis, acute
poliomyelitis, measles, and yellow fever. Immunizations against
Haemophilus influenzae type b (Hib) and hepatitis B (HepB)
vaccine were introduced in 2002, meningococal meningitis, Rota
Vitamin A.
 Despite several attempts to improve the programme, the national
immunization coverage has remained low
 The EPI goals articulated in this strategy include
the following:
 Eradication of poliomyelitis by the year 2000
 Elimination of measles by the year 2004
 Control of hepatitis by the year 2004
 Control of yellow fever by the year 2004.
 As part of attempts to improve the EPI services in the
country, the policy environment was strengthened.
 In 1991, daily immunization services (DIS) were
introduced for all delivery points, including hospitals
 The DIS policy stated that health workers should use
every contact with a child under five years of age to
inquire about their immunization status and should
proceed to vaccinate them or refer them as needed.
There is evidence, however, that this policy is not
being adhered to.
 Another strategy encouraged by EPI includes static,
outreach, and satellite clinics.
 Static clinics are facility based and operate daily
from 8 a.m. to 3 p.m.
 All logistics and other items needed for
immunization are expected to be available at these
sites.
 Outreach clinics have staff who move from their station
(static) to render the same kind of services they would have
carried out at the static clinic in the communities.
 Specialized care is usually not provided.
 Logistics and vaccines are carried by the team. Outreach
services are held either weekly, fortnightly, or monthly,
depending on staff strength and distance of operation.
 Satellite clinics are performed close to the static clinics.
Their purpose is to decongest static clinics. The main
difference between outreach and satellite clinics is the
distance from the static clinics
 In a recent review, EPI was:
 Criticized for its overdependence on outreach immunization
activities, and the review suggested that more static sites be created.
 The safety of injections policy was also introduced.
 It states that to ensure the safety of injections, the needles and
syringes for routine immunizations should be disposable and
autodestructive.
 Health staff are to use one sterile needle and syringe for each
injection and should not reuse disposable syringes and needles.
 These needles are to be placed in a puncture-proof container after
use and disposed of by burning (destructive incineration) or burying
at least 0.5 m below the surface.
Informal sector
Traditional medicine
“The sum total of all the knowledge and practices,
whether explicable or not, used in diagnosis,
prevention and elimination of physical, mental and
social imbalance and relying exclusively on practical
experience and observation handed down from
generation to generation, whether verbally or in
writing” (WHO, 1976).
Traditional Health care system in
Ghana

• The potentiality of traditional medical practice

is derived from the supernatural assumptions
underlying the practice.
• Traditional medicine utilized medicinal herbs,
but the potentiality of the herbal treatment is
believed is sought in terms of the powers of
the spiritual world.
Types of Traditional Healers

 There are four main types of traditional healers

 Traditional Birth Attendants (TBA)
 Spiritualists (Diviners)
 Traditional herbalists
 Faith healers
Traditional Birth Attendants (TBA’s)

 They focus their attention on pregnancy problems

and they assist pregnant women during deliveries.
 They are known as specialists in obstetrics but the
range of their activities extends into the field of sex
education and contraceptive counseling.
 Patients who seek the services of traditional birth
attendants are usually members of the same
community.
 Thus, traditional birth attendants tend to have an
intimate knowledge of their patients.
 It takes place in an informal setting.
 This is due to the fact that they are also members of
the same community as their clients.
 Thus, during deliveries they deal with patients they
intimately know.
 Women who become TBAs learn their skills from
relatives.
 They learn through observation and
apprenticeship.
 The trainee learns in an informal atmosphere while
performing other household duties.
 She acquires her skills by watching a trainer in
action.
 Over a period, sometimes 5 years or more, she
picks up the skills and knowledge of the practice.
 She is also trained in the preparation and
administration of herbs needed for assisting
deliveries.
CLASS DISCUSSION
 Are Traditional Birth Attendants still needed in our
modern health care delivery system in Ghana?
Spiritualists

 These are another type of traditional healers.

 They use methods of possession, divination and
other ritual means to diagnose illness and to heal
people
 They claim they are intermediaries between their
spiritual agencies and patients who seek their help.
 Spiritualists diagnose diseases through divinations.
 He often seeks for social and psychological
reasons for illness.
 Why?
 When medicine is given to a patient to “cure” any
of the illnesses and problems, a ritual ceremony is
usually performed at the healer’s shrine to augment
the potentiality of the medicinal preparation.
 The patient is also given a piece of advice on how
to live with other members of his household, on
how to take the medicine and on the nature and
type of food he must eat
Herbalists

 Herbalists are the most numerous of the traditional

healers.
 They approach healing through the use and
application of herbs.
 They also adhere to traditional principles in their
healing process.
Traditional Healers’ Approach to
Healing

 Witchcraft notions occupy a central place in the

thinking of clients/customers who access traditional
healers.
 Witchcraft is a belief in a mystical power possessed
by some individuals and exercised by them to harm
others and to inflict an illness on relatives.
 Treatment is based on “social analysis”, a process
in which the healer seeks to analyze the possible
causes and treatment of illness from a social and
supernatural realm.
 The healer calls for the patient’s background
history from his kinsmen.
 A ritual ceremony is performed to propipiate and to
get rid of the spirit that was thought to be causing
the problem.
 The healer functions variously as a social
philosopher, as a social psychologist or a magician
in a healing session.
 He links spiritual causes to physical manifestations
of illness.
 What about Faith healers?
Social structure
 Social (not natural)
 Made up by human beings
 Dynamic (change over time)
Social structure
 In order to achieve our goals for better health for
all, it is necessary to think beyond the delivery of
medical services
 Often the factors that have the greatest impact on
health don’t involve the health care system at all
 Strengthening the social structure is essential for
health
 If you do not have a refrigerator to store your
insulin. How well will you be able to control your
diabetes. Being provided with a safe place to store
your vaccine would be a better option
 If your child asthma is made worse by air pollution
in your neighborhood or the dust in your home,
intervention on public health measures to improve
air quality would be more effective than increasing
the number of your child's medication and trips to
the emergency room
 If a family don’t have enough food to eat, wouldn’t food
be the most important medicine?
 Traditionally, the health care system has not taken on
these and many factors that contribute to poor health
 Social determinants of health which encompass social,
environmental and behavioral influences like access to
healthy food and water, safe housing, employment or
working conditions, gender and culture play an important
role in promoting health and potentially lowering health
care costs and must be address by health system
Social Determinants of Health
Terminology: Learning a
Common Language

 Community
 Health disparities

 Health inequities

 Health equity

 Social determinants

of health (SDOH)
Community

 A group of people with a shared identity,

including: living in a particular geographic
area, having some level of social interaction, sharing
a sense of belonging or having common political or
social responsibilities
 Community can also be described as a group of
people living in a recognized place or defined area
who share the same problems, needs, aspirations,
interest with a common leadership and self-help
spirit.
 The WHO defined community as being a social
group determined by geographic boundaries and /
or common values and interest
Health Equity

 The opportunity for everyone to attain his or her

full health potential
 Equal opportunity

 No one is disadvantaged from achieving

this potential because of his or her social

position or other socially determined
circumstance.
 Distinct from health equality
Health Inequities

 Systematic ,unjust and avoidable distribution of

social, economic, and environmental conditions
needed for health
 Unequal access to quality education, healthcare,
housing, transportation, other resources (e.g., grocery
stores)
 Unequal employment opportunities and pay/income
 Discrimination based upon social status/other factors
Health Disparities

 A type of differences in health that is closely linked with social

or economic disadvantaged
 Differences in the incidence and prevalence of health
conditions and health status between groups, based on:
 Race/ethnicity
 Socioeconomic status
 Sexual orientation
 Gender
 Disability status
 Geographic location
 Combination of these
Health literacy
 Ability to obtained and understand basic health
information and services that are needed to make
suitable health decision.
 Ability to understand instructions on prescription
drug bottles
Determinants of Health
 Factors that contributes to a person's current state
of health.
 These factors may be biological, socio-economic,
psychosocial, behavioral, or social in nature.
Classification of social determinants of health

 Biological and genetics: sex and age

 Individual behaviour: alcohol use, drug use,
unprotected sex, and smoking
 Social environment: discrimination, income and
gender
 Physical environment: where a person lives and
crowding conditions
 Health services: access to quality health care
Social Determinants of Health

 Access to life-enhancing resources, such as food

supply, housing, economic and social relationships,
transportation, education and health care, whose
distribution across populations effectively
determines length and quality of life
 It is the economic and social conditions that
influence individual and group differences in health
status
Social and physical Determinants
of health

 Reflects the condition of the environment in which

people are born, live, learn, play, work and age
 Availability of resources to meet daily needs, such as
educational and job opportunities, living wages, or
healthful foods
 Social norms and attitudes such as
discrimination/social isolation
 Poverty
 Quality schools
 Transportation options
 The social determinants of health (SDH) must be
addressed through:
 effective policies based on sound global and local
evidence.
 The difference between the causes of health and the
causes of health inequities
 The factors which lead to general health improvement
– improvements in the environment, good sanitation and
clean water, better nutrition, high levels of immunization,
good housing – do not always reduce health inequity.
 This is because the determinants of good health are
not necessarily the same as the determinants of
inequities in health (Graham & Kelly, 2004)
 It is necessary to distinguish therefore between the
causes of health improvement and the causes of
health inequities.
 As was noted in the previous section, inequities are
linked to social disadvantage.
 If generalized health improvement is not linked to
questions of social disadvantage.
THANK YOU