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10 Cards in this Set
- Front
- Back
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How do we measure 'burden of disease'
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Disability Adjusted Life Yeards (DALYs)
=Years of life lost (YLL) + Years of life lived with disability (YLD) |
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Why use DALY's?
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Allow us to
1)Quantify morbidity from a disease 2)Diffenentiate between death of a child (greater loss) and death of auldie 3)Combine premature mortality with non-fatal health outcomes in a single measure - both have a cost |
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Safe Motherhood strategy (in relation to pregnancy):
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Community education
Antenatal care: e.g. nutritional supplements, blood pressure and infectious disease screening, Skilled assistance at delivery Interventions to manage obstetric complications & emergencies Post partum care |
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Health action goes beyond Health Services
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water, food, work, sex, travel, cooking……
investment in health vs. investment in health services environmental problems are important because they impact on health the health system is about more than just the health services |
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Five elements of Health Systems
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Production of resources
Trained staff, commodities (drugs), facilities Financing mechanisms Tax, insurance, user (patient) fees . Managing the health system Planning, administration, regulation, legislation Organisation of programmes By government ministries of health, private providers, voluntary agencies Delivering services Preventive and curative personal health services Primary, secondary and tertiary services (appropriate levels of care) Services for specific population groups, e.g. children, mental illness, travellers, disability, etc. |
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Problems wit African Health Care service
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80% of people in Africa continue to visit traditional healers because of physical, mental and social ill health
Healers are the first port of call for 50% who seek care for HIV and sexually transmitted diseases There are more formally trained Ayurveds and Homeopathists in India than Allopaths (MB BS doctors) Hospital focus no formal primary care service Urban concentration cities prioritised – rural areas neglected Focused on needs of elite few |
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How are developing country health systems financed?
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Government budgets
but the poorer the country, the smaller the tax base Out-of-pocket by patients (termed ‘user fees’) Donors (bilateral and multilateral) Programme and project support Pooling of donor aid Budget support (some bilateral donors) Debt relief (poverty reduction strategies) Loans - e.g. World Bank Global Health Initiatives |
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Government Stewardship six functions
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Overall system design
Performance assessment Priority setting Inter-sectoral action (across govt departments) Regulation Consumer Protection |
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Criteria for measuring health systems performance
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Coverage what % of people access services
Effectiveness use of proven interventions that bring + Efficiency maximum benefit for least cost Equity of access to care based on need, not on ability to pay (“fairness” as important as “effectiveness”) Responsiveness to service users needs |
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Health Systems - the agenda in resource poor settings
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1. finance:
chronic under-investment 2. human resources: the acute crisis in Africa 3. information: we cannot count the dead 4. vital commodities: shortages and stock outs 5. stewardship and governance: overall strategy |
