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What is a health system?

A health system responds in a balanced way to a population’s needs and expectations by:

1. improving the health status of individuals, families and communities

2. defending the population against what threatens its health

3. protecting people against the financial consequences of ill-health

4. providing equitable access to people-centred care


Staffing accounts for what % of health budgets?

over 70%


By 2020 africa will have a shortage of how many nurses? physicians?

over a million nurses, 200,000 physicians


What are the causes of health care worker shortages?

1. Heavy workloads
2. Unsafe
3. Poor pay
4. Out-migration


According to the WHO there is a shortage of how many nurses worldwide?

9 million


What is the MD/pop in Canada?



What is the nurse/pop in Canada?



Example of staffing in a Primary care center in rural Uganda

- Level 4 health centre
- serves a pop of 75 000
- 2 wards pediatric and adult
- delivery room and surgical theatre
- Nearest hospital is 90 min by car

What would the staffing be like?

No doctors
2 physician assistants
8 nurses/ midwives
1 pharmacy technician
1 lab technician
1 statistician
8 supporting staff(guards, cooks, cleaners)


What are 2 major challenges to healthcare staffing?

1. Training (who to train, team training, what to teach)
2. Retention (internal factors, migration, incentives)


What other options do we have (besides doctors and nurses)

- Physician assistants: 3-4 years
- Midwives: 2-3 years
- Dental technicians: 2-3 years
- Health assistants: 2 years
- Paramedics: 1-2 years
- Community health workers: 3-6 months
- Skilled birth attendants: 3 months
- Depot holders: 3 months
- Village (lay) health volunteers: 2 weeks


What is Task Shifting/Sharing?

The delegation of tasks shifted to less specialized or lay health workers


What are 5 barriers to Task Shifting/Sharing?

1. Professional associations stress because only a limited amount of money can be allocated on different partitioners

2. Delivery of care is limited to health professionals, but could also be handled by other people, diarrhea for example

3. No HMIS to guide manpower planning

4. Lack of incentive to keep people working there

5. Inability to supervise


What needs to be done to solve the global shortage of healthcare workers?

1. Global health workforce strategy need to be established (Agreements, regulations)

2. Accreditation of health training institutes

3. Adequate # of trainees in system

4. Adequate supervision/support of health workers

5. Adequate remuneration

6. Task sharing

7. Community/household case management


Which countries spend the most on health care out of pocket?

poor countries


What are the characteristics of Appropriate technologies? (6)

1. Meets people’s needs

2. Env friendly

3. Affordable

4. Use of local skills and materials

5. Helps LOCAL people make a living

6. Very little manpower, training or maintenance requirements


Give an example of an inappropriate technology

Motorcycle ambulance: costs lots of money but is not a good solution

Straw to filter water: hard to drink with and pollution when it breaks


Give an example of appropriate technology

Bambulance (bike ambulance)

Lamp with solar energy


What is the leading indirect cause of DALYs?

Unsafe medical practices


What % of patients receive the correct diagnosis?

less than 40%


What % of children with diarrhea are prescribed harmful treatments?

More than 75% (this can be easily treated with rehydration solution)


What % of reported practices actually occur?

less than 20%


Who provides most continuing education on drugs?

drug vendors/detailers


How often do district level health facilities face stock-outs?

50% of the time


What can be done to improve quality of care? (8)

1. Strengthened management competencies

2. Improved communication and application of eHealth innovations

3. Supportive supervision

4. Incentives

5. Quality of care monitoring

6. Issue focused training, e.g.
7. Emergency Triage, Assessment and Treatment (ETAT)

8. Identify barriers and facilitators of quality care


What is Integrated
Community Case
Management of
Childhood Illness?

An equity-focused strategy
to improve access to essential
treatment services for children


What types of health facilities exist? (5)

1. Health Posts: villages (1-2,000), staffed by Community Healthcare Workerss

2. Level 1-2 Health Centres: village clusters (unions 5-10,000), staffed by paramedics

3. Level 3-4 Health Centres: sub-districts (40-100,000) staffed by paramedics, nurses, lab techs, stats, +/- MDs

4. District (up to 500,000) and Regional (millions) hospitals

5. National/Teaching Hospitals


What are the important aspects of governance and leadership in health care? (6)

1. Policy Guidance
2. Knowledge and oversight
3. Collaboration and coalition building
4. Regulation
5. System design
6. Accountability


What are challenges to governance? (7)

1. Limited competencies & capacity

2. Political priorities

3. Turnover

4. Devolution of authority

5. Priority setting

6. Accountability

7. Recruitment


What is Partnership for Health Systems Strengthening in Africa?

A programme that aims at strengthening partnership and networking among training institutions in Africa for development of a critical mass of health workers for sustainable health systems strengthening.


What are the key elements of an effective Health Information System?

1. Health determinants (socio-economic, environmental behavioural, genetic factors) and the context

2. Inputs to the health system and related processes including policy and organization, health infrastructure, facilities and equipment, costs, human and financial resources

3. The performance or outputs of the health system such as availability, accessibility, training, quality and use of health information and services

4. Health outcomes (mortality, morbidity, disease outbreaks, health status, disability, wellbeing)

5. Health inequities, in terms of determinants, coverage and health outcomes stratified such as sex, socio-economic status, ethnic group, geographic location