is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populationsorganizationhealth carehealth Health system/ Health care system /

Primary Health Care Essential Health Care Methods which are: Practical, Scientifically sound, and Socially acceptable Technology made: Universally accessible to individuals and families in the community through their full participation and At a Cost that : the community and country can afford to maintain at every stage of their development in the spirit of self determination

Pillars of Primary Health Care  Equity  Intersectoral Coordination  Appropriate Technology  Community participation

The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s) Appropriateness Availability Adequacy Accessibility Acceptability Affordability Assessability Accountability Completeness Comprehensiveness Continuity

Principle are: 1.Equity or equitable distribution of health services 2.Effectiveness 3.Efficiency 4.Accessibility

5. Affordability 6. Acceptability 7. Community participation 8. Appropriate technology

What determines health?

What are Determinants of Health? –Policymaking –Social factors Social Determinants Physical Determinants –Health services –Individual behavior –Biology and genetics

Four Tiers of Public Sector TierFacility/Services First Outreach and Community-based Services Focus on Immunization, Sanitation, Malaria control, Maternal & Child Health and Family Planning Second The Primary Care Facilities include :  Basic Health Units (BHU) &  Rural Health Centres (RHCs) Mainly Preventive, Outpatient, and Basic Inpatient Care Third The Secondary Health Care Facilities include :  Tehsil Headquarters Hospital  District Headquarters Hospital for Outpatient, Inpatient and also Specialist Care Fourth Tertiary Care Hospitals located in the major cities for more specialized inpatient care

Comprises of all  Organizations,  Institutions, and  Resources that produce actions whose primary purpose is to improve health. Comprises of all  Organizations,  Institutions, and  Resources that produce actions whose primary purpose is to improve health. H EALTH S YSTEM

F OUR D IMENSIONS OF HEALTH SYSTEM 1.Functional Infrastructure  Information  Management  Human Resource Development  Logistics  Facilities  Research 2.Community involvement & inter- sectoral coordination 3.Primary health care element 4.Levels of service delivery

A good health system deliversA good health system delivers quality services to all people, when and where they need them (The exact configuration of services varies from country to country) quality services to all people, when and where they need them (The exact configuration of services varies from country to country) requires a robust financing mechanism; requires a robust financing mechanism; a well-trained and adequately paid workforce; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and well maintained facilities and logistics to deliver quality medicines and technologies. technologies. Good health system

Health promotion & protection Health maintenance, rehabilitation Health monitoring, HE, Health restoring, disability limitation The services might be Staffed Organized Administered Financed (People are being served)

1.Appropriateness 2.Comprehensiveness ≈ all  complete 3.Adequacy  sufficient to meet the need 4.Availability 5.Accessibility 6.Affordability 7.Feasibility  carry out capability

1.Concepts ( Health & Disease) 2. Ideas (Coverage, equity, effectiveness, efficiency, impact and objects) 3.Objects (hospital health center & health programs) 4. Persons (Providers and consumers) All components support one another.

Comprehensive health care in corporate aspects of care provision in the home, community & health care facilities. District health system: It provides quality PHC to every one in a defined geographical area. It is a system of health care in which individuals communities & all the health care providers of the area participate together in improving their own health.

1.Demographic indicators 2.Socioeconomic indicators 3.Maternal health indicators 4.Child survival indicators 5.Family planning indicators 6.Disease control indicators 7.Composite indicators

PHC HEALTH PLANNING

HealthSystem COMMUNITY Health Services Package Non- Health Agencies Health Infrastructure Government Health Sector Private Health Services Providers

An extensive network of public and privately managed health infrastructure throughout the province Government operated health care: BHU, RHCTHQH, DHQH  Comprises of BHU, RHC, THQH, DHQH, Tertiary Care Hospitals  financed from public sector revenues Private sector:  Dominated by GP clinics, Maternity Homes, Dispensaries, Diagnostic laboratories, Hospitals with about 30 beds per hospital on average, hakeems & Homeopaths, Traditional Healers  largely funded out-of-pocket household expenditures

Primary Health Care Basic Health Unit (BHU) Located at Union Council Serves a catchment population of up to ~25000 people Services provided are: promotive, preventive, curative & referral Outreach/ community –based services : part of BHU services package Provides all PHC services along with integral services that include basic medical & surgical care, CDD, CDC, ARI, malaria and TB control MCH services are also part of the services package Provides first level referral to patients by LHWs & refers patients to higher level facilities Provides clinical, logistical & managerial support to LHWs

Primary Health Care Rural Health Centre (RHC) Serves a catchment population of up to 100,000 people inpatient bedsHave inpatient beds Services provided are: promotive, preventive, curative & referral along with inpatient services Provides clinical, logistical & managerial support to BHUs,LHWs, MCH centre, and dispensaries. Provides medico-legal, basic surgical, dental and ambulance services.

Secondary Health Care Tehsil Headquarters Hospital (THQH) 0.5 million to 1.0 millionServes a catchment population of 0.5 million to 1.0 million people Have inpatient bedsHave inpatient beds Services provided are: promotive, preventive, curative & inpatient services, specialist care along with referral Provides basic and Comprehensive EmONC. Provides referral care to patients referred by RHCs, BHUs, LHWs, MCH centre, and other primary care facilities.

Secondary Health Care District Headquarters Hospital (DHQH) 1.0 million to 3.0 millionServes a catchment population of 1.0 million to 3.0 million people Have inpatient beds Services provided are: promotive, preventive, curative & inpatient services, advanced specialist care and advanced diagnostic and referral services. Provides basic and Comprehensive EmONC Provides referral care to patients referred by THQHs, RHCs, BHUs,LHWs, MCH centre, and other primary care facilities.

Health System Health Infrastructure Government Health Sector Private Health Services Providers COMMUNITY Health Services Package Non- Health Agencies

Health care “Multitude Of Services” is defined as a “Multitude Of Services” rendered to Individual Individual Families Families Communities Communities Health Services By the people of the Health Services or Health professionals

WHAT IS A HEALTH CARE SYSTEM?  The World Health Organization defines a health system as “all the activities whose primary purpose is to promote, restore, or maintain health.”

DHQ shall have the following services All PHC activities  All PHC activities  Morning and evening OPD  24-Hour emergency care  Special disaster services  In-patient facility  Specialist services ( Medicine, Surgery, Eye, ENT, Gyn & Obs., Pediatrics, Anesthesia, Radiology, Pathology, Physiotherapy.  Referral support  Blood transfusion services

DHQ DHQ  Diagnostic services  Cardiology wards  Dialysis Unit  Radiology  Laboratory  Operation theatre  Intensive and coronary care  Reproductive health services  Dental care  Nursing care  Pharmacy  Training and internship services  Ambulance services  Hospital records and HMIS  Kitchen and dietary services  Hospital waste, environment and estate management

THQ HOSPITALS The THQ Hospitals are located at Tehsil Headquarters, serve a catchment population of about 0.5 to 1.0 million people and are meant to:The THQ Hospitals are located at Tehsil Headquarters, serve a catchment population of about 0.5 to 1.0 million people and are meant to: Provide secondary level referral care to the patients including those referred by the RHCs, BHUs, LHWs and other primary care facilities. Serve as a static centre for: Serve as a static centre for: o Curative care o MCH, FP, EPI and advice on food & nutrition o Sanitation and Health education o CDC, ARI and other special programmes. Support clinically and technically RHCs, BHUs and LHWs Support clinically and technically RHCs, BHUs and LHWs

THQ shall have the following services  All PHC activities  Morning and evening OPD  24-hour emergency care  Special disaster plans/services  In-patient facility  Specialist services (Essential: Surgery, Gyn & Obs., Pediatrics and Anesthesia)  Referral support  Blood transfusion services –Diagnostic services Radiology –Laboratory  THQ Hospital (40-60 Bedded)

THQ THQ shall have the following services  Operation theatre  Reproductive health services  Dental care  Nursing care  Pharmacy  Training services  Ambulance services  Hospital records and HMIS  Kitchen and dietary services  Hospital waste management  Hospital management.

Rural Health Centre (RHC) RHCs are located at Markaz and meant to: RHCs are located at Markaz and meant to:  Provide first level referral care & treatment of common diseases.  Serve as a centre for static & out-reach services for: o MCH, FP, EPI and Food and nutrition. o Sanitation and Health education, o CDC, ARI and other special programs.  Act as a focal point, where community and the public sector health functionaries may come together to resolve issues concerning health.

Rural Health Centre (RHC)  Support;  Clinically, visits of SMOs, Medical Officer, WMO.  Logistically, supply of drugs, medical supplies, EPI supplies and cold chain maintenance etc.  Management support: in-service training, supervision, clinical and administrative practices, HMIS, data collection, record keeping, monitoring, surveillance etc. of diseases, especially of epidemics) to the BHUs. LHWs, TBAs, Dispensaries, MCH Centre, Sub Health Centres etc.

RHC RHC shall have the following services  All PHC activities.  Morning and evening OPD  24-hour emergency care  Special disaster plans  In-patient facility: (Typically the RHCs have beds and each serves a catchment population of about 50, ,000 people).  Referral support  Diagnostic services Radiology

RHC shall have the following services  Laboratory  Operation theater  Reproductive health services  Dental care  Pharmacy  Training services  Ambulance services  Hospital records and HMIS  Facility waste management  Facility management

RHC Functions  Patient awareness/education  Immunization  Mother and child care including growth monitoring, food and nutrition.  Control of diarrhoeal diseases and ARI.  Safe motherhood.  Safe delivery.  Disease surveillance and epidemic control  Tuberculosis control

RHC Functions  Malaria control.  Laboratory, radiology & diagnostic tests.  Patient assessment, treatment & follow- up system  Record keeping & information management.  Human resource continuing education.  Referral.  Emergency care.  Supply of essential drugs.  In - patient admission and discharge

Basic Health Unit (BHU) BHU located at Union Council level and is meant to: BHU located at Union Council level and is meant to:  Provide the first level referral care to patients referred by LHWs and TBAs; and primary level organized curative care & treatment of common diseases.  Centre for provision of static and out-reach services; o MCH, FP, EPI and Food and nutrition. o Sanitation and Health education, CDC, ARI and other special programmes CDC, ARI and other special programmes

Basic Health Unit (BHU)  Supports; clinically, logistically and managerially to the LHWs, TBAs, MCH Centres, Dispensaries, Sub Health Centres etc. focal point  Serve as a focal point, where community and the public sector health functionaries may come together to resolve issues concerning health.

BHU shall have the following services BHU shall have the following services  Reproductive health services  Pharmacy  Training services  Facility records and HMIS  Linen and sterilization  Facility waste, management  Facility management

MCH CENTRE  At certain locations MCH Centre may exist as separate establishment – usually this is a component of the BHUs and RHCs – that is meant to :  Provide to the women especially in their reproductive age (15-45 years) the static and outreach services in respect of: o Antenatal including nutrition education and supply of micro-nutrients. o Natal o Postnatal o Family planning

MCH centre  MCH centre shall have the following services:  Reproductive health services  Morning OPD  Referral support  Pharmacy  Training services  Facility records and HMIS  Linen and sterilization  Facility waste management  Facility management

Dispensary At certain localities dispensary may exist as separate establishment – usually this is a component part of the BHUs and RHCs – that is meant to:At certain localities dispensary may exist as separate establishment – usually this is a component part of the BHUs and RHCs – that is meant to: –Provide the primary level organized curative care and referral care to patients referred by the LHWs and TBAs; and –Support; clinically, logistically and managerially the LHWs and TBAs that work in its catchments area. – Serve as a focal point, where community and the public sector health functionaries may come together to resolve issues concerning health.

Dispensary shall have the following services: Treatment of common diseases Treatment of common diseases Morning (and may be evening) OPD. Morning (and may be evening) OPD. Referral support Referral support Pharmacy Pharmacy Training services Training services Facility records and HMIS Facility records and HMIS Linen and sterilization Linen and sterilization Facility waste, environment and estate management Facility waste, environment and estate management Facility management. Facility management.

Sub-Health Center  At certain localities a sub-health centre may exist as an establishment usually in a community premises and attached to or as a satellite to RHC – that is meant to: –Provide the primary care and –Serve as a focal point, where community and the public sector health functionaries meet to fulfill its obligations :  Treatment of common diseases  Morning OPD  Pharmacy  Facility records and HMIS  Facility waste management  Facility management.

Sub-Health Center Dispenser 1 Naib/Qasid 1 Total 2

PRIVATE HEALTH CARE SYSTEM  Modern, for-profit: ( not well organized, wide range of disparity in health care provision.) ( not well organized, wide range of disparity in health care provision.) 1.Regular hospitals 2.Nursing homes/centers. 3.Clinics. 4.Informal structures.  Modern, not-for-profit. 1.NGO,s 1800  Traditional. (Ayurvedic,Unani,Homeopathic)

Other Departments/ Public sector departments involved in Health care  Pakistan International Airlines Corporation.  Pakistan Railways.  Employees’ social security benefit organization.  Water and Power Development Authority (WAPDA).  Pakistan Bait-ul-Mal.  Others: i.Pakistan Telecommunication,ii Fauji Foundation,iii Armed Forces Institutions, etc. i.Pakistan Telecommunication,ii Fauji Foundation,iii Armed Forces Institutions, etc.

HEALTHCARE PROVIDERS  Allopathic service providers. 1)1.Qualified MBBS, Specialists. 2)2.Semi-qualified (LHV,s,LHW,s) 3)3.Non qualified (Dispensers, Peons etc)  Non-Allopathic service providers. 1)Homeopaths. 2)Hakims. 3)Pehlwans. 4)Acupuncturists.

THANK YOU