IMPLEMENTATION OF THE NATIONAL HEALTH SYSTEM OUR GREAT CHALLENGE FAMILY HEALTH

EL SALVADOR

5-year Strategic Plan 2004-2009. MSPAS Strategic Objective: “Implement a concerted CHANGE in the health sector that promotes an efficient integrated decentralized NATIONAL HEALTH SYSTEM TO ACHIEVE universal coverage, care for all people, in the entire country.”

Millennium Development Goals MDG 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria, and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development

Primary Health Care Health care put within reach of all individuals and families in the community, through means that are acceptable to them, with their full participation and at a cost that the community and the country can support.

NATIONAL HEALTH POLICY S N Strategic Objectives Impact Objectives UNIVERSAL COVERAGE MANAGEMENT MODEL DEVELOPMENT OF HUMAN RESOURCES IN HEALTH MSPAS STEERING ROLE BETTER HEALTH STATUS IN THE POPULATION MODEL OF CARE QUALITY OF CARE AND SERVICES FOCUS ON FAMILY HEALTH SOCIAL PARTICIPATION IN HEALTH SATISFACTION OF CONSUMERS AND PROVIDERS MODEL OF DELIVERY EQUAL ACCESS COMPLEMENTARY CONNECTED NETWORKS 1. Increase State budget allocation for public spending in health. 2. Improve the efficiency of public institutions. 3. New financing sources. ADJUSTMENT OF THE LEGAL FRAMEWORK FINANCING MODEL MECHANISM

PROCESS OF CHANGE IN HEALTH THE INITIATIVE aimed at creating a National Health System, in response to the following strategic objectives: Expand health services coverage for the population within a framework that gives special importance to family health. Improve quality AND compassion of health-care services holding as key the model of individual, family and community health care.

IMPLEMENTING THE CONCEPTUAL FRAMEWORK Family Health Model IMPLEMENTING THE CONCEPTUAL FRAMEWORK 8

FAMILY HEALTH PHC-based model, with emphasis on health promotion and community work that views as the unit of analysis the care and intervention of “the family”, provides intra- and extramural services, which promote healthy lifestyles, control of environmental risks and preventive care with focus on family life and life cycle in order to promote and preserve health of the family members and their environment.

General objective Guarantee access to and equity in the supply of health services, based on the strategy of primary care, with emphasis on health promotion, to family members and their environment in order to achieve satisfaction and improve the level of health; promoting co-responsibility.

Objective specific Determine geographical and population areas of responsibility, assigning families to family health teams and health facilities. Organize the network of services connecting the levels of care and strengthening the process of referrals and follow-up visits.

Specific objectives Strengthen the promotion and prevention of health risk and impairments. Establish integral management of service networks.

Characteristics Family and community focus, respecting their culture and rights. Define and guarantee continuous health services, applying standards, protocols, instruments, as well as evaluation mechanisms that ensure effectiveness. Made up of processes and procedures developed by interdisciplinary and integrated teams. 13

Characteristics A flexible, dynamic, and interactive model capable of predicting and responding on a timely basis to the current and future health characteristics and needs of the family. Based on social participation and intersectoral approach. Essential: address and resolve the population’s most common health problems and risks through family and community participation.

Essential Components 15

Instruments Family File Familiograma (“Family Diagram”) Family Registry, reduces time spent on data collection and allows longer time devoted to relation with the patients. Familiograma (“Family Diagram”) Structural diagram of family composition and of the system of relationships of several generations in the family, identifies risk factors and dysfunctions, and its important role in causing illness, recuperation and rehabilitation. 16

What does the Family File contain? NAME ADDRESS LIFE-CYCLE FILES CLINICAL HISTORIES HEALTH FILE INTERVENTION PLAN FAMILIOGRAMA

Value-added to the model Traditional Model Expansion of rural coverage, Fosalud, Hospital without walls Community work Service-oriented culture Availability of promoters Culture of volunteer service Population targeting (poverty) Prompt care Greater problem-solving capacity (physician) 18

Phases of Implementation Implementation of other Preparation Pilot Gradual implementation in the public network of Regional establishments Extension Expansion Selection of Units Preparation Inputs Training Implementation of other SIBASI Units in the 5 Regions All Units of all SIBASIS Nov-Dec 06 January-December 07 January-December 08 January 09 interface

Key Elements of Intervention FAMILIES EDUCATIONAL CENTERS WORK ENVIRONMENTS HEALTH FACILITIES

ORGANIZATION FOR IMPLEMENTING THE FAMILY HEALTH MODEL

Family Health Teams (FHT) Composition The FHT includes preferably: 1 health promoter 1 nurse and 1 physician. A Health Facility can have more than one family health team, according to its installed capacity and defined population. These teams are supported by other professionals (dentists, specialists, psychologists, nutritionists, etc.) as well as technical personnel (laboratory, RX, Pharmacy)

Family Health Team Area of Intervention The basic geographical unit is the program area of the Family Health Promoters and includes homes, dwellings, blocks, communities, country houses, grouping of cantons, or parts of these. Such geographical units include a maximum group of 250 families, approximately equal to 1,000 - 1,200 people.

Interventions

Families Assigned to the Family Health Model Geographical Area Programmed families Families Assigned Progress Western Region 8,590 3,161 37% Central Region 2,187 1,197 54% Metropolitan Region 1,947 862 44% Paracentral Region 3,633 1,240 34% Eastern Region 8,162 4,916 53% 25

THANK YOU 26 26