2. Public Health Core Functions LOUIS ROWITZ, PhD DIRECTOR Mid-America Regional Public Health Leadership Institute

3. Public Health Response Bioterrorism Emerging infections Other health status Surveillan ce Laboratory Practice Epidemic Investigati ons Workforce Capacity & Competenc y Information & Data Systems Organizationa l Capacity Essential Capabilities Basic Infrastructure Pyramid of Public Health System Preparedness

4. CORE FUNCTIONS: A PRACTITIONER AND AN AGENCY PERSPECTIVE DIAGNOSISASSESSMENT RULES OF PROFESSIONAL PROTOCALS POLICY DEVELOPMENT TREATMENTASSURANCE

5. ASSESSMENT IS… All the activities involved in community diagnosis: Surveillance Needs assessment Analysis of cause of problems

6. ASSESSMENT IS… Collection and interpretation of data Case-finding Monitoring and forecasting trends Research and evaluation

7. ASSESSMENT DATA SOURCES: Personal Health Data: Vital statistics Epidemiology Health screening Special disease or population registries Laboratory test data Hospital discharge data Research Behavioral Risk Factor Data

8. ASSESSMENT DATA SOURCES: Data about community concerns & resources: Health resource inventory Public forums Polling Special methods- APEX, PH part 2, PATCH, MAPP, etc Information from private & non-profit providers Research

11. Four MAPP Assessments Community themes and strengths assessment Identifies issues that interest the community, perceptions about quality of life, and community assets

12. Four MAPP Assessments Local public health system assessment Measures the capacity and performance of the local public health system-all organizations and entities that contribute to the public’s health

13. Four MAPP Assessments Community health status assessment Assesses data about health status, quality of life, and risk factors in the community

14. Four MAPP Assessments Forces of change assessment Identifies forces that are or will be affecting the community of the local public health system

15. ASSESSMENT DATA SOURCES: Methods of distribution of findings: Annual vital statistics report Special projects report State health report Monographs Fact sheets Professional publications Media releases

16. ASSESSMENT DATA SOURCES: Data on the range & quality of services: Selected treatment management review data Consumer complaint follow-up information Facility & professional licensure data Research

17. ASSESSMENT DATA SOURCES: Environmental Health Data: Sanitary survey Air & water monitoring Public reforms Facility inspections Laboratory test data Research

18. THE POLICY DEVELOPMENT PROCESS ENTAILS… Collaboration Decision-making about problems Choice of goals and steps to meet them Conflict resolution and negotiation

19. THE POLICY DEVELOPMENT PROCESS: Defines health needs Sets priority health issues by analyzing the outcome of assessment Develops policies and plans to address the most important health needs by setting goals & objectives with measurable objectives Develops alternative strategies for implementing plans Identifies necessary & available resources

20. THE POLICY DEVELOPMENT PROCESS USES: Scientific information Data from the assessment process Information from concerned citizens & providers

21. THE POLICY DEVELOPMENT PROCESS USES: Concepts of political & organizational feasibility Community values An open process, involving all private & public sectors by communicating, networking & building constituencies

22. THE ASSURANCE FUNCTION INVOLVES: Implementation of legislative mandates and statutory responsibilities Development of adequate responses to crises Support crucial services that have worked in the past

23. THE ASSURANCE FUNCTION INVOLVES: Regulation of services and products provided in both the public and private sectors Maintain accountability to the people by setting objectives and reporting on progress

24. THE ASSURANCE FUNCTION INVOLVES: Maintenance of a level of service needed to attain an intended impact or outcome that is achievable given the resources and techniques available

25. ASSURANCE The Assurance function calls upon public health agencies to: Provide public health nursing services Provide environmental health services Encourage, purchase or provide additional population-based services Maintain emergency response capacity

26. ASSURANCE The Assurance function calls upon public health agencies to: Administer quality assurance Help recruit & retain health care practitioners Maintain administrative capacity

27. THE TEN ORGANIZATIONAL PRACTICES OF PUBLIC HEALTH Assessment 1.Assess the health needs of the community 2.Investigate the occurrence of health effects and health hazards in the community 3.Analyze the determinants of identified health needs

28. THE TEN ORGANIZATIONAL PRACTICES OF PUBLIC HEALTH Policy Development 4. Advocate for public health, build constituencies, and identify resources in the community 5.Set priorities among health needs 6.Develop plans and policies to address priority health needs

29. THE TEN ORGANIZATIONAL PRACTICES OF PUBLIC HEALTH Assurance 7.Manage resources and develop organizational structure 8.Implement programs 9.Evaluate programs and provide quality assurance 10.Inform and educate the public

30. The capacity of the public health system is its ability to perform the core functions of assessment, policy development, and assurance on a continuous, consistent basis made possible by maintenance of the basic infrastructure of the public health system, including human, capital, and technology resources. The smooth running of the system requires the application of sound leadership skills at all levels of the public health system. -Modified from the Washington State Public Improvement Plan, March 1994

31. Public Health in the U.S.

32. Vision: Healthy People in Healthy Communities

33. Mission : Promote Physical and Mental Health and Prevent Disease, Injury, and Disability

34. Public Health Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services

35. Essential Public Health Services Monitor health status to identify community health problems Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues

36. Essential Public Health Services Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety

37. Essential Public Health Services Link people with needed personal health services and assure the provision of health care when otherwise unavailable Assure a competent public health and personal health care workforce

38. Essential Public Health Services Evaluate effectiveness, accessibility, and quality of personal and population- based health services Research for new insights and innovative solutions to health problems Source. 1990 Centers for Disease Control and Prevention

39. Public Health: The foundation of a national health system Public Health System Infrastructure Human Resources Development (Training) Information Systems Community Planning Systems Secondary Medical Care Primary Medical Care Essential Population-Based Public Health Services Human Resources Development(Training) Information Systems Community Planning Systems Tertiary Medical Care Capacity to Deliver Public Health Services

40. The Future

41. Health Information System in Sri Lanka Dr Sunil Senanayake MBBS, MSc, MD Director/Health Information by

42. Information System Components of National HMIS: –Hospital Information System –Preventive Health Information System –Disease Surveillance System –Population Census –Surveys –Other special surveys ( NCD Risk Factor Survey )

43. Sources of Information Hospital Information System: –Clinical Data –Diagnosis of diseases (Using ICD-10) –Procedures performed –Cancer Registry –Cause of Death (Hospital deaths) –Hospital facilities –Hospital services

44. Sources of Information ctd… Preventive Health Information System: –Maternal, Child Health and FP data –Food Sanitation, Environmental & Occupational Health data –Nutrition data –School Health data –Immunization data –Data from Disease Control Programmes

45. Sources of Information ctd… Disease Surveillance System: –Mainly Communicable Diseases –Monitoring of disease trends –Leading causes of Hospitalization Ischaemic Heart Diseases Hypertension and complications Cancers Diseases of elderly

46. Sources of Information ctd.. Population Census: National Census: –Started in 1881 –Every ten years (except 1991) –Wide range of information

47. Sources of Information ctd.. Surveys: 1. Demographic and Health Survey: –Started in 1973 –Every five years –Support Health Information –Confirm Health Information

48. Sources of Information ctd.. Surveys: ctd… 2.Household Income Survey: –Nutritional status –Energy consumption –Common Health Problems –Expenditure pattern

49. Sources of Information ctd.. Surveys: ctd… 3. Nutrition Survey: –Nutritional status –Nutritional disorders –Energy consumption –Vitamin deficiencies –Micro-nutrient deficiencies

50. Sources of Information ctd.. Surveys: ctd… 4. Other Special Surveys (NCD RF Survey): –NCD Risk Factor Survey –Injury Surveillance

51. Sources of Information ctd.. Other Sources Health Related Data: –Alcohol and Drug Information Centre –National Dangerous Drugs Control Board & Police Narcotic Bureau –Non Governmental Agencies –Sri Lanka Customs –Trade and Commerce Ministry Food, tobacco, alcohol etc (imports & sales)

52. In the past …………….. -Well established health infrastructure -Very good preventive health care service -Eradication of diseases -One of the world best EPI programmes -Better health Indicators for the investment -Model for low cost health services -- Among many other things …... Some of the remarkable achievements ….

53. Recent past ……. -Health for all by 2000 -Primary Health care approach -MCH and FP -Immunization -Health Education -Disease prevention -Healthy environment etc……

54. Future problems ……. Changing demography Changing disease pattern Changing life styles High expectation of people Equity Responsiveness Technological advances etc……

55. Our strategies …………. -Improve ambulatory care -Concentrate on Non Communicable Diseases -Integrated Disease Surveillance -Rehabilitation in the community -Promote healthy lifestyles -Ensure equity -Exploit IT -Better dialogues between clinicians, public health personnel, researchers & planners

56. Issues (Hospital) There are many Issues: (Hospital) –Manual Record keeping system –Only inpatient data –Only from Government Hospitals –ICD10 at Hospital but aggregated groups are transmitted to the centre –Doctors do not concern about writing of diagnoses

57. Issues ctd… (Hospital) ctd… There are many Issues: (Hospital) ctd… –Inadequate human resources –Untrained coders –Patient record formats –No established Medical Record Departments in some hospitals –No unique ID –Repeated admissions counted as new cases –Use of IT is minimal

58. Issues ctd… (Public Health) There are many Issues: (Public Health) –Total system is manual –Behind time –Processing is difficult –No/weak data from Estate sector Occupational health Nutrition surveillance Health education NCDs

59. Issues ctd… (Other) There are many Issues: (Other) –Poor Financial Information –No unit cost system –No Disease burden study –No routine NCD surveillance system –HIS policy has not been laid down

60. Challenges Hospital System: –Re-designing the hospital record keeping system –Changing of record keeping formats –Adaptation of ICD 10 at all hospitals –Transmitting of data by ICD 10 4 digit level

61. Challenges ctd.. Hospital System: ctd.. –Changing of attitudes of doctors –Introduction of ICD 10 to basic curriculums –Introduction of IT to hospitals (EPR) –Development of IT Networks in hospitals –Training of users –Quality of Medical Records

62. Challenges ctd.. Public Health System: –Introducing IT at lowest possible level –Development of suitable software –Development of routine NCD, nutrition and occupational disease surveillance systems –Integration of disease surveillance systems

63. Challenges ctd.. Other Systems: –Introduce a Unit cost system –Updating of Human Resource Information System –Mapping of Health Facilities (GIS) –Convincing Policy makers and decision makers on investment in IT in Health

64. Challenges ctd.. The biggest challenge is “get decision makers and policy makers to use information for decision and policy making.” Therefore “evidence based decision making culture” has to be promoted among them.

65. Challenges ctd.. Information dissemination would be one of the strategies that could be adopted to overcome this situation.

66. Dissemination of Information Annual Health Bulletin Annual Administrative report Weekly Epidemiology Bulletin Quarterly Epidemiology Bulletin Annual Family Health Report Census reports DHS reports Survey reports Health Ministry Website

67. Current status of IT Facilities IT Facilities available: –Ministry of Health has a Local Area Network with a dedicated e-mail service and Internet services. –All the Provincial Health Offices and most of the District Offices are connected to the LAN of the Ministry of Health via dial-up lines for electronic data transfer. –Network will be expanded to MOH Offices and large hospitals by end of 2005.

68. Opportunities Millennium Development Goals Health sector master plan WB assisted Health Sector Development project E-Sri Lanka project Government budget monitoring mechanism

69. Thank You! Dr Sunil Senanayake sunil@health.gov.lk sunilsenanayake@hotmail.com