Society, Culture & Health Care System: Dr. Babar T Shaikh

Society, Culture & Health Care system
Dr. Babar T Shaikh

The Aga Khan University, Karachi
1
New doctors advise that colostrum should be given. It is essential. Our elders say that colostrum should be disposed off, therefore, we practice what our elders advise us to do.
Mothers focus group
Rural Sindh, Pakistan.

2
Health System
a set of cultural beliefs and practices;
the institutional arrangements; and

the socio-economic, political & physical context Health system includes environmental conditions, nutrition, water supply, education, housing, status of women, social structures, economic and political system
3
Factors influencing health service utilization

Socio-demographic factors
Age/sex of child Family size/ parity
Education
Occupation
4
Economic factors
Possession of household items
Possession of cattle
Possession of agriculture land
Type of residential house
Physical accessibility factor

Availability of the transport
Physical distance for Health Facility/Health Care Provider Time taken to reach Health Facility/Health Care Provider
6
Financial accessibility factors

Fare spent for one round trip to Health Facility/Health Care Provider
Total amount spent for treatment of last illness (excluding fare)
Health service factors

Attitudes of health provider Satisfaction with the treatment Received medicines from Health Facility/Health Care Provider Received prescription for medicines to be purchased from bazaar
8
Mothers autonomy
Freedom to visit HF alone
Permission to spend money on health

Decision power in emergency situation
9
Conceptual framework of Kroeger

Socio-demographic factors Age/sex of child Family size/ parity Education Occupation Economic factors Possession of household items Possession of cattle Possession of agriculture land Financial accessibility factors Fare spent for one round trip to HF/HCP Total amount spent for treatment of last illness (excluding fare) Mothers autonomy
Freedom to visit HF alone
Govt./ Private HF/HCP
Permission to spend money on health Decision power in emergency situation Health service factors
Type of residential house

Physical accessibility factor Availability of the transport
Attitudes of health provider

Satisfaction with the treatment Received medicines from HF/HCP Received prescription for medicines
Physical distance for HF/HCP

Time taken to reach HF/HCP
to be purchased from bazaar 10
Challenges
Knowledge of illness/wellness and of services available Perceptions of services/service providers Risk/symptoms assessment Cultural prescriptions Social barriers/social pathways to care Etc
11
Changing disease patters Advances in biomedical/ clinical sciences Health Sector Reform
Health Sector Change Agents
Global perspectives on health and health care New specializations/ professions Ethical issues: New dimensions Information/ Communication revolution Globalization
12
PROVISION OF HEALTH CARE
Focus on Life-styles Focus on the Environment Shift focus from individuals to populations
Cost-effective health care

PRODUCING HEALTH
Evidence-based decision/ policy Resources to sector that contribute to health

13
HEALTH CARE SYSTEM: TYPES AND COMPONENTS

T R A D I T I O N A L
PRIMARY Physicians office Dispensaries NGO/Community Groups BHU/RHC SECONDARY Clinics/Maternity homes Tehsil Hospitals NGO-run clinics/hospitals
P R I V A T E
M O D E R N
TERTIARY
Distric Hospitals Large Urban Hospitals
P U B L I C
14
Outreach/Communitybased activities [Immunization, malaria control, MCH, FP]
GOVT. (PUBLIC) HEALTH DELIVERY SYSTEM (4 TIERS)
PHC Facilities (OPD)
TEHSIL & DISTRICT HQ. Hospitals
Tertiary Care Hospitals

15
1 - 2 Million Pop
DISTRICT HQ HOSPITAL (80 - 100 Beds)
50,000-1 ml. Pop PUBLIC HEALTH DELIVERY SYSTEM 25-50,000 Pop
TEHSIL HQ HOSPITAL (40 - 50 Beds)
RURAL HEALTH CLINICS (Extensive OPD; 10-20 Beds)
10-20,000 Pop
BASIC HEALTH UNITS (Preventive & Curative; mostly OPD)

16
IMMUNIZATION PROGRAM
MCH SERVICES
PREVENTIVE HEALTH SERVICES
FP SERVICES
LHW PROGRAM [45,000 LHW /2000; Target 1:1,000 Pop]

17
Insufficient focus on Prevention/Promotion Gender Imbalances
GOVT. HEALTH SERVICES: WEAKNESSES
Excessive centralization of management

Political Interference Lack of openness Weak human resource development Lack of integration Lack of Healthy Public Policy
18
Problem areas
POVERTY
ILLITERACY
PROBLEM AREAS
LOW STATUS OF WOMEN
INADEQUATE SANITATION & WATER SUPPLIES
POOR QUALITY OF HEALTH SERVICES

19
Income influences health
People in the top income bracket are healthier than middle income earners Middle income earners are, in turn, healthier than people with low income This means that the poorer people are, the less healthy they are likely to be.
20
Social status affects health

It affects health by determining the
degree of control people have over life circumstances
It affects their capacity to act and make choices for themselves Higher social position and income somehow act as a shield against disease.
21
Gender influences health

Gender is linked more to the roles, power and influence society gives to men and women, than it is to their biological differences.
22
Culture influences health

Culture and ethnicity influence how people link with health system, their access to health information and their lifestyle choices. Dominant cultural values largely determine the social and economic environment of communities. Result:
Marginalization Loss/devaluation of culture and language
Lack of access to culturally appropriate health services
23
Health Care system 25% Biological endowment 15% Physical environment 10% Socio-economic environment 50% Estimated Health Impact of Determinants of Health on Population health Status: CIAR 1997
24
Population Health Approach
Focuses on the entire range of individual and collective factors (income and social status, education, employment and working conditions, social environment, physical environment, gender, culture, personal health and coping skills, healthy child development, health services)
The interaction among these factors
25

Health is determined by the complex
interactions between individual characteristics, social and economic

Strategies to improve population health must
address the entire range of factors that determine health

Important health gains can be achieved by
focusing interventions on the health of the entire population/significant sub-populations rather than individuals
26

Improving health is shared responsibility
that requires the development of healthy public policies in areas outside the traditional health system
The health of a population is closely
linked to the distribution of wealth across the population

27
Creating a Healthy Community

Community Economy
Environment
Based on a model from: Hancock, Trevor. 1993, heath, human development and community ecosystem: three ecological models
28
Health Services
move towards broader resources to support well-being
the design: services to maintain and promote health, to prevent disease, and to restore health system functioning to contribute towards population health.
29
30

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Society, Culture & Health Care system

Dr. Babar T Shaikh

Rural Sindh, Pakistan.

the institutional arrangements; and

Factors influencing health service utilization

Type of residential house

Physical accessibility factor

Financial accessibility factors

Total amount spent for treatment of last illness (excluding fare)

Health service factors

Permission to spend money on health

Conceptual framework of Kroeger

Freedom to visit HF alone

Govt./ Private HF/HCP

Type of residential house

Attitudes of health provider

Physical distance for HF/HCP

to be purchased from bazaar 10

Health Sector Change Agents

PROVISION OF HEALTH CARE

Cost-effective health care

Evidence-based decision/ policy Resources to sector that contribute to health

HEALTH CARE SYSTEM: TYPES AND COMPONENTS

Outreach/Communitybased activities [Immunization, malaria control, MCH, FP]

GOVT. (PUBLIC) HEALTH DELIVERY SYSTEM (4 TIERS)

PHC Facilities (OPD)

TEHSIL & DISTRICT HQ. Hospitals

Tertiary Care Hospitals

DISTRICT HQ HOSPITAL (80 - 100 Beds)

50,000-1 ml. Pop PUBLIC HEALTH DELIVERY SYSTEM 25-50,000 Pop

TEHSIL HQ HOSPITAL (40 - 50 Beds)

RURAL HEALTH CLINICS (Extensive OPD; 10-20 Beds)

BASIC HEALTH UNITS (Preventive & Curative; mostly OPD)

LHW PROGRAM [45,000 LHW /2000; Target 1:1,000 Pop]

Insufficient focus on Prevention/Promotion Gender Imbalances

GOVT. HEALTH SERVICES: WEAKNESSES

Excessive centralization of management

LOW STATUS OF WOMEN

INADEQUATE SANITATION & WATER SUPPLIES

POOR QUALITY OF HEALTH SERVICES

Income influences health

Social status affects health

degree of control people have over life circumstances

Gender influences health

Culture influences health

Lack of access to culturally appropriate health services

Population Health Approach

Population Health Approach

interactions between individual characteristics, social and economic

address the entire range of factors that determine health

Population Health Approach

linked to the distribution of wealth across the population

Creating a Healthy Community

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