Health Care System Strengthening

Background and rationale

Worldwide, many countries face difficulties in reaching the Millennium Development Goals (MDGs): fighting the diseases of poverty, HIV, tuberculosis and malaria, and improving the health of their populations. Failing or inadequate health systems are one of the main obstacles to achieving better health outcomes, and the persistence of deep inequities in health status is also a problem from which no country in the world is exempt.

Access to basic health care is a fundamental human right, as stated in the WHO Constitution and not just a privilege to be enjoyed in a few wealthy societies. But this right hardly matches the reality. The existing interventions are not corresponding by the performance of health systems to bring them to those in greatest need in a comprehensive way, and on an adequate scale. In many countries, the rich receive all the health care they need, while the poor have to be financed through out-of-pocket payments on the erroneous assumption that it is cheap and the poor should be able to afford it. This situation needs to be corrected, and ways are urgently needed to improve the performance and effectiveness of health systems. 

It is increasingly recognized that stronger health systems are considered necessary to deliver health care interventions and technologies for curing disease and prolonging life. The World Health Report 2000 defined overall health system outcomes are as improving health and health equity. There are also important intermediate goals as the route from inputs to health outcomes is through achieving greater access to and coverage for effective health interventions, without compromising efforts to ensure provider quality and safety. 

During the last few decades, concern for the quality of health care has been growing. This concern has been triggered by enhanced socioeconomic development, as reflected by higher public demand for quality health care. With this concern, the concept of the district health system is widely accepted as the core piece of health system development, and is the key to deliver the basic health services in developing countries.  According to WHO, a district health system consists of a large variety of interrelated elements that contribute to health in homes, schools, work places and communities, through health and other related sectors providing health care in the district. It includes self-care and all health care workers and facilities, up to and including the hospital at the first referral level, and appropriate laboratory, diagnostic and logistic support services. Therefore, the district is the most appropriate level for coordinating top-down and bottom-up planning; for organizing community involvement in planning and implementation, and for improving the coordination between government and private health care. Many key development sectors are represented at this level.  

The strengthening of health care systems is an essential step in making health services accessible and affordable for population groups which would otherwise be unable to obtain the benefits of health promotion, good quality health care, and access to essential drugs. It is one part of the global health agenda and it is reflected in the 11th General Programme of Work (2006-2015) and the Medium-term Strategic Plan (2008-2013) to WHO’s response. In addition, a district health system can be used as an excellent practical model for improved performance.   If it is argued that district health systems need to be strengthened, it is essential to be clear about the problems, where and why investment is needed, what will happen as a result, and by what means change can be monitored. This training course will provide a common understanding of what a district health system is, and what activities are included in district health systems strengthening through different patterns of allocation or different ways of working.

The program will refer to the following framework, adapted from frameworks developed by Sicotte, WHO, Van Olmen J, Marchal B et al.

Course Obj​ectives

1. To introduce the basic concepts on which district health system management should be based: primary health care, integrated health system, health system management, system approach.

2. Through the revue of important health system management components, demonstrate how managerial activities may strengthen, or on the contrary jeopardize, the smooth functioning of the health system: human resource management, health information, financial management, community participation.

3. To reinforce participants’ capacity in analyzing their own health system organization and management, in order to make appropriate decisions.

4. To introduce principles and methods for planning, monitoring and evaluation.

5. To reinforce participants’ capacity in planning and follow up of health interventions in order to strengthen their own health system.

Programme:

The sessions are scheduled :

• Participative lectures: primary care and integrated health system, health system management and systemic approach, workforce management, health information, financial management, community participation, planning, stakeholders’ analysis, vertical approach and integration, monitoring and evaluation, health system research. A scientific paper on health service organization will be discussed during one session.
• Field visits with preliminary briefing by local partners and discussion of the findings: organization of health services, care provision, complementarities and cooperation relationships between first line health facilities and referral hospital, contribution of the community.
• Conferences on field experiences:
  • Health policies and Health System Reform in Thailand
  • Universal coverage scheme in Thailand
  • Patient information management in Thailand
  • Community participation in Thailand
  • Context based learning in Thailand
  • Contracting unit for primary care, medical doctors for primary care
• group work: initial presentation in plenary and groups of participants’ health system (4), presentation by participants of interesting experiences in workforce management, health information system, financial management, community participation (2), groups of work on management of demand and needs, definition of objectives and expected results, selection of indicators (3).
• Sessions for practical application: briefing, initial presentation in plenary of participants’ health system, presentation of interesting experiences in workforce management, health information system, financial management, community participation, groups of work on management of demand and needs, definition of objectives and expected results, selection of indicators, individual work with coaching, final presentation in plenary of participants’ own health system analysis and planning of an intervention.
• Introductory and closing sessions.

Content of lectures :

Practical application : integrated exercise.

Participants describe and analyse the organisation of their local health system, identify a priority unsatisfactory issue and propose an intervention in order to improve on the outcome of their health system. They are individually supported by a coach. Some intermediary presentations and group works are organized to facilitate individual work. Participants submit a memorandum and present the result of their work in plenary at the end of the course.

Training methods :

Course intends to be very participative, being supported by some Thai and international expert inputs.

• Participative lectures and analysis of international field experiences.

• Conferences on experiences in Thailand.

• Field visits.

• Readings.

• Groups of work

• Exchange of experiences between participants.

• Integrated practical application (coached individual exercise)

Expected results:

At the end, participants translate teaching to practise through an individual coached exercise: they analyze a managerial problem they face in their own professional environment and tentatively plan an intervention.

Evaluation:

• Presentations of participants’ own health system analysis and plan for intervention.
• Participation during the course.

Instructors/ Lectures /Facilitators:

• AIHD:  Dr.Supattra Srivanichakorn, Dr.Aroonsri Mongkolchati,

             Asst. Prof. Somsak Wongsawass

• International guest lecturer: Dr.Patrick Martiny

• National guest speakers: Dr.Yongyuth Pongsupap, Dr.Surakiat Archananuphap

Duration: 1 - 26 July 2013

Closing Date for Application: March 15, 2013

Number of Participants:  17 Persons

Target group

The course targets executive staff working at district or sub-national level  and professionals with relevant experience in  provincial and district health management.

Invited Countries: 

Afghanistan, Angola, Bangladesh, Benin, Bhutan, Botswana, Burundi, China, CARICOM Member Countries, Egypt, Eritrea, Ethiopia, FEALAC Member Countries, Gabon, Ghana, India, Indonesia, Iran, Jordan, Kenya, Lao PDR, Lesotho, Libya, Madagascar, Malaysia, Maldives, Mali, Mauritania, Mongolia, Morocco, Mozambique, Myanmar, Namibia, Nepal, OAS Member Countries, Nigeria, Pakistan, Palestine, Philippines, PIF Member Countries (Fiji, Papua New Guinea, Palau, Cook Island, Solomon Island, Marshall Island, Niue, Tonga, Samoa, and Vanuatu), Republic of Seychelles, Senegal, Sri Lanka, South Sudan, Sudan, Swaziland, Tajikistan, Tanzania, Timor-Leste, Tunisia, Vietnam, Uganda, Uzbekistan, Zambia and Thailand

Qualifications

The participants should meet the following criteria :

• Be nominated by their government;
• Have worked as a health personnel for at least 2 years
• Posses good command of spoken and written English (TOEFL score 500 or equivalent)
• Submit one reference and Curriculum Vitae
• Be computer literate
• Be able to fully participate throughout the training course
• Be under 45 years of age
• Be in good health both physically and mentally

Institutio​n:

Executing/Implementing Agency

ASEAN Institute for Health Development, Mahidol University

Dr. Supattra Srivanichakorn M.D., M.P.H.
      Director of ASEAN Institute for Health Development, Mahidol University
      25/5 Phuttamonthon 4 Rd., Phuttamonthon District, Nakhon Pathom 73170
      Tel {662} 4419040-3 ext. 41
      Fax [662] 4419871
      E-mail: [email protected], [email protected]
      Website: www.aihd.mahidol.ac.th

Collaborative Organization

• National Health Security Office, Thailand

• Ministry of  Public Health

• International Health Policy Program Thailand (IHPP)