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International Health Care Management Part 3a

International Health Care Management Part 3a. Steffen Fleßa Institute of Health Care Management University of Greifswald. Supply of Health Services: Structure. 1 International Public Health 2 Demand for Health Services 3 Supply of Health Services 3.1 Factors of Production

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International Health Care Management Part 3a

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  1. International Health Care Management Part 3a Steffen Fleßa Institute of Health Care Management University of Greifswald

  2. Supply of Health Services: Structure 1 International Public Health 2 Demand for Health Services 3 Supply of Health Services 3.1 Factors of Production 3.1.1 Buildings and Plants 3.1.2 Staff 3.1.3 Problems of Donations 3.2 Spatial Structure of Supply 3.3 Levels of Care 3.4 Provider Portfolio 4 Health Care Systems and Reforms

  3. 3.1.1 Buildings and Plants • Basic Problems: • Applied Technology • No maintenance • Consumption of own structure

  4. Dimensions of Applied Technology • Functional Adjustment: • Technology fulfils what is required, but not more than that • e.g. • Basic radiographic system • Ramps instead of elevators in developing countries • Robust equipment that does not need much maintenance • Resource Adjustment: • Technology is adjusted to resources • E.g. • No devices with high cost of maintenance • Technology that can be operated by local staff

  5. Example „Fixateurexterne“ made from bicycle spokes Source: http://www.airahospital.org/?tag=appropiate-technology

  6. Precondition: Strategic Planning • Equipment Life Cycle

  7. Maintenance • Culture of Maintenance • “Climate-Theory”: tropical climate with steady supply of food fosters short-term planning • WHO-Standards: • 1% of original value of buildings for maintenance p.a. • 5% of original value of devices for maintenance p.a.

  8. Consumption of Structure Buildings and Plants DONATIONS Drugs and Staff FEES Mainte-nance and Develop-ment Consumption of Structure

  9. Quality of Structure Kenya Service Provision Assessment Survey (2004)

  10. In the beginning…

  11. … then …

  12. … then …

  13. … and finally …

  14. … the view of a woman in labor…

  15. Quality Of 421 million annual global hospitalizations, approx. 42.7 million result in adverse events loss of 23 million disability adjusted-life years (DALYs); 2/3 occur in low and middle-income countries JhaAK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJQualSaf 2013; 22(10): 809-15. WHO systematic review of 900 studies from 1990-2009: only 40% of patients in public health facilities, and only 6-19% of patients in private facilities were treated according to standard guidelines. Holloway KA, Ivanovska V, Wagner AK, Vialle-Valentin C, Ross-Degnan D. Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence. Trop Med Int Health 2013; 18(6): 656-64.

  16. But: middle-income countries!

  17. 3.1.2 StaffMedical Training in the USA High School: 12 Years

  18. Medical Training in the USA Bachelor Studies (i.e. Human Biology): 4 Years High School: 12 Years

  19. Medical Training in the USA Medical Studies (MD): 4 Years Bachelor Studies : 4 Years High School: 12 Years

  20. Medical Training in the USA Specialist4 Years Medical Studies (MD): 4 Years Bachelor Studies : 4 Years High School: 12 Years

  21. Medical Training in the USA Specialist4 Years PhD 3 Years Medical Studies (MD): 4 Years Bachelor Studies: 4 Years High School: 12 Years

  22. Medical Training in Tanzania Time of Study (Years) Primary School: 7 Years

  23. Medical Training in Tanzania Time of Study (Years) Secondary School(O-Level): 4 Years Primary School: 7 Years

  24. Medical Training in Tanzania Time of Study (Years) 20 Secondary School(A-Level): 2 Years Secondary School(O-Level): 4 Years Primary School: 7 Years

  25. Medical Training in Tanzania Time of Study (Years) Military Service Secondary School(A-Level): 2 Years Secondary School(O-Level): 4 Years Primary School: 7 Years

  26. Medical Training in Tanzania Time of Study (Years) Medical Officer Studies: 6 Years Military Service Secondary School(A-Level): 2 Years Secondary School(O-Level): 4 Years Primary School: 7 Years

  27. Medical Training in Tanzania Time of Study (Years) Medical Officer Studies: 6 Years Military Service Medical Assistant Training: 3 Years Secondary School(A-Level): 2 Years Secondary School(O-Level): 4 Years Primary School: 7 Years

  28. Medical Training in Tanzania Time of Study (Years) Ass. Med. Off. 2 Years 20 Medical Officer Studies: 6 Years Professional Experience Military Service Medical Assistant Training: 3 Years Secondary School(A-Level): 2 Years 10 Secondary School(O-Level): 4 Years Primary School: 7 Years

  29. Medical Training in Tanzania Time of Study (Years) Ass. Med. Off. 2 Years 20 Medical Officer Studies: 6 Years Professional Experience Military Service Medical Assistant Training: 3 Years Secondary School(A-Level): 2 Years 10 Secondary School(O-Level): 4 Years Rural Medical Aid: 3 Years Primary School: 7 Years

  30. Medical Training in Tanzania Time of Study (Years) Ass. Med. Off. 2 Years 20 Medical Officer Studies: 6 Years Professional Experience MA-Training Military Service Medical Assistant Training: 3 Years Secondary School(A-Level): 2 Years Professional Experience 10 Secondary School(O-Level): 4 Years Rural Medical Aid: 3 Jahre Rural Medical Aid: 3 Years Primary School: 7 Years

  31. Medical Training in Tanzania Time of Study (Years) Ass. Med. Off. 2 Years 20 Medical Officer Studies: 6 Years Professional Experience Professional Experience MA-Training Military Service Medical Assistant Training: 3 Years Secondary School(A-Level): 2 Years Professional Experience 10 Secondary School(O-Level): 4 Years Rural Medical Aid: 3 Years Primary School: 7 Years

  32. Training in Nursing Care in the USA

  33. Training in Nursing Care in the USA

  34. Training in Nursing Care in the USA

  35. Training in Nursing Care in the USA

  36. Training in Nursing Care in the USA

  37. Training in Nursing Care in the USA

  38. Training in Nursing Care in Tanzania Time of Study (Years) 15 10 Primary School: 7 Years

  39. Training in Nursing Care in Tanzania Time of Study (Years) 15 Secondary School(O-Level):4 Years 10 Primary School: 7 Years

  40. Training in Nursing Care in Tanzania Time of Study (Years) Nursing Training A-Nurse:4 Years 15 Secondary School(O-Level):4 Years 10 Primary School: 7 Years

  41. Training in Nursing Care in Tanzania Time of Study (Years) Nursing Training A-Nurse:4 Years 15 Secondary School(O-Level):4 Years 10 Pre-Nursing Course Primary School: 7 Years

  42. Training in Nursing Care in Tanzania Time of Study (Years) Nursing Training A-Nurse:4 Years 15 Nursing Training B-Nurse: 3 Y. Secondary School(O-Level):4 Years 10 Pre-Nursing Course Primary School: 7 Years

  43. Training in Nursing Care in Tanzania Time of Study (Years) Nursing Training A-Nurse:4 Years 15 Mid-Wifery 1 Y. Nursing Training B-Nurse: 3 Y. Secondary School(O-Level):4 Years 10 Pre-Nursing Course Primary School: 7 Years

  44. Training in Nursing Care in Tanzania Time of Study (Years) A-Nurse 1 Y. Nursing Training A-Nurse:4 Years 15 Professional Experience Midwifery 1 Y. Nursing Training B-Nurse: 3 Y. Secondary School(O-Level):4 Years 10 Pre-Nursing Course Primary School: 7 Years

  45. Training in Nursing Care in Tanzania Time of Study (Years) A-Nurse 1 Y. Nursing Training A-Nurse:4 Years 15 Nursing Assis-tants Professional Experience Midwifery 1 Y. Nursing Training B-Nurse: 3 Y. Secondary School(O-Level):4 Years 10 Pre-Nursing Course Primary School: 7 Years

  46. Training in Nursing Care in Tanzania Time of Study (Years) A-Nurse 1 Y. Nursing Training A-Nurse:4 Years 15 Nursing Assis-tants Nursing Atten-dants (semi-skilled) Professional Experience Midwifery 1 Y. Nursing Training B-Nurse: 3 Y. Secondary School(O-Level):4 Years 10 Pre-Nursing Course Primary School: 7 Years

  47. Staff Ratios: Physicians per 1,000 Inhabitants Latest available data (access 2014) http://www.who.int/gho/health_workforce/physicians_density/en/

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