B subha sri mps course july 2010
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Components of a health care delivery system PowerPoint PPT Presentation


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B Subha Sri, MPS course, July 2010. Components of a health care delivery system. Components of a functioning health care delivery system. Attitudes Technical competence Referral systems Infrastructural requirements Access Organisation of services Supplies and Equipment systems

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Components of a health care delivery system

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B subha sri mps course july 2010

B Subha Sri,

MPS course, July 2010

Components of a health care delivery system


Components of a functioning health care delivery system

Components of a functioning health care delivery system

Attitudes

Technical competence

Referral systems

Infrastructural requirements

Access

Organisation of services

Supplies and Equipment systems

Accountability mechanisms


Attitudes

Attitudes

Client provider interaction

Hierarchical

Cultural appropriateness

Response to gender / poverty issues

Abuse

Corruption


Attitudes1

Attitudes

Health care delivery systems can reinforce prevailing gender norms.

Negative attitudes can infringe on the reproductive and sexual rights of the people.

Negative attitudes affect quality of care – perceived quality of care can affect health seeking.

Affects women much more than men.

Eg. Adolescent girl asking for contraceptives


How can you bring about a change in attitude

How can you bring about a change in attitude?

“Attitude, like water, flows from top to below” - Role models

Training to change attitudes

Better working atmosphere

Counsellors

Performance appraisal – to probe into provider attitudes and gender biases

Gender mainstreaming into medical / paramedical education


Technical competence

Technical competence

Rational

Evidence based

Standard treatment protocols


Technical competence1

Technical competence

Technical incompetence leads to failure in providing appropriate care and unnecessary / inappropriate referral.

Leads to low self esteem and low morale among the staff and puts them under stress.

Inadequate services impact differentially and detrimentally on women and men.


How can you bring about a change in level of competence

How can you bring about a change in level of competence?

Staff training

Standard protocols and guidelines

Based on problems, relevant to local context

Continuous monitoring

Multi skilled people who can stand in for each other

Training to handle difficult situations with tact

Training in inter personal skills

Appropriate allocation of adequately trained staff – prime responsibility of managers


Referral systems common issues

Referral systems- common issues

Unnecessary / inappropriate referral

Lack of ambulances

Referral note

Follow up of referred patients

Reverse referral

Lack of awareness about the time constraints and gender issues in the patient’s real life context


How can change happen in referral systems

How can change happen in referral systems?

Referral protocols needs to be worked out

Referral system needs to be developed

Development of systems should be based on practical and systematic thinking process – Accompanied transfers

Staff at each level needs to be trained in using the protocols and monitored.

Follow up and reverse referral


Infrastructural requirements

Infrastructural requirements

Ensuring privacy

Cleanliness

Ancillary services

Enabling environment to put into practice the training and skill up gradation

Should look into all factors of operational difficulties and not leave the clients to make their own arrangements

Health providers in helpless situations and at the receiving end


Access

Access

Distance

Socio cultural barriers

Costs

Organisational barriers

Perceived quality of care

Staff related

System's responsibility to provide for overcoming barriers


Organisation of health services

Organisation of health services

Timing

Waiting time

Interdepartmental referrals – multiple queues

Staffing patterns


How to improve organization of services

How to improve organization of services?

Flexibility

Better organisation of services

Training in managerial skills

Quality of service indicators

Integration of services to meet client needs

Multiple services by trained providers under one roof

Inform the people about the facilities and the services they deliver.

Information about where and what each level of facility provides


Supplies and equipments

Supplies and equipments

In spite of all training lack of supplies will be a barrier to effective services

Demoralise providers

Lose interest in taking forward initiatives

Investment in training is lost

Ordering and supply mechanisms and sometimes simple transport is non functional

Local purchase from untied funds


Accountability mechanisms

Accountability mechanisms

To community

To system

Mechanisms

Monitoring


Health care delivery system wheel

Health care delivery system wheel


Functioning health care delivery system

Functioning health care delivery system

The generic components of the health care delivery system needs to be in place and working for any health service intervention to be effective. They are like spokes on a wheel – the health system wheel.

The role of health managers is to think through each of the components and to make them function


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