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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MPS course, July 2010Components of a health care delivery system
Organisation of services
Supplies and Equipment systems
Client provider interaction
Response to gender / poverty issues
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
“Attitude, like water, flows from top to below” - Role models
Training to change attitudes
Better working atmosphere
Performance appraisal – to probe into provider attitudes and gender biases
Gender mainstreaming into medical / paramedical education
Standard treatment protocols
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.
Standard protocols and guidelines
Based on problems, relevant to local context
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
Unnecessary / inappropriate referral
Lack of ambulances
Follow up of referred patients
Lack of awareness about the time constraints and gender issues in the patient’s real life context
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
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
Socio cultural barriers
Perceived quality of care
System's responsibility to provide for overcoming barriers
Interdepartmental referrals – multiple queues
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
In spite of all training lack of supplies will be a barrier to effective services
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
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