Module 5
Emergencies and theHealth Systems
Module 5
Hospital
System
Health System
Epidemiology and
Surveillance
Prevention and Control of
Communicable Disease
Food and Water and
Nutrition Sanitation
Preparedness
Response
Recovery
Health System
Module 5
Objectives
At the end of this 1-hour session, the participants willbe able to:
Define and discuss the building blocks of the health system
Discuss how emergencies/disasters disrupt the existinghealth system
Describe health emergency response using the healthsystems approach
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Contents
WHO health system building blocks
Health systems in emergencies
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Emergency
Save lives
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Emergency
Health system
Evacuation centresSecurity NutritionSurveillance Diseaseprevention and controlLogistics InformationManagementResource MobilizationRisk Communication
Save lives
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What is a health system?
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The Health System
A health system consists of all organizations,people and actions whose primary intent is topromote, restore or maintain health
Includes efforts to influence determinants ofhealth as well as more direct health-improvingactivities
Includes
A mother caring for a sick child at home
Private care providers
Behaviour change programmes
Vector-control campaigns
Health insurance organizations
Occupational health and safety legislation
Inter-sectoral action by health staff
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The WHO Health SystemsFramework
System building blocks
Goals/outcomes
Service delivery
Health workforce
Information
Medical products &technologies
Health financing
Leadership/governance
Improved health
(level and quality)
Responsiveness
Financial riskprotection
Improved efficiency
Accesscoverage
Qualitysafety
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The WHO Health SystemsBuilding Blocks
Service delivery
Health workforce
Information
Medical products and technologies
Health financing
Leadership/governance
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The WHO Health SystemsBuilding Blocks
Service delivery
Effective, safe, quality personal and non-personal healthinterventions to those who need them, when and whereneeded, with minimum waste of resources
Health workforce
Responsive, fair and efficient to achieve the best healthoutcomes possible, given available resources andcircumstances
Sufficient numbers and mix of staff, fairly distributed
Competent, responsive and productive.
Information
ensures the production, analysis, dissemination and use ofreliable and timely information on health determinants,health systems performance and health status
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The WHO Health SystemsBuilding Blocks
Medical products and technologies
Equitable access to essential medical products, vaccines andtechnology
Assured quality, safety, efficacy and cost-effectiveness, andtheir scientifically sound and cost-effective use
Health financing
Adequate funds for health, in ways that ensure people can useneeded services, and are protected from financial catastropheor impoverishment associated with having to pay for them
Leadership/governance
Existence of strategic policy frameworks that are combinedwith effective oversight, coalition-building, the provision ofappropriate regulations and incentives, attention to system-design, and accountability
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Health Systems in Emergencies
Emergencies/disasters affect the health system
Consideration for assessment, planning andimplementation of response
Response, reconstruction and preparedness phases
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How do disasters affect thehealth system?
Socio-politicalcontext
Environmentalcontext
Economic context
Community lifelines:water, electricity,transportation
6 Building Blocks ofthe Health System:
Health services
Health Workforce
Health Information
Medical Productsand Technologies
Health Financing
HealthGovernance
Health
Source: Informal discussion with Dr R Lejano, UC Irvine, 2009
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Activity 3: Howemergencies/disasters affect thehealth system
Divide into 3 groups
Discuss on how disasters can affect the buildingblocks of the health system,
Group A: Service delivery, health workforce
Group B: Information, medical products andtechnologies
Group C: Health financing, leadership/ governance
List down salient points and discuss with thegroup
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Activity 3: Results
Service delivery
Health workforce
Information
Medical products and technologies
Health financing
Leadership/governance
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How disasters affect the healthsystem
Service delivery
Medical & surgical services: outpatient and inpatientcare
Public health services: immunization, healthpromotion, reproductive health, environmentalhealth, maternal and child health
Health workforce
Direct and indirect impact to health professionals andtheir families
Same number of staff to work on increased demand
Safety, security & psychosocial support
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How disasters affect the healthsystem
Information
Information system breakdown
Need for rapid information
Medical products and technologies
Damages and losses
Increased demand for medical products and technologies
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How disasters affect the healthsystem
Health financing
Direct and indirect economic losses
Increased demand for expenditure
Response require faster resource/finance mobilizationmechanisms
Leadership/governance
Increased demand for quick decision making
Shift to emergency mode
Influx of external agencies, NGOs and groups
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WPRO Health SystemsAssessment Tool
WHO/WPRO, 2009
(Lejano, Sablan, et al)
Tool developed for assessment of the health systems in order to aidhealth emergency planners and policy makers for medium- and longer-term decisions.
Questions are answerable by YES or NO.
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WPRO Health SystemsAssessment Tool
Service delivery
Are there health facility structures/buildings and/or keyequipment within them that have been damaged by thedisaster?
Are there support systems that have been damaged by thedisaster?
Are there health services/programs that have beencompromised by the disaster?
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WPRO Health SystemsAssessment Tool
Health workforce
Did staff complement/ number of personnelreporting for work become a problem in theadequate carrying out of emergency responseand recovery measures?
Did staff knowledge and skills become a problemin the adequate carrying out of emergencyresponse and recovery measures?
Were the members of the hospital staff affectedby disrupted lifelines (i.e., communication,transportation, shelter)?
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WPRO Health SystemsAssessment Tool
Information
Are there concerns regarding health information systemsconcerning individuals as patients?
Are there concerns regarding health information systemson health facilities?
Are there concerns regarding health information on thegeneral population?
Are there concerns regarding health information concernedwith public health?
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WPRO Health SystemsAssessment Tool
Medical products and technologies
Is there adequate supply of essential drugs in the healthfacilities? Are these readily available and affordable?
Are there concerns regarding quality of the drugs/vaccinesavailable in the health facilities and pharmacies?
Are there concerns regarding availability, safety andaccessibility of blood transfusion services in the healthfacilities?
Are there concerns regarding the availability of hospitalequipment necessary for the basic surgical, anesthetic,medical and emergency care appropriate for the level ofservice a health facility offers?
Are there concerns regarding safety, reliability and availabilityof diagnostic and laboratory technology services in the area?
Are there concerns regarding safety, reliability and availabilityof diagnostic and imaging services in the area?
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WPRO Health SystemsAssessment Tool
Health financing
Did the disaster affect (increased, decreased, scrapped)the revenue, government funding, and expenses of thehealth facilities in the subject area?
Was funding of health programs affected (increased,decreased, scrapped) by the disaster?
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WPRO Health SystemsAssessment Tool
Leadership/governance
Did the disaster reveal any major issues in howemergencies are responded to, in how tasks andfunds are allocated during emergencies, and howdecisions are made during emergencies?
Did the government and other agency responseto the disaster divert from and possibly changethe way decision-making, allocation of funds,and allocation of tasks among agencies are madeduring an emergency?
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References
Philippine Floods Response: Evaluation using the HealthSystems Approach (WHO/WPRO, 2009)