International Health Care Management Part 1b

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International Health Care Management

Part 1b

Steffen Fleßa

Institute of Health Care Management University of Greifswald

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1.3 Concepts

• Structure:

1 International Public Health 1.1 Background

1.2 Health and Development 1.3 Concepts

1.3.1 Prevention

1.3.2 Primary Health Care 1.3.3 Health Promotion

1.3.4 Recent Developments

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1.3.2 Primary Health Care

• Background: Declarations of Tuebingen

– Tubingen I (19.-24. May 1964) and – Tubingen II (1.-8. September 1967)

• Christian health care work is holistic; purely physical healing is contradicting with the Biblical understanding of human beings

• Christian health care work should involve many members of the Christian community, not only professional nurses and physicians

• Christian health care work should be preventive

• Christian health care work cannot be separated from other development work, i.e., medicine work, nutrition,

agriculture and community development should be

integrated

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• Declaration of Alma Ata

– 6.-12. September 1978

• Overview:

– Primary Health Care as a concept

– Community Based Health Care as a method – Comprehensive and Selective Primary Health

Care

Primary Health Care

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Definition

• Primary health care:

– meeting people’s health needs through comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care throughout the life course, strategically prioritizing key health care

services aimed at individuals and families through primary care and the population through public health functions as the central elements of integrated health services;

– systematically addressing the broader determinants of health (including social, economic, environmental, as well as people’s characteristics and behaviours) through evidence-informed public policies and actions across all sectors; and

– empowering individuals, families, and communities to optimize their health, as advocates for policies that promote and protect health and well-being, as co-developers of health and social services, and as self- carers and care-givers to others.

https://www.who.int/news-room/fact-sheets/detail/primary-health-care 5

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Principles

• Accessibility — or making sure that primary care services are available, affordable and provided equally to all individuals irrespective of their gender, age, ethnicity or location

• Public or community participation — or involving all of community’s resources in promoting health and addressing health problems at the grass roots level

• Health promotion— or helping a community to strengthen the socioeconomic conditions that contribute to good health

• Appropriate use of technology — or using medical technologies that are affordable, feasible and culturally acceptable to individuals and the

community

• Intersectoral collaboration — or recognizing that any community’s health and well-being doesn’t depend solely on effective health care services.

Governments, businesses and organizations in other sectors are equally important in promoting the health and self-reliance of communitieshttps://www.von.ca/en/principles-primary-health-care ₆

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Elements

1. Health education on prevailing health problems and the methods of preventing and controlling them

2. Nutritional promotion including food supply 3. Supply of adequate safe water and sanitation 4. Maternal and child health care

5. Immunization against major infectious diseases 6. Prevention and control of locally endemic diseases

7. Appropriate treatment of common diseases and injuries 8. Provision of essential drugs

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• PHC always refers to the community while determining

relevant objectives and instruments. Community members take responsibility for their health („Community Based Health Care“, CBHC)

• PHC and CBHC build primarily on existing resources and

respect financial limitations of the community. In low income countries this will entail a re-allocation of health care

resources towards basic curative health care and prevention

Community Based Health Care

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• PHC calls for a strict orientation of curative and preventive interventions towards the needs of the grass-root level. The higher levels of the health care pyramid are not excluded; but they are restricted to cases which cannot be treated on lower levels

• PHC is an integral element of the entire health care system

• PHC is always multi-sectoral, i.e., activities of PHC should be fully integrated in other sectors of human development

(agriculture, education, water, …)

Primary Health Care Innovation

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Comprehensive and Selective PHC

• GOBI-FFF: UNICEF, 1982

• Bamako Initiative: UNICEF, 1987

• Cairo conference on reproductive health and family planning (1994)

• Poverty Reduction WB, IMF, 1999

• Millennium Development Goals (MDG) 2000

• Global Fund 2001

• Sustainable Development Goals (SDG) 2015

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1.3.3 Health Promotion

• Paradigms:

• Pathogenesis

– Biological mechanism that leads to a diseased state – Why do people fall sick?

• Salutogenesis

– Medical approach focusing on factors that support human

health and well-being rather than on factors that cause disease – How and where is health improved?

• Politics:

• First Internationale Conference on Health Promotion, WHO-meeting in Ottawa, 1986

• World Health Assembly 1989: Approval of Ottawa Charter

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• “Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical mental and social wellbeing, an individual or group must be able to

identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for

everyday life, not the objective of living. Health is a positive concept

emphasizing social and personal resources, as well as physical capacities.

Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing.” (Ottawa Charter, 1986)

• “Health promotion enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.” (https://www.who.int/news- room/q-a-detail/what-is-health-promotion)

Definition

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Elements

• Good governance for health

– Health promotion requires policy makers across all government departments to make health a central line of government policy. This means they must factor health implications into all the decisions they take, and prioritize policies that prevent people from becoming ill and protect them from injuries.

– These policies must be supported by regulations that match private sector incentives with public health goals (e.g. tax policies on unhealthy or harmful products such as alcohol, tobacco, etc.

• Health literacy

– People need to acquire the knowledge, skills and information to make healthy choices, for example about the food they eat and healthcare services that they need. They need to have opportunities to make those choices. And they need to be assured of an environment in which people can demand further policy actions to further improve their health.

• Settings

– Cities, regions, hospitals, schools, … and other settings play a major role in promoting good health. Strong leadership and commitment is essential to health

https://www.who.int/news-room/q-a-detail/what-is-health-promotion# 13

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Health Promotion Strategies

• build healthy public policy

– Not only health policy – but healthy public policy!

• create supportive environments

– Healthy “worlds of living”

• strengthen community action

– “healing community”

• develop personal skills

– “health literacy”

• reorient health services

– Towards health promotion and prevention instead of curative medicine – Including all other services impacting on health

https://thelearner101.wordpress.com/2018/10/26/eds-143-module-3- health-education-and-health-promotion/

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Health Promotion

Health Governance

Public Policy (e.g.

banning public smoking)

Economic Regulation (e.g. tax on alcohol

and tobacco) Organisational

Development (e.g.

health promoting schools)

Prevention

Primary Prevention (e.g. vaccination

programs)

Secondary Prevention (e.g. cancer screening

programs)

Tertiary Prevention (e.g. rehabilitation) Community Based

Work (e.g. public transport)

Environmental Health (e.g. reused bags)

Health Education (e.g.

Sexual Education)

H ea lt h P ro m o ti o n a n d P re ve n ti o n

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https://www.slideshare.net/DrRoohiBanu/principles-of- health-promotion-disease-prevention

International Health Care Management Part 1b