Conceptual Frameworks: Health Systems and the Community


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Conceptual Frameworks: Health Systems and the Community

Henry Perry, Johns Hopkins University

CORE Group Spring Meeting, April 30, 2010

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Conceptual Frameworks: Health Systems and the Community

  1. 1. Conceptual Frameworks: Health Systems and the Community<br />Henry Perry<br />Johns Hopkins University<br />CORE Group, 30 April 2010<br />
  2. 2. Frameworks are mental models<br />
  3. 3. Tools for Transformational Change to Promote the Production of HealthThe Leadership Disciplines*<br />Personal Mastery<br />Mental Models<br />Systems Thinking<br />Shared Vision<br />Team Learning<br />*Peter Senge, The Fifth Discipline, 1990<br />
  4. 4. Do we actually see reality or just our “mental models”?<br /> “ ‘Mental models’ are deeply ingrained assumptions, generalizations, or even pictures or images that influence how we understand the world andhow we take action.”<br />Peter Senge, The Fifth Discipline, p.8.<br />
  5. 5. Mental Models<br />Mental models are the lenses through which we observe reality. <br />Our perception of reality is totally dependent upon the amount of distortion in these lenses. But do we accept that we all have these lenses?<br />
  6. 6. Mental Models<br />Mental models are the structures that we impose on reality.<br />We produce in our minds concepts of reality (paradigms), and these predetermine what we will actually be able to see when we observe reality.<br />
  7. 7. Mental Models by Other Names<br />Perceptions<br />World View<br />Assumptions<br />Paradigm, Conceptual Framework<br />Beliefs<br />Prejudice<br />How we think determines what we see and how we act. <br />It’s not “Seeing is believing”, but “Believing is seeing”!<br />
  8. 8. Mental Models Define Our “Reality” and Pre-determine the Choices We Make and the Actions We Take<br />Who “produces crops” in your mental model of the agricultural system?<br />How does your answer determine the roles and functions of the Ministry of Agriculture?<br />Who “produces health” in your mental model of the health system?<br />How does your answer determine the roles and functions of the Ministry of Health?<br />
  9. 9. What is a system?<br />
  10. 10. Systems Thinking<br />Looks at:<br />The whole and the parts and <br />The interactions among the parts<br />Studies the whole in order to understand the parts<br />
  11. 11. Systems <br />A system is something that:<br /><ul><li>maintains its existence and
  12. 12. functions as a whole</li></ul>Through the interaction of its parts.<br />
  13. 13. The Health Production System<br />Households<br />HEALTH<br />Government<br />Communities<br />
  14. 14. The Health System has an inherent stability<br />
  15. 15. Mosley and Chen, 1984<br />
  16. 16. Mosley and Chen 1984<br />
  17. 17. Census-base, Impact-Oriented (CBIO) Conceptual Framework<br />Basic assumptions: improving the health of a defined population is the overarching goal<br />Strong community-partnerships are required for this, and this trust between the health system and the community, and this requires, among other things, responding to community priorities<br />
  18. 18. CBIO (cont.)<br /> Steps:<br />Define the community<br />Make a community diagnosis of epidemiological priorities and the community’s priorities<br />Epidemiological priorities: most serious, preventable, readily preventable or treatable conditions in the community<br />Community priorities: no clear framework for defining this<br />Clarify program priorities by merging epidemiologial priorities and community priorities<br />
  19. 19. CBIO (cont.)<br /> Steps (cont)<br /> - Define resources available (social capital, <br /> human resources, money, etc.)<br /> - Plan program<br /> - Implement program<br /> - In 3-5-10 years, carry out community <br /> diagnosis again<br />
  20. 20. Routine systematic home visitation a key action<br /> - For defining epidemiological priorities<br /> - For defining community priorities<br /> - For delivering key services<br /> - For monitoring progress and measuring <br /> health improvement<br />
  21. 21.
  22. 22. Strengthening Health Systems to Improve Health Outcomes. WHO, 2007<br />
  23. 23.
  24. 24. Framework of the Health of the Public<br />Disease-oriented public health <br />Control specific diseases or conditions<br />Services-oriented public health<br />Ensure that those who need services get them<br />Community-oriented public health<br />Work with communities to help them improve their health<br />All three are equally important and are like the legs of a three-legged stool<br />John Wyon<br />
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  29. 29. Primary Health Care: An Ambiguous Mental Model?<br />Medical care system delivery concept<br />Alma Ata concept<br />Health system model vs. production of health model (World Health Organization vs World “Disease” Organization)<br />Community-based primary health care<br />
  30. 30. IMCI<br />Facility-based IMCI<br />Community-based IMCI<br />
  31. 31. What Is Health? <br />
  32. 32. Final Challenge<br />What is the most appropriate mental model <br /> conceptual framework for thinking about how <br /> to achieve a world in which no one dies of a <br /> preventable disease or health-related <br /> condition?<br />