Democrat party is expanding its type of healthcare system in Nepal

1. Definition - the health system and describe
the functions and elements of health system
Mr. Chiranjeebi Shah
M.Sc. M.P.H.

2. Everything is POSSIBLE
‘The word
impossible is
not in my
dictionary’
Nepolian Bonapart

3. Three Pillars of Health
ASSESSMENT
POLICY DEVELOPMENT
ASSURANCE

5. Health System Development
Health:
Health is the state of complete physical, social and mental well-
being and not merely absence of disease or infirmity. - WHO
Care:
• The service provided to the people well-being is known as
care. It is provided in the form of promotive, preventive,
curative and rehabilitative. Such health services are provided
by the government and as well non-governmental
organization.
System:
• System is the complete form and made by integrating of
several units. So it is the systematic arrangement of different
units in the organized way and this makes organization
dynamic objected to achieve the organization aim/goals.
• For example Ministry of Health.

6. Health System
Health system, also sometimes referred to as health care
system or healthcare system, is the organization of people,
institutions, and resources that deliver health care services to meet
the health needs of target populations.
There is a wide variety of health systems around the world, with as many
histories and organizational structures as there are nations.
Implicitly, nations must design and develop health systems in
accordance with their needs and resources, although common
elements in virtually all health systems are primary health
care and public health measures.
In some countries, health system planning is distributed
among market participants. In others, there is a concerted effort
among governments, trade unions, charities, religious organizations,
or other co-ordinated bodies to deliver planned health care services
targeted to the populations they serve.

7. Health System Development
Health Care:
Greater number of services provided to individuals, families and
communities by the health care stake holders agents/profession
for the purpose of promoting, surveillance, maintain or restore
health.
Health Care System:
In today’s complex world; it is very difficult to say what exactly a
health system is, what it is composed of, and where it begins
and ends. According to world health report 2000, health system
has been defined as to include all those; whose primary purpose
is to promote, restore and maintain health. Therefore the
boundary of this definition may include;
• Personal medical attention
• Home care of sick
• Health promotion

8. Health System Development
Health systems should not be expressed in terms of their
components only, but also of their interrelationships;
• Health systems should include not only the institutional or supply
side of the health system, but also the population;
• Health systems must be seen in terms of their goals, which
include not only health improvement, but also equity
responsiveness to legitimate expectations, respect of dignity, and
fair financing, among others;
• Health systems must also be defined in terms of their functions,
including the direct provision of services, whether they are
medical or public health services, but also "other enabling
functions, such as stewardship, financing, and resource
generation, including what is probably the most complex of all
challenges, the health workforce."

9. What is Health Care System
Health system has been defined with a reductionist
perspective, for example reducing it to health care system.
Health systems should not be expressed in terms of their
components only, but also of their interrelationships;
• Health systems should include not only the institutional or
supply side of the health system, but also the population;
• Health systems must be seen in terms of their goals, which
include not only health improvement, but also equity,
responsiveness to legitimate expectations, respect of
dignity, and fair financing, among others;

10. World Health Organization Definition
The World Health Organization defines health system
as follows:
"A health system consists of all organizations, people
and actions whose primary intent is to promote,
restore or maintain health.”
This includes efforts to influence determinants of health
as well as more direct health-improving activities.

11. Health system--
A health system, also sometimes referred to as health care
system or healthcare system is the organization of people,
institutions, and resources to deliver health care services to meet
the health needs of target populations.
• There is a wide variety of health systems around the world, with
as many histories and organizational structures as there are
nations.
• In some countries, health system planning is distributed among
market participants.
• In others, there is a concerted effort among governments, trade
unions, charities, religious, or other co-ordinated bodies to deliver
planned health care services targeted to the populations they
serve.
• However, health care planning has been described as often
evolutionary rather than revolutionary.

12. Goal
According to the World Health Organization, health care
systems' goals are good health for the citizens,
responsiveness to the expectations of the population,
and fair means of funding operations.
Progress towards them depends on how systems carry
out four vital functions: provision of health care
services, resource generation, financing, and
stewardship.

13. Providers
Health care providers are institutions or individuals providing health
care services.
Individuals including health professionals and allied health
professions can be self-employed or working as an employee in
a hospital, clinic, or other health care institution, whether
government operated, private for-profit, or private not-for-profit
(e.g. non-governmental organization).
They may also work outside of direct patient care such as in a
government health department or other agency, medical
laboratory, or health training institution.
Examples of health workers are doctors, nurses,
midwives, dietitians, paramedics, dentists, medical laboratory
technologists, therapists, psychologists, pharmacists, chiropracto
rs, optometrists, community health workers, traditional medicine
practitioners, and others.

14. Health System Development
So, all these activity’s primary objective is to promote health.
 Health system does not include education but it may include
health education as it also promotes health of an individual
and community.
 Health care system is an approach of transforming resources
into health services to improve and reinstate the health of the
people.
 Health services are designed to meet the health needs of the
community through the use of available knowledge and
resources. It is not possible to define a fixed role for health
services when the socio-economic patterns of the countries
are different.

15. Health System Development
Various kinds of health services are delivered by the health
system, which constitutes the management sector and involves
organizational matters.
Two major themes have emerged in recent years in the delivery
of health services:
a. First, the health services should be organized to meet
the needs of entire population and not merely the selected
groups. Health services should cover the full range of
preventive, curative and rehabilitative services.
b. It is now fully realized that the best way to provide health
care to the vast majority of underserved rural people and urban
poor is to develop effective “primary health care” service
supported by an appropriate referral system.

16. Health System Development
The current effort or the social policy throughout the world is to
build up health system based on PHC, towards the policy
objective of health for all by 2000 AD.
Community participation is also encouraged in PHC. So, health
care systems are there; to deliver the health care services. It
operates in the context of the socio-economic and political
framework of the country.
The whole health system of Nepal is composed of -------------
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17. Health System of Nepal is composed of---
• Public health sector- Primary health care (Primary health care
center, Health post, Sub-health post, Female community health
volunteer, etc.), Hospital (Central hospital, Regional hospital,
District hospital and Zonal hospital), Other agencies (Department
of health service, Environment ministry)
• Private sector- Private hospitals, Nursing homes, Poly clinics,
Dispensaries, Practitioners etc.
• Indigenous system of medicine- Ayurvedic and Siddha, Unani and
Tibbi, Homoeopathy, Unregistered practitioners etc.
• Voluntary health agencies- NGOs, INGOs etc.
• National health programmes- TB control Programme, Leprosy
control Programme etc.

18. Health System Development
The challenge faced by most of the nation in health
care system is that it is not able to reach the whole
population with adequate health care services and to
ensure their utilization.
The hospital as health care delivery outlet is not
sufficient as it serves only a small part of the
population and the services are mostly curative in
nature. So, hospitals are not for the delivery of
comprehensive health care services.

19. Health System Development
• Rising costs in the maintenance of these large hospitals and
their failure to meet the total health needs of the community
have led many countries to seek alternative models of health
care delivery system with a view to provide health care
services that are affordable and essential.
• Every country has some kind of health system however good
or bad, systematic or not so systematic, it may seem to
operate.
• Health system may be described as “a set of cultural beliefs
about health and illness that forms the basis for health
seeking and health promoting behavior. The institutional
arrangements within which, that behavior occurs, the socio-
economic/political/physical context for those beliefs and
institutions”.

20. Health System Development
• Institutional arrangements include:
• Individual, family and community
• Health care services (public, private, international health
care sectors)
• Thus health system is intended to deliver health services, in
other words, it consists of management sector and involves
organizational matters like planning, determining priorities,
mobilizing and allocating resources, translating policies into
services, evaluation and health education.

21. Health System Development
The components of health system include:
• Concepts (health and disease)
• Ideas (equity, coverage, effectiveness, efficiency, impact)
• Objects (hospitals, health centers, programs)
• Persons (providers and consumers

22. Concept of Health System Development
Characteristic of Health Care System:
• An systematic approach
• Transformation process
• Improve and Restoration of health
Purpose of Health Care System:
• Health service
• Appropriately resources/technology use
• Monitoring health
• Restoring health
• Regular health services
• Healthy life style

23. Concept of Health System Development
Level of Health Care in Health Care System
There are all together there levels of health care and they are:
Primary care level
It is the first contact point of individual, family and community with the
national health system, where primary health care (essential health
care) is provided. PHC is provided by the means of primary health
centers, health posts, sub health posts by the means of health workers,
VHWs, FCHVs etc. since Nepal opted for “Health For All” by 2000 AD,
the PHC system has been reorganized and strengthened to make the
PHC delivery system more effective.
PHC includes health education, provision of food supply and nutrition,
safe drinking water and sanitation, MCH including FP, immunization,
prevention and control of locally endemic disease, appropriate
treatment of common disease and injuries and provision of essential
drugs.

24. Concept of Health System Development
Secondary level
This is the first referral level. At this level more
complex problems are dealt with. In Nepal, this kind of
care is provided by District and Zonal Hospitals. The
service includes medication, counseling and general
surgery.

25. Concept of Health System Development
Tertiary care level
This tertiary care level is more specialized than secondary
care level and requires specific facilities and attention of
highly specialized health workers or staffs. The care is
provided by the central and regional hospitals, specialized
hospitals, such as central hospitals, teaching hospitals etc.

26. Health System Development
Health Care Services Delivered by Health Care System
Health care services are the delivery component of health care.
They are provided by hospitals, PHC, HP, Private sector, NGO,
INGO etc which are part of the health care system.
The purpose of health care services is to improve the health
status of the country and population. In the light of “health for all”
by 2000AD, the goals of health care services are:

27. Health System Development
Goals of Health Services
• Mortality and morbidity reduction
• Increase in life expectancy
• Decrease in population growth rate
• Improvements in nutritional status
• Provision of basic sanitation
• Health and resources development
• Food production
• Increase in literacy rate and reduction of poverty etc.
• Indigenous production of drugs
• National Health Human Resources
• Many More-----------------

28. Health System Development
WHO Global Health Agenda :-
1. Investing in Health to reduce poverty
2. Building individual and Global health security
3. Promoting universal coverage, gender equality, &
health related human rights
4. Tackling the determinants of health
5. Strengthening health systems and equitable
access
6. Harnessing knowledge, science and technology
7. Strengthening Governance, leadership and
accountability

29. Health System Development
The scope of health services varies widely from nation to
nation and is influenced by ever changing national, state
and local health problems need an attitude as well as the
available resources to provide these services.
Health services should be:
• Comprehensive
• Accessible
• Acceptable
• Provide scope for community participation
• Affordable

30. The importance of healthcare systems
Effective healthcare systems are the ones that involve
everyone beginning from the patient who needs
medical attention to the largest healthcare facility.
The healthcare system is such a large movement
because it includes people without any form of
healthcare insurance who seek treatment on charity,
the small clinic on the side of the road to the largest
referral hospital with the best of procedures that cost
millions of dollars.
Anyone who needs healthcare of any form and any
organization that provides it is an integral part of it.

31. Why is Health system Important?
• Health system is fundamental to 21st century
healthcare and shares the same overall goals as the
rest of the health care system - reducing premature
death and minimizing the effects of disease, disability,
and injury.
• After all, the main intent of public health is to promote
a healthier population.
• This is quintessential to a sustainable health care
system, and also provides economic and social
benefits for the province, due in part to increased
productivity.

32. Why is Health system Important?
• There are two underlying principles in public health
programs, services and institutions that differ from
clinical medicine:
• The focus of public health is prevention rather than
treatment of diseases; and
• Public health addresses the health needs of
populations as a whole instead of individuals.

33. Conclusion
Health care systems are designed to meet the health
care needs of target populations.
There are a wide variety of health care systems around
the world. In some countries, the health care system
has evolved and has not been planned, whereas in
others a concerted effort has been made by
governments, trade unions, charities, religious, or
other coordinated bodies to deliver planned health
care services targeted to the populations they serve.
Private health system has developed slowly.