This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
"Medical Doctors are Poor Managers". This presentation has tried to do brainstorming for them how to operate as better Health Managers. Leaders lead from the Front. Managers control from the Behind. A Doctor in a facility needs to play the role of both Leader as well as Manager.
Indicator is a variable which gives an indication of a given situation or a reflection of that situation.
Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community.
Indicators help to measure the extent to which the objectives and targets of a programme are being attained.
This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
"Medical Doctors are Poor Managers". This presentation has tried to do brainstorming for them how to operate as better Health Managers. Leaders lead from the Front. Managers control from the Behind. A Doctor in a facility needs to play the role of both Leader as well as Manager.
Indicator is a variable which gives an indication of a given situation or a reflection of that situation.
Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community.
Indicators help to measure the extent to which the objectives and targets of a programme are being attained.
Planning is making current decisions in the light of their future effects.
Health planning is a process culminating in decisions regarding the future provisions of health facilities and services to meet health needs of the community.
Health administration
health care planing
health care management and planning
Objective of health planning
element of health planning
health planing cycle
Data
Information
Intelligence
Health information system
Sources of data
Census
Registration of vital events
Sample registration system
Notification of diseases
Hospital records
Disease registers
Record linkage
Epidemiological surveillance
Other health service records
Environmental health data
Health manpower statistics
Population surveys
Other routine statics related to health
Non – quantifiable information
Health management information system
Central Bureau of health Ingelligence
National health profile
WHO Reports
Global Health Observatory
World bank
Health stats
New Organogram of Nepalese Health System (Please check the updated slides on ...Prabesh Ghimire
This slide has been updated to accommodate the recent changes. Please check the following link for the updated presentation:
https://www.slideshare.net/PrabeshGhimire/organogram-organization-structure-of-nepalese-health-system-updated-nov-2021
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Planning is making current decisions in the light of their future effects.
Health planning is a process culminating in decisions regarding the future provisions of health facilities and services to meet health needs of the community.
Health administration
health care planing
health care management and planning
Objective of health planning
element of health planning
health planing cycle
Data
Information
Intelligence
Health information system
Sources of data
Census
Registration of vital events
Sample registration system
Notification of diseases
Hospital records
Disease registers
Record linkage
Epidemiological surveillance
Other health service records
Environmental health data
Health manpower statistics
Population surveys
Other routine statics related to health
Non – quantifiable information
Health management information system
Central Bureau of health Ingelligence
National health profile
WHO Reports
Global Health Observatory
World bank
Health stats
New Organogram of Nepalese Health System (Please check the updated slides on ...Prabesh Ghimire
This slide has been updated to accommodate the recent changes. Please check the following link for the updated presentation:
https://www.slideshare.net/PrabeshGhimire/organogram-organization-structure-of-nepalese-health-system-updated-nov-2021
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Disaster managment can save many lives.This presentation enumerates all steps required for Damage-control.It also stresses upon the importance of Primordial mode of prevention.
If you like this presentation and want to make for yourself,Please do contact me at rohit.bhansalis@gmail.com
QUESTION 1What are the main streams of influence, according to.docxmakdul
QUESTION 1
What are the main streams of influence, according to the Theory of Triadic Influence? Please provide examples factors/attributes that belong to each of those streams. What is the relationship/correlation between each of those streams?
Your response should be at least 200 words in length.
QUESTION 2
The PRECEDE-PROCEED approach has several key assessment/diagnosis phases. Please describe the epidemiological assessment. What are some key sources of data used in this assessment? Which main questions is this assessment is trying to address/answer?
Your response should be at least 200 words in length.
QUESTION 3
What specific questions the evaluators are bringing forward as they are trying to collect the necessary evaluation data? What are the three main types of evaluation discussed in the PRECEDE-PROCEED approach? What is each of them trying to identify, measure, evaluate?
Your response should be at least 200 words in length.
QUESTION 4
What are some of the key assumptions behind the PRECEDE-PROCEED approach? What are some of the key benefits of using this approach? What are some of the “real-life” examples of using this approach?
Your response should be at least 200 words in length.
Unit Lesson Study Guide
In Unit 4, we will continue to discuss health behavior and its association with factors that could influence such behaviors. These types of influences are referred to as multilevel factors of behaviors, and they typically fall into five main categories:
1. individual factors,
2. inter-personal factors,
3. organizational factors,
4. community factors, and
5. policy factors
Consider the following scenario:
A 50-year-old man may purposely postpone getting a prostate cancer test because he is scared of finding out that he may have prostate cancer. This is an example of an individual- level factor. However, we need to look into this further and consider the following: his inaction might also be influenced by his primary physician’s failure to actually recommend and insist that he would need to take the prostate test. Another factor might be the difficulty of scheduling an appointment due to either unavailable equipment or the unavailability of staff at his local clinic. Another limiting factor could be that the fee for the exam is so high he cannot afford it, and his insurance does not cover this type of procedure. Thus, all these interpersonal, organizational, and policy factors are influencing this man’s behavior to not complete the prostate test. Therefore, for health promotion practitioners, it is very important to be aware of all these factors so effective change strategies or interventions can be prescribed.
One of the multilevel theories that will be discussed is the Theory of Triadic Influence (TTI). TTI behaviors arise due to one’s current social situation, general cultural environment, and their personal characteristics. Any health-related behaviors are influenced by an individual’s decisions.
What wo ...
Module 1 OverviewThe purpose, function, and application of str.docxraju957290
Module 1 Overview
The purpose, function, and application of strategic planning in health care administration is studied. Content includes strategic planning, situational analysis, strategy formulation, action planning, and metrics. Leader qualities are used in this module to effectively identify strategic issues, develop a team, and develop a plan of action for overall improvement. Organizational behavior is examined to view its impact on organization vision/mission, organizational goals, organizational communication, and the diverse environment of professionals in health care organizations.
Strategic planning models can offer a range of opportunities to an organization. The National Criminal Justice Association (2017) recommends the following strategic planning models:
Model One: The Basics
Organizations that are small, busy, and have not done much strategic planning before might want to start with this approach. Top-level management often carries out planning in this model rather than using a community-based approach. Basic strategic planning includes:
1. Create a mission statement. A mission statement describes why the organization exists (i.e., identifies its basic purpose). The statement should address both the types of communities or audience that the organization serves, and the services and products it will provide. The top-level management will generally develop the mission statement. The statement will change somewhat over the years.
2. Select the organization’s intermediate goals. Goals are general statements about what needs to be accomplished to meet the purpose or mission and address major issues.
3. Identify approaches or strategies to reach each goal. Strategies are often what change most as the organization eventually conducts more robust strategic planning, particularly as external and internal environments are examined more closely.
4. Identify action plans to implement each strategy. Action plans list the steps that each major function (for example, a department or agency) must take to ensure that it is effectively implementing a strategy. Objectives should be clear enough to be assessed if they have been met. Ideally, top management will develop committees, each with their own work or set of objectives.
5. Monitor and update the plan. Planners regularly monitor progress towards goals and whether action plans are being implemented. Perhaps the most important indicator of success is positive feedback from customers.
6. Note that organizations may want to extend step 3 by identifying additional goals that help develop central operations or administration (e.g., implementing a new goal that strengthens financial management).
Model Two: Issue- or Goal-Based Strategic Planning
Organizations that begin with basic planning often evolve toward this more comprehensive and effective approach. This model will be the focus of recommendations for use as the preferred process in community-based planning.
1. Identify SWOT (Strengths, W ...
is exactly what the name implies. It’s the overall management of a healthcare facility, such as a clinic or hospital. A healthcare manager is in charge of ensuring a healthcare facility is running as it should in terms of budget, the goals of the facility’s practitioners, and the needs of the community. A person in charge of healthcare management oversees the day-to-day operations of the facility.his individual also acts as a spokesperson when providing information to the media. The person in charge of healthcare management also collaborates with medical staff leaders on issues such as medical equipment, department budgets, planning ways to ensure the facility meets their goals, and maintaining a good relationship with doctors, nurses, and all department heads. The healthcare manager also makes decisions about performance evaluations, staff expectations, budgeting, social media updates, and billing. The objective of the Program in Healthcare Management is to train professionals, according to the needs of the healthcare sector, that are committed to basic principles and values of the sector, have knowledge of managerial procedures and practices, and are competent in inpatient/customer relations and communication
What is plan and how to make your plan successful? A successful work is a reflection of a disciplined, delicate and strictly maintained plan. These discipline is discussed in above discussion. I know it never can satisfy you, but it is the summery. And I hope it will help you.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
How to Give Better Lectures: Some Tips for Doctors
health management
1. 55
CHAPTER IV
HEALTH MANAGEMENT
Objectives :
1. Define management.
2. Identify the main management functions
3. Enumerate the planning functions
4. Identify the levels of planning
5. Define the components of situation analysis in a community.
Definition of management: group of activities done for reaching goals. It is
a science and art that needs experience. Management is getting things
effectively done to achieve desired objectives through proper planning,
efficient implementation, and evaluation to assess achievements and identify
the needs for re-planning. Management is thus a dynamic process.
Management is not only for projects or large business but it can be applied
in daily life for every one. The art of management is how to do tasks
successfully in the right way, within your available resources and in its fixed
time.
"Needs lead to invention" it is true statement also for management science.
An individual can do his daily tasks, prioritize these tasks, change time
schedule in doing it, i.e. he is free in how, when, why to do things providing
that he will do what should he done. If the same job is distributed on two or
more individuals, there must be rules for doing that job to prevent
duplication, lack of responsibility, waste of resources. These rules are the
bases of management. So management is rules (functions) that control
execution of work (or job) to reach goals (aims) properly (with zero mistake)
with maximal use of available resources in the least time.
Aim of health management:
To reach goals easily (getting things done) with least resources, effort and
time
The goals in the medical field are: to promote health, prevent health
problems, control problems (mortality and morbidity) and rehabilitation of
handicaps.
So management in the medical field is used to reach promotion of health,
prevention and control of diseases in a proper way, with minimal resources,
effort and time.
Scopes of H. management: in scientific research, thesis, projects, program,
experiment, medical services (hospital, health units, clinics) to add something
new (new technique or treatment) or to improve something already present in
these areas and needs improvement management techniques.
2. 56
Management functions:
1- Where are we now? = situational analysis = what is the background of
the health problem (or subject under study). To study and understand the
nature, distribution, importance and contributing factors related to that
problem (or research point) you are interested in. Collect data from all
previous studies in that subject. Do field study ask about the needs of the
people (customers) who will benefit from that research. Do SWOT
analysis to assess strengths, weak points, opportunities and threats that
can help or complicate your research. Think in the whole situation to
formulate problem statement .i.e. to choose certain aspect (or point) in the
problem to be solved (or improved).
Example: suppose we want to increase the sales of a factory. First of all we
should study well market needs, competitive factories products, the resources
of the factory (man power, budget, tools and instruments) work shifts,
problems of workers, availability of materials in market (local or imported)
system of work, all steps before production. This situational analysis revealed
that to increase sales we must retrain workers, increase incentives.
Example: if we do situational analysis to solve parasitic diseases problem we
should collect data about the prevalence of these infections, who are infected,
how, where, and why. Study life cycles of the parasites, study host and the
environment that helps the presence of the infection (ecology). From this
situational analysis we know the most prevalent parasite in the area, factors
that facilitate infection.
Situational analysis for community health includes:
1. Political and administrative rules
2. Demographic features 3. Economic resources
4. Social stratification and relations
5. Leadership pattern and its influence.
6. Community organizations and their functions and activities
7. Cultural facets or traditions
8. Health, nutrition, and sanitation levels 9.Education levels
The sources of information are various: from records, books, previous
researches, surveys (focus group, in depth interview), census, internet,
experts etc.
2- What can we do? formulation of the vision, mission, goals, objectives.
Vision is a broad scope for the importance of the selected problem. Mission
is the goals we dream to achieve. Goals are broad statements of what we
are going to accomplish. Objectives must be measurable, specific,
attainable, applicable, reliable and time limited statements that define what
we are going to achieve. Example: to decrease infant mortality is a goal.
3. 57
To decrease post neonatal mortality rate from 25 to 15 per 1000 in Egypt at
the year 2010 is an objective.
3- How can we reach these objectives? By planning.(or preparation) Plan is
the details of answers to how, who, where, when, which etc.the objectives
can be reached. In other words what are the activities that must be done, how
to execute, who will do what, what are the available resources (man, money,
materials, time). Planning is to think well before doing. In the planning stage
we can prioritize objectives if we have no enough time, money or equipment.
Priority setting is not easy. There must be objective criteria to be respected
for selection. The prime objective should be SMART as we previously
mentioned and it must be acceptable by consumer, should serve large sector
of them, satisfy their needs. Priority should be within policy, ethics and law.
It should be effective for health (do an improvement) and cope with the
available resources and at the same time can cope with obstacles.
Types of plans:short plan for 1 to 5 years.Long plan is for more than 5 years.
(1) Allocation plan: (or strategic plan) to prepare objectives, setting
priority, preparing resources as man power, money, materials,
determine time needed etc.
(2) Action plan deals with assignment of hierarchy of employee, the
relation between teams, co-ordination, supervision methods, how to
do monitoring and evaluation.
Levels of population based planning:
• Ministry of Health and Population (MOHP) is concerned with the
planning at the country level.
• Health Directorate is concerned with planning at the governorate level.
• Health District is concerned with planning at the district level.
• Community based planning: Concerned with planning for the
catchments area at the health unit level (as field training of students).
4- How to activate the plan? Implementation (execution, to do, to act, to
perform): to make plan real. Can be preceded by pilot test, to test the success
of the plan before actual performance of the whole plan. Through this pilot
we can detect obstacles or defects in the plan to be repaired. Every member
sharing in the plan should perform his task properly, within stated time, with
the available resources. Supervision: is to make sure that the staff perform
their duties effectively. It means that a supervisor helps and guides the staff
and trains them as necessary in such a way that they become more competent
and keep the standard of work.
Objectives of supervision:
-To maintain the expected quantity and quality of a health team work.
-To assess the performance of team members.
4. 58
-To identify some causes of work deficiency, e.g. insufficiency of resources,
lack of training, lack of motivation of employees, personal problems, unclear
job descriptions......
-To help resolve dispute among team members.
-To help with personal problems.
-To train (On-the-job training)
Supervision methods: Observation checklist, record and reports review
5- Do I reach my stated objectives? Do I succeed to solve the problem? =
Evaluation: is to assess effectiveness of the plan objectives. Evaluation can
be done all through processes or at the end of the program or at mid and end
etc. It can be done by calculating indicators, opinion of experts, customer
opinion, on job owner opinion (workers). Evaluation should not be
subjective. All aspects should be evaluated (plan, time, effort, performance,
cost/benefit).
Evaluation process should answer: is that work succeeded? Can it be
repeated? Who evaluates? How to evaluate? When? What to evaluate?
Failure can be positive if we reach to its causes in order not to get through
those faults again. The perfect is the plan the better will be the outcome.
Success is not the end, but sustainability of success is needed.
Management cycle can be summarized in the following steps:
Situation analysis
evaluate(check) Plan
Do(perform,implement)
Therefore planning function includes:
1. Situation analysis.
2. Problem identification and priority setting.
3. Objective setting.
4. Selection of alternative solutions/interventions.
5. Planning for resources.
6. Planning for monitoring and evaluation.
7. Planning for sustainability.
Criteria for selecting priority problems on community basis
1-The extent of the problem (prevalence, incidence rates).
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2- Seriousness of the problem which has four main components:
* Urgency: Some problems require a rapid response in order to prevent the
spread of the problem or death e.g. contaminated food, or radioactive waste.
* Severity: This is measured by immediate effects e.g. high mortality rates,
or late sequels in the form of complications or handicapping conditions.
* Economic costs should include the costs of medical expenses, public
services and prevention programs to the community.
* Impact on others: communicable disease control remains an important
priority; however, other problems include water and air pollution, passive
smoking, ..etc.
3-Effect on economy and productivity, and other socio-economic
implications.
4-Availability of cheap feasible technologies for prevention and control
5-Single, or multi-sectoral approach, and the feasibility of implementation
and monitoring of the program.
6-Time required for achieving visible results.
At the end of this step it should be clear what are the priority problems to
be dealt with first, among who, and where.
QUALITY MANAGEMENT
Objectives:
1- Define quality
2- Explain the criteria of quality in health care
3- Describe quality improvement cycle
Definition of quality: Quality is the degree of adherence to pre-established
criteria or standards.Is to do the right thing right at the first time in the planed
time.
Criteria of quality in health care:
1- Appropriateness: refers to the balance between user's needs and the
capacity of the system from the technical and materialistic aspects. (It is
equivalent to functional accessibility).
2- Accessibility: Four elements are important
2-1. Physical accessibility which means that the service is located within
reach of individuals walking or by using transport.
2-2.Financial / economic accessibility is the affordability of the cost of
service.
2-3.Cultural accessibility is the acceptability of the service by the clients.
2-4.Functional accessibility means that the right kind of care is available to
those who need it whenever they need it.
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3- Effectiveness: refers to the degree to which care is provided in correct
manner to achieve the desired outcome or how successful it was to meet
the desired objectives and the patient needs.
Effectiveness can be measured for community health programs; in this
case it estimates success in decreasing morbidity and mortality, coverage
of all health services i.e. prevention and control.
4- Equity: refers to fairness in dealing with the clients.
5- Efficiency: refers to the best use of resources to minimize cost and
achieve cost containment.
6- Support to health care providers at all levels they need economic and
social support to motivate good work.
7- Acceptability: A health care system should be acceptable and
attractive to its users.
8- Continuity: is the harmony and integrity of delivery of care at
different levels. Clients are provided with comprehensive, integrated
care, without interruption. Health care is ongoing at the levels of first
contact with health services (PHCC), referral service, follow up is
another aspect of continuity, which necessitates better record-keeping
and information regarding the patient or services.
9- Respect and Caring: The degree to which patients are involved in the
decision and the provider’s reaction to the patient needs and
expectations.
10-Competency: The degree to which practitioner adheres to professional
standards of care and practice. It refers to skills and actual
performance of health providers
11- Safety: ensures minimizing risks of injury and harmful side effects to
health services delivery to patients and also to health provider. i.e
patient (free of infection) should not be infected because of admission
to hospital. Also physicians should not get infection from patients.
Steps for quality improvement
1. Develop a plan with SMART objectives for improvement of service
2. Set standards which include:
• practice guidelines
• administrative procedure, clear rules and regulations
• Specifications, distribution of responsibilities.
• performance standards in relation to time and resources
3. Communicate standards for the workers.
4. Monitoring of implementation; continuous supervision.
5. Identify problems, analyze each problem to identify its root causes (by
Fish-bone diagram) and put priorities to these problems to be solved
6. Choosing a team to solve the problem
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7. Develop solutions and actions for quality improvement.
8. Implement and evaluate the quality improvement efforts.
9. If succeeded repeat the cycle again in another area.
Example: one of the objectives of surgical departments is to prevent post
operative infection. All surgery departments have rules and standards for the
performance of surgeons and nurses in pre operative, intra operative and in
yard after surgery. Infection rate of certain department was 25% (high). This
is a problem to be improved. Analysis of the problem revealed that the staff
does not follow the rules for proper sterilization. The head of department
puts an objective to decrease the infection rate to 0% within 6 months.
Distribute responsibilities on all the department team. All the needed
resources were available (disposable gloves, sterilization techniques,
antiseptic solutions etc). He disseminates the new standards on all staff, hang
regulatory rules every where in the department. Staff begins to follow the
strict rules for performance. He supervises their action in the operative room,
nurse's behavior in sterilization of instruments etc. One of the staff is
responsible for detection and recording of infection. Analysis of records
reveled that there was still 5% post operative infection rate. This solution
succeeds in decreasing the infection rate but does not reach the objective. He
chooses a team for analysis of cause of failure to reach 0% infection rate.
They analyze all possible causes and find that the antiseptic measures done
for patient skin before operation is still deficient. They put new standard
technique, disseminate it to nurses, apply it, supervised and calculate the
infection rate again. The infection rate reaches 0% , they recommend this
technique to be applied in all surgical departments. (If infection is still
present, try other solution by analysis of all processes to find any defect,
suggest an improvement, plan for it, act, evaluate and so on).
TOTAL QUALITY MANAGEMENT TQM
• Total quality management is a way of strict management of
business/service's processes and at every stage to ensure complete customer
satisfaction, internally and externally, the first time and every time.
• TQM focuses on preventive measures, not detection of problems and
correction i.e. proactive rather than reactive actions.
• TQM is to ensure quality standards from the beginning and in every step
(planning, implementation, supervision, output). Put possibility of any thing
that can occur and causes failure of reaching the standards, change in plan to
prevent this threat.
Example: to make TQM of teaching in the faculty of medicine we should
select students by quality standards, study contents of curricula of different
subjects carefully, correct to verify pre stated objectives according to national
or international standards, select staff carefully, define responsibility to every
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one in the teaching process. Supply of place, materials and resources needed
in the teaching process. Continuous supervision and assessment for teaching
process and evaluation by final exam result, student satisfaction, student
standard in relation to similar medical schools.
HEALTH ECONOMICS
Objectives :
1. Define the major aspects of health economics
2. Describe financing mechanisms
3. Understand cost-effectiveness analysis
• Economics is the study of how people and society choose to employ
resources, usually scarce / limited resources. Economics analyze the
costs and benefits.
• Health economics is the application of economic principles to the
health field. It is an important component of health management.
Major aspects of Health Economics
I- Financing Health Care: There are many methods for Financing Health
Services as:
1.Governmental financing. The government resources come from tax
resources (income tax and indirect taxes). The percentage allocated to the
health sector varies from one country to the other.
2.User fees (user’s out of pocket charges).
3.Health insurance: is based on the concept of risk-sharing / cost-sharing. It
involves three parties:
• The insurer
• The health care provider, paid by the insurer
• The patient who usually pays a premium and co-payment for each
service received
Separation of finance from service delivery is a new strategy in Health
Reform in Egypt
4. Non-governmental organization (NGO's) and the donations.
Criteria of evaluation of the financing system
Equity: People should be able to utilize health care when they are in need to
do so. Equity in finance: According to ability to pay (poor pays minimum fee
and rich shares by larger fees).
Equity in delivery of health care: Health care distributed equally on all areas
according to the need of population, rather than their ability to pay.
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Efficiency: A measure of how well resources are used to produce the desired
results. It relates inputs to outputs of the health service. Is the health service I
got proportional to what I pay?
Sustainability: A health service is sustainable when operated by an
organizational system with long term ability to mobilize and allocate
sufficient resources despite changes in the outside environment
Quality: Quality of care is the extent to which actual care is conforming with
preset criteria or standards for good care.
II- Cost Analysis: Classification of cost by inputs:
• Category I = Fixed cost
This category covers salaries and wages.
• Category II = Direct cost
This category covers operational cost including drugs, supplies, rents,
petrol for vehicles, maintenance, water, electricity.............
• Category III = Capital cost
This category covers durable assets with a life more than one year. It
includes buildings ( owned not rented), and equipment.
In some countries there is category IV used for payment of loans or
liabilities.
III-Cost-Effectiveness: Effectiveness is a measure of the extent to which
objectives are achieved. Cost-effectiveness analysis (CEA) is an analytical
tool to help decision makers, assess and compare the costs and effectiveness
of alternative ways of achieving an objective. It is a technique to identify the
most effective use of limited resources. CEA is also used in evaluation of the
interventions. The results of CEA are used for re-planning. Example: the
most cost effective line of treatment of gastroenteritis and dehydration is the
oral therapy by rehydration salts. It is cheap and at the same time effective.
Some of the indicators used to measure the effectiveness of health
improvement in relation to cost
• Morbidity reduction: decreased incidence or prevalence of disease
• The number of days with disability prevented: if the treatment can
decrease or prevent any number of days with disability or impairment.
• Mortality reduction which can be quantified as the number of averted
deaths; can be adjusted to measure the potential years of life gained.
• DALYs for a disease are the sum of the years of life lost (YLL) due to
premature mortality in a population and the years lost due to disability
(YLD) for cases of certain health condition.
IV-Cost containment:
• Cost containment refers to the "measures taken to reduce the rate of
growth of expenditure".
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Causes of rise of health care spending
- Demographic changes producing populations that are older on average.
-A changing pattern of disease towards chronic illness.
-Advances in medical technology and highly sophisticated equipment.
-Rising public and professional expectations connected with technological
advances.
-Increased utilization of curative health services rather than self or
community care.
- Higher wages and salaries.
-Higher cost for drugs and supplies.
-Lack of cost-conscious behavior by providers.
-Insurance coverage introducing a third party in the health financing system
(over-utilization & increased cost).
-Inefficiency and inadequate management of resources. Overstuffing,health
workers are badly deployed and supervised, hospital beds are underutilized.
Examples of the public health activities that are highly cost-effective:
• Immunization : in the first year of life would have the highest cost-
effectiveness of any health measure available in the world today.
• School-based health services, screening and immunization.
• Health information for family planning and nutrition.
• Program to reduce tobacco & alcohol consumption.
• Regulatory action and limited public investments to improve
household environment.
• Health education for Aids prevention.
• Primary health care is cost effective than building five star hospital.
• Using head helmets to prevent complications of accidents.
Measures for decreasing costs:
1.Identify the most cost-effective actions and re-orient the resources towards
them.
2.Training of managers at all levels: Policy level, top / middle management
and health care providers on rules of health economics.
3. More appropriate technology in the more costly services and rationalized
use of expensive technology as MRI, CT scan.
4.Rationalized use of drugs.
5.The health insurance systems need to be reformed for better use of
resources.