A health system, also sometimes referred to as health care system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. Health systems are responsible for delivering services that improve, maintain or restore the health of individuals and their communities. Common elements in virtually all health systems are primary healthcare and public health measures.

1. PRIMARY HEALTH CARE
(EHT 106)
SIR OAK
(ACCRA SCHOOL OF HYGIENE)

2. LECTURE EIGHT
Health system development
& National health policy

3. Learning objective:
After completing this topic, students are expected to:
• explain the term health system;
• identify the models of health care system;
• describe the development and delivery of health care systems;
• explain the essence of national health policy in addressing
issues of public health.

4. Introduction
• A health system, also sometimes referred to as health care system,
is the organization of people, institutions, and resources that
deliver health care services to meet the health needs of target
populations.
• Health systems are responsible for delivering services that improve,
maintain or restore the health of individuals and their communities.
• Common elements in virtually all health systems are primary
healthcare and public health measures.

5. Models of health care systems
1. The Beveridge Model
• Named after William Beveridge, the social reformer who designed
Britain’s National Health Service.
• In this system, health care is provided and financed by the
government through tax payments.
• The system tend to have low costs per capita, because the
government, as the sole payer, controls what doctors can do and
what they can charge.
• Countries using the Beveridge model include Great Britain, Spain,
most of Scandinavia and New Zealand.

6. Models of health care systems cont…
2. The Bismarck Model
• Named for the Prussian Chancellor Otto von Bismarck, who invented the
welfare state as part of the unification of Germany in the 19th century.
• It uses an insurance system — the insurers are called “sickness funds”
— usually financed jointly by employers and employees through payroll
deduction.
• The Bismarck model is found in Germany, France, Belgium, the
Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

7. Models of health care systems cont…
3. The National Health Insurance Model
• This system uses private-sector providers, but payment comes from
a government-run insurance program that every citizen pays into.
• The single payer tends to have considerable market power to
negotiate for lower prices.
• National Health Insurance plans also control costs by limiting the
medical services they will pay for, or by making patients wait to be
treated.
• The classic NHI system is found in Canada, Taiwan and South
Korea

8. Models of health care systems cont…
4. The Out-of-Pocket Model
• The developed or industrialized countries (perhaps 40% of the
world’s countries) have established health care systems.
• Most of the nations on the planet are too poor and too
disorganized to provide any kind of mass medical care.
• The basic rule in such countries is that the rich get medical care;
the poor stay sick or die.
• In rural regions of Africa, India, China and South America,
hundreds of millions of people go their whole lives without ever
seeing a doctor.

9. Development of health system
• There’s a global ambition to achieve universal health coverage
and health equity by the year 2030.
• SDG 3 aims to ensure healthy lives and promote well-being for
all, at all ages.
• There is increasing interest in access to and utilization of PHC in
low- and middle-income countries.
• The quality of health care system is expressed through coverage,
access, equity, efficiency in use of resources, and financing.

10. Development of health system cont…
• Health care system infrastructure includes: services, facilities,
institutions/establishments and organizations.
• The health care system in Ghana has a formidable task of
improving and guaranteeing the health and well-being of
Ghanaians.
• The health system has the responsibility of combating illnesses
associated with poverty and lack of education; at the same time, it
has to deal with a growing population, inadequate funding and
resources.

11. Structure of delivery of services.
• As a result of decentralization and health sector reform, services are
integrated as one goes down the hierarchy of health structure from the
national to the sub-district.
• The Regional Health Administration provides supervision and
management support to the districts and sub-districts within each region.
• At the regional level, curative services are delivered at the regional
hospitals.
• The public health division of the Regional Hospital as well as the District
Health Management Team (DHMT) deliver public health services.

12. Structure of delivery of services cont...
• The District Health Administration provides supervision and management support
to the sub-districts.
• At the district level, curative services are provided by district hospitals, many of
which are mission based.
• Public health services are delivered by the DHMT and the public health unit of the
district hospitals.
• At the sub-district level, both preventive and curative services are provided by the
health centers, as well as outreach services to the communities within their
catchment areas.
• The role played by the traditional birth attendants (TBAs) and the traditional healers
is also receiving national recognition.

13. National Health Policy

14. National Health Policy
• Health policy can be defined as the "decisions, plans, and actions that
are undertaken to achieve specific healthcare goals within a society.
• An explicit health policy can achieve several things: it defines a vision
for the future; it outlines priorities and the expected roles of different
groups; and it builds consensus and informs people.
• Categories of health policies include: global health policy, public
health policy, mental health policy, health care services
policy, insurance policy, vaccination policy and breastfeeding
promotion policy.

15. National Health Policy cont…
• In 2007, the National Health Policy was designed within the context of
Ghana's vision of achieving middle income status by 2015.
• It places health at the center of socio-economic development and
presents a clear shift in the role of health in the national and
international development framework.
• This is based on the recognition that health is not only a human right
issue, but also a key driver of development, and ultimately of wealth
creation.
• Globalization is facilitating the transfer of goods, services, people,
values and lifestyles from one country to another. Hence, policies of
one country affect another country.

16. National Health Policy cont…
• The mission of the MoH as stated in the policy document is to
contribute to socio-economic development and wealth creation by:
promoting health and vitality,
ensuring access to quality health,
population and nutrition services for all people living in Ghana and
promoting the development of a local health industry.
• This mission puts the concept of health beyond the confines of
curative care to other socio-economic determinants of health.

17. PHC as the basis for National Health Policy
• The theme of the Ghana’s Health Policy is “Creating Wealth through
Health”.
• The strategic direction of improving human capital makes health central to
Ghana's development efforts.
• Only a healthy population can bring about improved productivity and
subsequent increase in GDP, and by doing so ensure economic growth.
• Hence, the old adage “a healthy population is a wealthy population”

18. Class Exercise
Suggest five (5)
environmental health challenges
that require National Health Policy
intervention to address.

19. Why National Health Policy?
• In fact, the poor environmental conditions in which Ghanaians live, work
and go to school has a major impact on their wellbeing.
• The poor air, water and soil quality in the country is mainly due to
improper disposal of waste, emission of dangerous gases from industries
and vehicles, and smoke from burning of waste and bush fires.
• Only a third of the waste produced in the urban centers is collected
leaving the rest to pollute the environment.
• Less than half of the population in the country has access to potable
water, leaving the rest to obtain water from streams and rivers, which are
often contaminated.

20. Why National Health Policy cont…
• Our poor lifestyle, together with known environmental factors, most
of which are preventable, manifest in a high level of morbidity and
mortality in the country.
• Resource limitations and budget constraints call for participatory
health policy planning to ensure equitable and balanced distribution
of health facilities, projects and interventions.

21. Why National Health Policy cont…
• The policy argues that the disease profile and mortality patterns of the
country are directly linked to:
 improvements in environmental hygiene and sanitation
 proper housing and town planning
 provision of safe water
 provision of safe food and nutrition
 encouragement of regular physical exercise
 improvements in personal hygiene
 immunization of mothers and children
 prevention of injuries in our work places
 prevention of road accidents
 practicing of safe sex.

22. Thank you