Healthcare system documnet

1. Module I: Health System and Health Policy
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2. Module One: Health System and Health
Policy
Module outline
Unit 1: Current and emerging health issues and trends
Unit 2: Health system strengthening initiatives
Unit 3: Health policy, strategies and reforms in Ethiopia
Unit 4: Policy analysis
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3. Unit 1: Existing and Emerging Health
Issues & Trends
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4. Unit 1: Existing and Emerging Health
Issues & Trends
Unit outline:
• Session 1: Introduction to existing and
emerging health issues and trends
• Session 2: Implication of global and local
health issues/trends on the health care
system
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5. Session 1: Introduction to existing and
emerging health issues and trends
Session objective
 Discuss the major existing and emerging global
health issues and trends.
 Identify the existing and emerging health issues
and trends in Ethiopia
 Analyze the health care trends considering the
local health situations
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6. Activity 1
Duration: 20 minutes
Brain storming exercise and group work– refer
your participant’s manual to do this activity.
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7. Existing vs. Emerging Issues
• Emerging issues are trending since after or around
the last ten years
• Existing issues have been around since before
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8. Emerging Issues in Existing Issues
Some existing issues have new emerging components
like;
water contamination and
new toxic dumping practices etc
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9. The issues of concern for the globe
 Primary health care and Health for all
 Reproductive health and Neglected-tropical
diseases
 Poverty (fight against diseases related to poverty)
 Good governance and Health sector reform, etc.
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10. Despite major strides to improve the
health of the population Ethiopia still face
 High population growth rate and Malnutrition
 One of the highest rates of maternal and neonatal
mortality
 Health workforce shortage and Low institutional
delivery
 Increasing number of people affected by Non
Communicable Diseases/NCD/
 Neglected Tropical Diseases and Inadequate
immunization coverage
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11. Quite encouraging improvements (1)
1. Steady reduction in under five mortality
2. Increasing utilization of modern family planning
methods
3. Success in the combat against malaria, TB and
HIV/AIDS
4. Accelerated expansion of health care services
5. Training of Health workers
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12. Quite encouraging improvements (2)
6. Health extension program and Health
development army
7. Harmonization and alignment of health projects
with government plans
8. Private sector participation in provision of public
health services
9. Doubling of the treasury budget for health
10.Human Resource for Health Development
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13. Session 2:Implication of global and local health
issues/trends on the health care system
Session objective
 Interpret the Impact of the observed trends in the
health of the people
 Analyze the implication of global and local health
care trends with the leadership, Management and
Governance practices in your organization
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14. Activity 1
Duration: 15 minutes
Group work
• By referring your participant’s manual discuss the
implications on the health care delivery system and
the health of the community you serve.
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15. Implications of emerging health problems
on health systems(1)
Opportunities
1. New delivery strategies create new demands on the
health system
o Staffing and referral system
o Upgrading facilities
o New approach for mental health and non-
communicable diseases
o And introduction to new drugs and technologies
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16. Implications of emerging health problems
on health systems(2)
2. Internationally coordinated disease control system
3. Demands the need for proactive and strategic
leadership at all levels
4. Linkage of Community and health care
organizations strengthen
5. Decentralization and Devolution
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17. Challenging situations
 Doing more with less financial inputs
 Shifting burden of disease
 Decentralization and Devolution
 In adequacies on the key Leadership,
Management, & Governance skills
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18. Competing issues to be considered;
 Policy Makers and Public Health Regulators
 Public Health NGOs
 Health Care Professionals, Administrators
(Clinical & Hospital Staff)
 Scientists/Researchers/Pharmaceutical
Companies
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19. Unit 2: Health System Strengthening
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20. Unit 2: Health System Strengthening
Unit outline
Session 1: Health System building blocks and the
role of the management system in health system
strengthening
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21. Session 1: Health System building blocks and
the role of the management system in health
system strengthening
Session objectives:
 Analyze key health system building blocks and
their interactions
 Identify gaps considering the six building blocks
in the national health system
 Propose alternative interventions for the
identified gaps
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22. Activity 1
Duration: 15 minutes
Discussion and group work– refer your
participant’s manual to do this activity.
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23. Health System Building blocks as defined by the
WHO include (WHO 2007)
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24. Advantage of well integrated building
blocks
 Routine transactions are systematic
 Replicable, consistent, and complete
 Critical information is well documented
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25. Frame work for people centered health
system strengthening
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26. The Ethiopian Health System
Strengthening Initiatives
• Business Process Reengineering
• Decentralization of Health Service
• Health Care Financing
• Hospital Reform Initiatives
• Harmonization and Alignment
• Different Health Work Force Development initiatives
• Health Management Information System
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27. Activity 2
 Duration: 10 minutes
 Discuss in pair
 By taking your own organization, discuss Systems
thinking vs. program focused approach by referring
your participant manual
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28. Systems thinking versus program focused
approach
“Systems thinking” is an approach to problem solving
that views "problem" as part of the wider, dynamic
system (WHO, 2009).
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29. Usual program focused approach
 Static thinking
 Systems-as-effect thinking
 Tree-by-tree thinking
 Factors thinking
 Straight-line thinking
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30. Systems thinking approach
 Dynamic thinking
 System-as-cause thinking
 Forest thinking
 Operational thinking
 Loop thinking
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31. Elements of systems thinking
 Systems organizing
 Systems networks
 Systems dynamics
 Systems knowledge
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32. Unit 3: Health Policy, Strategy and Reform
in Ethiopia
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33. Unit 3: Health Policy, Strategy and Reform
in Ethiopia
Unit outline
Session 1: Health Policy of Ethiopia
Session 2: Health Sector Strategies and reforms in
Ethiopia
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34. Session 1:Health Policy of Ethiopia
Session objectives:
• Elucidate the health policy of Ethiopia
• Discuss its implication with your routine
organizational activities
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35. Activity 1
Duration: 15 minutes
Group Discussion
• Look at the Health Policy provided to you and
clarify the major principles stated in the policy
document
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36.  Envisioned the health care sector development
(HSDP) for the next twenty years.
 Reorganized the health services delivery system
contribute to the overall socio-economic
development.
 It principally focuses on fiscal and political
decentralization, expanding the PHC services
National Health Policy
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37. 1. Democratization and decentralization of the
health service system.
2. Development of the preventive and promotive
components of health care.
3. Development of an equitable and acceptable
standard of health service system
4. Promoting and strengthening of inter-sectoral
activities.
5. Promotion of attitudes and practices conducive to
the strengthening of national self-reliance
General theme of the policy(1)
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38. General theme of the policy(2)
6. Assurance of accessibility of health care for all segment of
the population.
7. Working closely with neighboring countries, regional and
international organizations
8. Development of appropriate capacity building based on
assessed needs.
9. Provision of health care for the population on a scheme of
payment
10. Promotion of the participation of the private sector and
governmental organizations in health care.
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39. Session 2: Health Sector strategies and
reforms in Ethiopia
Session objectives
 Identify the various Health sector strategies
implemented in the Country
 Analyze the reform processes practiced in the
health sector with its implications
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40. Activity 1
Duration: 15 minutes
Group Discussion
In your team list the different health sector reforms
implemented in the nation by referring your
participant manual
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41. The main goals of HSDP are threefold:
• Building basic infrastructure
• Provide standard facilities and supplies
• Develop and deploy appropriate health personnel
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42. • Prioritized disease prevention
• Introduced a four-tier system for health service
delivery
• Characterized by a primary health care unit
(PHCU)
• The three one’s principle and harmonization
HSDP I (1997/98–2001/02)
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43.  Introduced the Health Service Extension Program
(HSEP).
 Innovative health service delivery system
 It is a community based health care delivery
system provided at kebele and household levels
HSDP-II (2002/03–2004/05)
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44. • Directly aligned with the health-related MDGs
• Focuses on high-impact health system
strengthening interventions needed to accelerate
scale-up and increase coverage
HSDPIII (2005/6-2009/10)
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45. 1. Developed as part of the National Growth and
Transformation Plan (GTP)
2. The expression of the renewed commitment to the
achievement of MDGs.
3. Gives priority to maternal and child health, nutrition,
prevention and control of major communicable
diseases
HSDP IV (2010 –2015)
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46. HSDP IV (2010 –2015) 2
4.Emphasizes the strengthening of HSEP to improve
the
quality of PHC, human resource development and
health infrastructure.
5. Developed the three tier health delivery system
6. Community empowerment/ownership
7. Developed through two approaches.
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47.  Maternal and newborn health
 Child health
 TB and HIV/AIDS
 Malaria and nutrition
The priorities and targets of the HSDP IV
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48.  Solidarity
 Equity
 Ethics
 Cultural identity
 Gender equity
Values of the health for all policy for the
21st century
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49.  Business Process Reengineering
 Decentralization and Health Facility Governance
 HSDP and Woreda Based Planning
 Joint Governance and Coordination
 Health Insurance Scheme and Health Care
Financing
Health sector reform in Ethiopia
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50.  Improved equity in health and health care services
 Increase and better management of health
resources
 Improved performance of health systems and
quality of care
 Greater satisfaction of consumers and providers of
health care
Expectations of the health sector reform
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51.  Under-five mortality has dropped significantly
 An increase in Antenatal care ,FP and skilled birth
attendance
 Maternal mortality ratio declined
 Malaria admissions and deaths have been reduced
 The national point prevalence of HIV
(2.3%)decreased to 1.5
Positive outcomes of the nation’s
health system
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52. Unit 4:Policy Analysis
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53. Unit 4:Policy Analysis
Unit outline
Session 1: Policy Formulation and analysis
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54. Session objectives
 Discuss policy formulation and analysis
 Analyze national health policy using policy
analysis checklist
Session 1: Policy Formulation and analysis
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55. Activity 1
Duration: 15 minutes
Group Discussion
For this exercise you need to refer back the section
that dealt about Ethiopian health policy in the
participant manual
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56. 1. Reflect the ideology and values of an
organization or institution
2. Elicit the principles that guide action
3. Serve as planning tools for goal setting and
service delivery
4. Provide the terms of reference for setting
program priorities and guide program
development
Characteristics of good policy(1)
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57. Characteristics of good policy(2)
5. Help set roles, the limits, define areas
within the organization’s setting
6. Provide rules, regulations and guidance for
routine, unique and controversial decisions
7. Provide the justification for the
determination of resource allocations
8. Provide a tool assisting in the evaluation of the
progress and accountability
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58.  Problem identification and agenda setting
 Policy formation
 Adoption
 Policy implementation
 Policy evaluation
The five key stages in the health policy-
making process are
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59. • Political climate (context)
• Content, process, and interests
• Level of involvement
Policy setting can be affected by different
factors like;
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60. The policy making triangle
Context
Process Content
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61. Activity 2
Duration: 30 minutes
Brainstorming and group Discussion
In order to do the this exercise on policy analysis
please refer your participant manual
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62.  A multidisciplinary craft involving rigorous enquiry
 Traces cause- effect relationship
 Purports more to explain policies, than to prescribe.
 Ultimately an advice based on thorough and objective
scrutiny of assumptions, options, consequences and
implementation issues
 Governments depend on it to make an informed
policy choice
Policy analysis
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63. • Helps them to scan more opportunities/risks
• Evaluate the congruency of a policy within the context of
mission & goals
• Assist them to recognize the viability of a policy regarding
the 4 factors:
A. Political Feasibility
B. Economic feasibility
C. Administrative feasibility
D. Consideration of Cultural values
Importance of policy analysis for leaders
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64. 1. Defining the problem
2. Establishing goals
3. Selecting a policy
4. Implementing a policy
5. Evaluating the policy
Steps to undertake policy analysis
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65. Policy analysis process
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66.  Law overshadows it
 Multi-disciplinary by nature
 Requires training, insight and experience
 Strong analytical and communications skills
 Technical training and experiences
Characteristics of policy analysis
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67.  Policy analysts should maintain proper
relationship with their Minister and Government
 The public servants should provide honest
impartial and comprehensive policy advice
 Public managers or servants should not withhold
relevant information from Ministers
Ethical points on policy analysis
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68.  Time management and critical reading and note
taking
 Clear, logical, sequential, pragmatic thinking to solve
problems
 High level research and synthesis
 Solid quantitative and qualitative data analysis
 Abstract thinking and creating frameworks for
analysis
 Original, exciting and to the point writing and verbal
skills
Skills necessary for policy analysis
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69. Thank you
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