Module 5

Emergencies and the Health Systems

Module 5

HospitalSystem

Health System

Epidemiology andSurveillance

Prevention and Control of Communicable Disease

Food and Water andNutrition Sanitation

Preparedness

Response

Recovery

Health System

Module 5

ObjectivesAt the end of this 1-hour session, the participants

will be able to:Define and discuss the building blocks of the health

systemDiscuss how emergencies/disasters disrupt the

existing health systemDescribe health emergency response using the

health systems approach

Module 5

ContentsWHO health system building blocks

Health systems in emergencies

Module 5

Emergency Save lives

Module 5

Emergency

Health system

Evacuation centres Security Nutrition Surveillance Disease prevention and control Logistics Information Management Resource Mobilization Risk Communication

Save lives

Module 5

What is a health system?

Module 5

The Health SystemA health system consists of all organizations,

people and actions whose primary intent is to promote, restore or maintain health

Includes efforts to influence determinants of health as well as more direct health-improving activities

IncludesA mother caring for a sick child at homePrivate care providersBehaviour change programmesVector-control campaignsHealth insurance organizationsOccupational health and safety legislation Inter-sectoral action by health staff

Module 5

The WHO Health Systems Framework

System building blocks Goals/outcomes

Service delivery

Health workforce

Information

Medical products & technologies

Health financing

Leadership/ governance

Improved health

(level and quality)

Responsiveness

Financial risk protection

Improved efficiency

Access coverage

Quality safety

Module 5

The WHO Health Systems Building BlocksService delivery

Health workforce

Information

Medical products and technologies

Health financing

Leadership/governance

Module 5

The WHO Health Systems Building BlocksService delivery

Effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources

Health workforce Responsive, fair and efficient to achieve the best health

outcomes possible, given available resources and circumstances

Sufficient numbers and mix of staff, fairly distributed Competent, responsive and productive.

Information ensures the production, analysis, dissemination and use

of reliable and timely information on health determinants, health systems performance and health status

Module 5

The WHO Health Systems Building BlocksMedical products and technologies

Equitable access to essential medical products, vaccines and technology

Assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use

Health financing Adequate funds for health, in ways that ensure people

can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them

Leadership/governance Existence of strategic policy frameworks that are

combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system-design, and accountability

Module 5

Health Systems in EmergenciesEmergencies/disasters affect the health system

Consideration for assessment, planning and implementation of response

Response, reconstruction and preparedness phases

Module 5

How do disasters affect the health system?

Socio-political context

Environmental context

Economic context

Community lifelines: water, electricity,

transportation

6 Building Blocks of the Health System:

Health services

Health Workforce

Health Information

Medical Products and Technologies

Health Financing

Health Governance

Health

Source: Informal discussion with Dr R Lejano, UC Irvine, 2009

Module 5Activity 3: How emergencies/disasters affect the health system

Divide into 3 groups

Discuss on how disasters can affect the building blocks of the health system,Group A: Service delivery, health workforceGroup B: Information, medical products and

technologiesGroup C: Health financing, leadership/ governance

List down salient points and discuss with the group

Module 5

Activity 3: ResultsService delivery

Health workforce

Information

Medical products and technologies

Health financing

Leadership/governance

Module 5

How disasters affect the health systemService delivery

Medical & surgical services: outpatient and inpatient care

Public health services: immunization, health promotion, reproductive health, environmental health, maternal and child health

Health workforceDirect and indirect impact to health professionals

and their familiesSame number of staff to work on increased

demandSafety, security & psychosocial support

Module 5

How disasters affect the health systemInformation

Information system breakdownNeed for rapid information

Medical products and technologiesDamages and losses Increased demand for medical products and

technologies

Module 5

How disasters affect the health systemHealth financing

Direct and indirect economic losses Increased demand for expenditureResponse require faster resource/finance

mobilization mechanisms

Leadership/governance Increased demand for quick decision makingShift to emergency mode Influx of external agencies, NGOs and groups

Module 5

WPRO Health Systems Assessment Tool

WHO/WPRO, 2009(Lejano, Sablan, et al)

Tool developed for assessment of the health systems in order to aid health emergency planners and policy makers for medium-

and longer- term decisions.Questions are answerable by YES or NO.

Module 5

WPRO Health Systems Assessment ToolService delivery

Are there health facility structures/buildings and/or key equipment within them that have been damaged by the disaster?

Are there support systems that have been damaged by the disaster?

Are there health services/programs that have been compromised by the disaster?

Module 5

WPRO Health Systems Assessment ToolHealth workforce

Did staff complement/ number of personnel reporting for work become a problem in the adequate carrying out of emergency response and recovery measures?

Did staff knowledge and skills become a problem in the adequate carrying out of emergency response and recovery measures?

Were the members of the hospital staff affected by disrupted lifelines (i.e., communication, transportation, shelter)?

Module 5

WPRO Health Systems Assessment ToolInformation

Are there concerns regarding health information systems concerning individuals as patients?

Are there concerns regarding health information systems on health facilities?

Are there concerns regarding health information on the general population?

Are there concerns regarding health information concerned with public health?

Module 5

WPRO Health Systems Assessment ToolMedical products and technologies

Is there adequate supply of essential drugs in the health facilities? Are these readily available and affordable?

Are there concerns regarding quality of the drugs/vaccines available in the health facilities and pharmacies?

Are there concerns regarding availability, safety and accessibility of blood transfusion services in the health facilities?

Are there concerns regarding the availability of hospital equipment necessary for the basic surgical, anesthetic, medical and emergency care appropriate for the level of service a health facility offers?

Are there concerns regarding safety, reliability and availability of diagnostic and laboratory technology services in the area?

Are there concerns regarding safety, reliability and availability of diagnostic and imaging services in the area?

Module 5

WPRO Health Systems Assessment ToolHealth financing

Did the disaster affect (increased, decreased, scrapped) the revenue, government funding, and expenses of the health facilities in the subject area?

Was funding of health programs affected (increased, decreased, scrapped) by the disaster?

Module 5

WPRO Health Systems Assessment ToolLeadership/governance

Did the disaster reveal any major issues in how emergencies are responded to, in how tasks and funds are allocated during emergencies, and how decisions are made during emergencies?

Did the government and other agency response to the disaster divert from and possibly change the way decision-making, allocation of funds, and allocation of tasks among agencies are made during an emergency?

Module 5

Referenceshttp://www.wpro.who.int/sites/hsd/overview.htm

Philippine Floods Response: Evaluation using the Health Systems Approach (WHO/WPRO, 2009)