THE HUBERT KAIRUKI MEMORIAL UNIVERSITY FACULTY OF MEDICINE

THE HUBERT KAIRUKI MEMORIAL UNIVERSITY FACULTY OF MEDICINE BEHAVIOURAL SCIENCES AND ETHICS

TOPIC: ISSUES IN HEALTH CARE DELIVERY DATE: 13 TH May 2015 FACILITATOR: DR. LIWA PRESENTERS: BONAVENTURE NYAKI BUKOMBE BULOLE DORAH MOLLEL LYDIA BARNABAS SOSPETER MANDAMANO

TABLE OF CONTENTS � � � � INTRODUCTION OBJECTIVES DEFINITION OF TERMS MAIN PRESENTATION CONCLUSION SUMMARY RECOMMENDATIONS REFERENCES

Introduction � Health care delivery is a diagnosis treatment and prevention of disease, illness, injury and other physical and mental impairment in human beings, in which the services are rendered by members of the health professionals for the benefit of a patient.

• Issues in health care delivery refers to problems or obstacles facing health professionals in delivering or providing health care to patients. • This presentation is about the issues in health care delivery generally, our presentation will depict the issues and solutions.

OBJECTIVES At the end of this presentation we should all be able to: � Define Health and Health care � Know the levels of health care � Know the issues in health care delivery � Understand how the government and community based organizations participates in healthcare delivery

� Know the problems and solutions in health care delivery � Apply the solutions in our medical field

DEFINITION OF TERMS. � � � Health: Is the state of complete physical, mental and social well-being and not merely absence of disease or infirmity. Health care: Is a diagnosis treatment and prevention of disease, illness, injury and other physical and mental impairment in human beings. Heath care delivery: Are services rendered/provided by members of the health professionals for the benefit of a patient.

Cont………. . � Issues in Health care delivery: refers to problems or obstacles facing health professionals in delivering or providing health care to patients.

Main presentation LEVELS OF HEALTH CARE � Primary health care: -It refers to the work health professional who act as a first point of consultation for all patients within the health care system. E. g. General practitioner, Family physician. � Secondary health care: - Is the health care that is provided by medical specialists and other health professional's who do not have first contact with patients. E. g. Cardiologist, Dermatologist.

Cont. …… Tertiary care: -Is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment such as tertiary referral hospital. E. g. Cancer management, Cardiac surgery and Plastic surgery �

Cont……. GOVERNMENT METHODS OF PAYMENT FOR SERVICES. � MEDICARE: Federal government program that makes health care payments to those on social security. i) Pays cost for the: Ø Ø Ø Elderly age (>65) Disabled Dependents of disabled

Cont…. . ii) Covered services include: � Hospitals � Laboratory work-ups � Non self administered drugs � Ambulance transport iii) Non-covered services: � Eye/Ear examination for glasses/hearing aids � Most self administered drugs � Routine foot care

Main presentation B) MEDICAID: Health care payment for those on welfare. i) Covers all care including: � Hospital stays � Physician services � Medication � Nursing home

Main Presentation ii) Poor and over 65 years of age, Medicare is first used the Medicaid. C) DIAGNOSTIC RELATED GROUPS(DRGs): Payment categories used to classify patients(medicare patients) for the purpose of refunding hospitals for each case in a given category. DRGs are assigned based on diagnosis, procedure, age, sex and discharge status.

Cont…. . COMMUNITY BASED ORGANIZATIONS IN HEALTH CARE DELIVERY Community based organizations in their role of health care delivery have started insurance organizations such as the National Health insurance Fund (NHIF), Changamka Microhealth Limited, Micro. Ensure , Tanzania’s National Social Security Fund and Assurances Générales du Laos(AGL).

Cont…. . National Health Insurance Fund (NHIF) Enrolment in the national health insurance fund is mandatory formal sector employees and voluntary for all informal sector workers. The scheme offers wide range of preventative and curative medical care benefit. � The benefits of the government driven scheme includes diagnostic test, out-patients services, dental services physiotherapy, glasses and minor surgery. Services are provided by the accredited health facilities and pharmacies.

Cont…. . � � The premium formal sector employees is 6% of the employees salary. The employer contributes 3% and the employees pays the remaining 3%. The informal sector workers pays a flat fee. In 2010 the membership size increased to 373, 326 from 332, 650 in 2009 and to 1, 971, 251 beneficiaries from 1, 830, 375 in 2009. Tanzania’s National Social Security Fund It began in 1997 to replace the National provident Fund and to compliment the National Health Insurance Fund. The goal was to enroll 85% of the employees in the informal and 85% of individual living……

Cont…. . in rural areas. This program covers out-patients services including consultations, basic and specialized investigations, simple and specialized procedures, Drugs in the national drug lists, Referrals to higher levels and special hospitals. 3. 9% of the Tanzanian population was covered in 2009 and 2010.

Cont… BIGGEST PROBLEMS IN HEALTH CARE TODAY INCLUDE: � Lack of medical personnel. � Inadequate medical equipment's. � Usage of expired drugs. � Bad government policy. � Ignorance.

Cont… � Centralization of health care centers. � Limited Knowledge and skills among staff and counselor's in planning health care delivery.

Cont… � Corruption and misuse of resources � Brain drain ( Continuous loss of personnel to foreign countries) � Eruption of new diseases due to change in environment. eg Malaria, Rift Valley fever, Bird flue and Dengue. � Overpopulation � Poor infrastructure

Cont… SOLUTIONS IN HEALTH CARE DELIVERY INCLUDE: � To motivate people into the medical field. � Health care centers should be built around all areas. � Invest more in the health sector. � Management of all resources in health facilities. � Modified working conditions to prevent brain drain. � Policies formulated should be implemented.

Cont… There is need to discuss the professional socialization of nurses, physicians, and other members of the health care delivery system in relations to scheme of services and benefits, especially the opportunity to pursue higher degrees after the primary degree in an area of specialization. Ø There is need to describe the “culture” of the health care providers. Ø

Cont… Comparing the growth of the Gross Domestic Product and National Health Care Expenditures over time, in Tanzania, East Africa and Africa in general, medical personell is somehow left out, that means the is a challenege of not getting effective motivation, not effective payments, and recognition for the services they render compared to politicians, and other rare professions. Ø

Cont… We also need to recognize the interrelationships and trends of sociocultural, public health, and medical events that have produced the crises in today’s modern health care system. Ø We then have to break down the complex web of factors that impede a given person’s passage through the health care system. Ø Issues in health care delivery call for a description of barriers to health care to all, including medical and health care professionals. Ø

e v ei a h t e o t r e i p s i It p a h v i g o t n c e r

SUMMARY Health care delivery applies in the government and in the community. In some areas there are poor facilities so health delivery is not appropriately administered for example in remote areas. �

CONCLUSION Ultimately, medical personnel must be willing to collaborate with all members of the health care team in order to provide the best possible care for patients. With thorough knowledge of health care delivery models and leadership skills, they can provide their patients with the highest quality care that only a good leader can provide. �

Recommendations. The government should enable electronic financial management to ensure effective collection allocation and use of health financial resources at all levels in accordance with health plan priorities, this includes comprehensive planning, budgeting and reporting between central levels and recipients(District, Region and National). �

REFERENCES � www. en. m. wikipedia. org/wiki/Health_care � Tanzania e. Health startegies. pdf � Behavioral Science 5 th edition by, Barbara Fadem � Kaplan USMLE-1(2003)-Behavioral Sciences Bond J. & Bond S. (1994). Sociology and Health Care. Churchill Livingstone. � Johns Hopkins Medicine. Patient Care: Tertiary Care Definition. 2011. �

REFERENCES Simmons J. Primary Care Needs New Innovations to Meet Growing Demands. Health. Leaders Media, 2009. � Tulenko et al. , "Framework and measurement issues for monitoring entry into the health workforce. " Handbook on monitoring and evaluation of human resources for health. Geneva, World Health Organization, 2012. � World Health Organization. International Classification of Primary Care, Second edition (ICPC 2). Geneva. 2011. �

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