Emergencies and the Health Systems

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Emergencies and the Health Systems
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Health System
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Objectives

• At the end of this 1-hour session, the
  participants will be able to
• Define and discuss the building blocks of the
  health system
• Discuss how emergencies/disasters disrupt the
  existing health system
• Describe health emergency response using the
  health systems approach

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Contents

• WHO health system building blocks
• Health systems in emergencies

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Emergency
Save lives
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Health system
Evacuation centres Security Nutrition
Surveillance Disease prevention and control
Logistics Information Management Resource
Mobilization Risk Communication
Emergency
Save lives
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What is a health system?
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The Health System

• A 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
• Includes
• A mother caring for a sick child at home
• Private care providers
• Behaviour change programmes
• Vector-control campaigns
• Health insurance organizations
• Occupational health and safety legislation
• Inter-sectoral action by health staff

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The WHO Health Systems Framework
System building blocks
Goals/outcomes
Service delivery
Improved health (level and quality)
Health workforce
Access coverage
Responsiveness
Information
Medical products technologies
Financial risk protection
Quality safety
Health financing
Improved efficiency
Leadership/ governance
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The WHO Health Systems Building Blocks

• Service delivery
• Health workforce
• Information
• Medical products and technologies
• Health financing
• Leadership/governance

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The WHO Health Systems Building Blocks

• Service 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

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The WHO Health Systems Building Blocks

• Medical 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

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Health Systems in Emergencies

• Emergencies/disasters affect the health system
• Consideration for assessment, planning and
  implementation of response
• Response, reconstruction and preparedness phases

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How do disasters affect the health system?
6 Building Blocks of the Health System Health
services Health Workforce Health
Information Medical Products and
Technologies Health Financing Health Governance
Socio-political context
Environmental context
Health
Economic context
Community lifelines water, electricity,
transportation
Source Informal discussion with Dr R Lejano, UC
Irvine, 2009
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Activity 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 workforce
• Group B Information, medical products and
  technologies
• Group C Health financing, leadership/ governance
• List down salient points and discuss with the
  group

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Activity 3 Results

• Service delivery
• Health workforce
• Information
• Medical products and technologies
• Health financing
• Leadership/governance

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How disasters affect the health system

• Service delivery
• Medical surgical services outpatient and
  inpatient care
• Public health services immunization, health
  promotion, reproductive health, environmental
  health, maternal and child health
• Health workforce
• Direct and indirect impact to health
  professionals and their families
• Same number of staff to work on increased demand
• Safety, security psychosocial support

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How disasters affect the health system

• Information
• Information system breakdown
• Need for rapid information
• Medical products and technologies
• Damages and losses
• Increased demand for medical products and
  technologies

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How disasters affect the health system

• Health financing
• Direct and indirect economic losses
• Increased demand for expenditure
• Response require faster resource/finance
  mobilization mechanisms
• Leadership/governance
• Increased demand for quick decision making
• Shift to emergency mode
• Influx of external agencies, NGOs and groups

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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.

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WPRO Health Systems Assessment Tool

• Service 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?

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WPRO Health Systems Assessment Tool

• Health 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)?

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WPRO Health Systems Assessment Tool

• Information
• 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?

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WPRO Health Systems Assessment Tool

• Medical 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?

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WPRO Health Systems Assessment Tool

• Health 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?
  

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WPRO Health Systems Assessment Tool

• Leadership/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?

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References

• http//www.wpro.who.int/sites/hsd/overview.htm
• Philippine Floods Response Evaluation using the
  Health Systems Approach (WHO/WPRO, 2009)