1. To understand determinants of health with special focus on social determinants of health(SDH). 2. To define responsibility for Health. 3. To learn about health delivery system of Pakistan.

2. Determinants of Health and
Health Delivery System of
Pakistan
DR. SINDHU ALMAS
LECTURER COMMUNITY MEDICINE
DEPARTMENT, LUMHS JAMSHORO.

3. OBJECTIVE
S
To understand determinants of
health with special focus on social
determinants of health(SDH)
To define responsibility for Health
To learn about health delivery
system of Pakistan
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4. HEALTH
HEALTH IS A STATE OF PHYSICAL,
MENTAL, SOCIAL AND SPIRITUAL
WELLBEING AND NOT MERELY
ABSENCE OF DISEASE OR INFIRMITY.
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5. DETERMINANTS OF HEALTH
Biological
Behavioral
Environmental
Socio-economic
Health
System
Socio-
cultural
Ageing of
population Science &
technology
Information &
communication
Gender
Equity &
Social justice
Human
rights

6. ASSIGNMEN
T
WRITE A DETAILED NOTE
ON DETERMINANTS OF
HEALTH. (HANDWRITTEN)
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ECONOMIC STATUS: The per capita GNP is the most
widely accepted measure of general economic
performance.
The economic progress of many countries has been a
major factor in reducing the morbidity, mortality,
increase in life expectancy & improving of the quality of
life, family size, & the pattern of disease & deviant
behaviour in the community.

9. EDUCATIO
N
• EDUCATION IS THE SECOND
MAJOR INFLUENCING FACTOR IN
AFFECTING THE HEALTH OF THE
POPULATION.
• THE WORLD MAP OF ILLITERACY
CLOSELY COINCIDES WITH THE
MAPS OF POVERTY,
MALNUTRITION, ILL HEALTH, HIGH
INFANT & CHILD MORTALITY
RATES.
• STUDIES INDICATE THAT
EDUCATION TO SOME EXTENT
COMPENSATES THE EFFECTS OF
POVERTY ON HEALTH,
IRRESPECTIVE OF THE
AVAILABILITY OF HEALTH
FACILITIES.
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10. OCCUPATIO
N
• UN EMPLOYMENT USUALLY
SHOWS A HIGHER INCIDENCE
OF ILL HEALTH & DEATH.
• FOR MANY, LOSS OF WORK
MAY MEAN LOSS OF INCOME
& STATUS.
• IT CAN CAUSE
PSYCHOLOGICAL & SOCIAL
DAMAGE.
• THE VERY STATE OF BEING
EMPLOYED IN PRODUCTIVE
WORK PROMOTES HEALTH.
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11. RESPONSIBILI
TY FOR
HEALTH
IN OLDEN DAYS THE PRIMARY
PURPOSE OF A HEALTH CARE SYSTEM
WAS TO PROVIDE CARE TO THE ILL
AND INJURED. HOWEVER, WITH
INCREASING AWARENESS HEALTH
CARE SYSTEMS ARE CHANGING.
HEALTH CARE PROVIDER HAS THE
MANY RESPONSIBILITIES TOWARDS
COMMUNITY AND CLIENTS. APART
FROM US OUR CLIENTS HAS SOME
RESPONSIBILITIES TOWARDS THE
HEALTH CARE SYSTEM ALSO.
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12. HEALTH
CARE
A MULTITUDE OF SERVICES
PROVIDED TO INDIVIDUALS,
FAMILIES OR COMMUNITIES BY
PROVIDERS OF HEALTH
SERVICES OR HEALTH
PROFESSIONALS FOR
PROMOTING, MAINTAINING,
MONITORING OR RESTORING
HEALTH IS CALLED HEALTH
CARE.
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13. PREVENTAT
IVE CARE
A PATTERN OF NURSING AND
MEDICAL CARE THAT
FOCUSES ON DISEASE
PREVENTION AND HEALTH
MAINTENANCE. IT INCLUDES
EARLY DIAGNOSIS OF
DISEASE, COUNSELLING, AND
OTHER NECESSARY
INTERVENTION TO AVERT A
HEALTH PROBLEM. SCREENING
TESTS, HEALTH EDUCATION,
AND IMMUNIZATION
PROGRAMS ARE COMMON
EXAMPLES OF PREVENTIVE
CARE.
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14. CURATI
VE CARE
CURATIVE CARE IS THE
KIND OF HEALTH
CARE TRADITIONALLY
ORIENTED TOWARDS
SEEKING A CURE FOR
AN EXISTENT DISEASE
OR MEDICAL
CONDITION.
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15. REHABILITATI
VE CARE
REHABILITATIVE CARE
IS A TREATMENT OR
TREATMENTS
DESIGNED TO
FACILITATE THE
PROCESS OF
RECOVERY FROM
INJURY, ILLNESS, OR
DISEASE TO AS
NORMAL A
CONDITION AS
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16. TYPES
OF
HEALTH
CARE
SERVICE
S
• HEALTH PROMOTION
& ILLNESS PREVENTION
( PRIMARY
PREVENTION)
• DIAGNOSIS &
TREATMENT (
SECONDARY
PREVENTION )
• REHABILITATION &
HEALTH RESTORATION
( TERTIARY
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18. HEALTH
DELIVERY
SYSTEM
OF
PAKISTAN
HEALTH CARE SERVICES ARE
DELIVERED THROUGH A
SYSTEM CALLED: HEALTH
CARE DELIVERY SYSTEM THAT
CONSTITUTES THE
MANAGEMENT &
ORGANIZATIONAL MATTERS
WITH THE AIM OF HEALTH
DEVELOPMENT OF
POPULATION TO ACHIEVE
GOAL OF “HEALTH FOR ALL”.
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19. HEALTH DELIVERY SYSTEM
Basic Health
Units
Rural Health Centers
District
Headquarters
Hospital
Tertiary
Hospitals
Population Served
Referral Centers
DHQ: 1Million to 1.5m
THQ: 100,000 – 300,000
5,000 – 10,000
Health Care Providers
Specialists, Doctors,
Nurses,
Paramedical Staff
RHC: Pop: 50,000 to 100,000 , 10-20 beds, with
about 30 staff including 2 M.Os, 1 WMO, 1
dental surgeon & a no: of paramedics.
, x-ray, laboratory and minor surgery facilities.
These do not include delivery and emergency
obstetric services.
THQ / DHQ: They typically have 40-60 beds and
appropriate support services
including x-ray, laboratory and surgery facilities. The
staff includes at least three
specialists: an obstetrician & gynecologist, a
pediatrician and a general surgeon.
BHUs staff of 10 ( a male doctor, a LHV or a
FHT, a Male Medical Technician or/and a
dispenser, a trained or unqualified midwife (dai),
a sanitary
inspector, a vaccinator, and 2-3 support staff
(guard, sweeper, gardener, etc.). They are
required to offer first level curative, MCH, family
planning and preventive services .
50,000 –100,000
Primary care facilities:
(MCH, BHU, RHC)
MCH ,Family planning ,
& Curative, prev:
services
Referral level care facilities:
THQH, DHQH
Tertiary care facilities:
Teaching Institutions

20. BASIC
HEALTH
UNITS:
• BHU: STAFF OF 10 ( A MALE DOCTOR, A
LHV OR AN FHT, A MALE MEDICAL
TECHNICIAN OR/AND A DISPENSER, A
TRAINED OR UNQUALIFIED MIDWIFE (DAI),
A SANITARY INSPECTOR, A VACCINATOR,
AND 2-3 SUPPORT STAFF (GUARD,
SWEEPER, GARDENER, ETC.).
• THEY ARE REQUIRED TO OFFER FIRST
LEVEL CURATIVE, MCH, FAMILY PLANNING
AND PREVENTIVE SERVICES

21. FUNCTION
S
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Treatment & medication of Rural
population
Vaccination programs
Health Education
Implementation of National programs
Provision of basic health and antenatal
care for women & children.

22. RURAL
HEALTH
CENTER:
• RHC: POP: 50,000 TO 100,000 ,
10-20 BEDS, WITH ABOUT 30
STAFF INCLUDING 2 M.OS, 1
WMO, 1 DENTAL SURGEON & A
NO: OF PARAMEDICS.
• X-RAY, LABORATORY AND MINOR
SURGERY FACILITIES. THESE DO
NOT INCLUDE DELIVERY AND
EMERGENCY OBSTETRIC
SERVICES

23. TALUKA
HEADQUARTE
R HOSPITALS
• POPULATION COVERAGE 100-K
TO 300-K
• THEY TYPICALLY HAVE 40-60
BEDS AND APPROPRIATE SUPPORT
SERVICES
• X-RAY, LABORATORY AND
SURGERY FACILITIES. THE STAFF
INCLUDES AT LEAST THREE
SPECIALISTS: AN OBSTETRICIAN &
GYNECOLOGIST, A PEDIATRICIAN
AND A GENERAL SURGEON

24. DISTRICT
HEAD
QUARTER
HOSPITAL
S
• POPULATION COVERED 1
MILLION TO 1.5 MILLIONS
• EMERGENCY AND INDOOR
FACILITIES, 24/7
• NON COMPLICATED SURGERIES
ARE DONE
• ESSENTIAL MATERNAL AND CHILD
HEALTH CARE SERVICES
• MOST OF THE PREVENTIVE AND
CURATIVE SERVICES ARE
PROVIDED THERE
• REFERRALS OF COMPLICATED
CASES AND SUPER-SPECIALITIES

25. TERTIARY CARE/TEACHING
HOSPITALS
Divisions and many
districts are the
catchment population
These hospitals are the
highest seats of
healthcare delivery
system
Teaching
institutes/Medical
Colleges/Universities are
attached to these
hospitals
All types of Surgeries,
Intensive care and
investigations services
are available here
Neurosurgery, Cardiac
interventions, Plastic
surgery and other
specialities are specific to
Tertiary level hospitals
It also serves for
Teaching and training
purpose for Medical,
Dental and other allied
health disciplines

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