SlideShare ist ein Scribd-Unternehmen logo
1 von 23
Downloaden Sie, um offline zu lesen
Future Scenarios for Health
        Service Delivery

               Hilary Standing
         Date: 01:01:2006
Plenary presentation for the 12th Annual Scientific
Conference (ASCON): Health Systems Research:
People’s Needs First 10-12 February 2009, ICDDR,B,
Dhaka, Bangladesh
Acknowledgements

Research partners and colleagues:
   – Future Health Systems Consortium
   – ICDDRB and BRAC University School of Public
      Health, Bangladesh
   – Health and Social Change Programme, Institute
      of Development Studies, UK

   Photography
    – Thanks to Dr Shah Mohammed, BSPH MPH
      batch 2007-8
Health service delivery in low and middle
                income countries
     Operational and research challenges for the (not-so-
                       new) Millennium

A changing world:
   Epidemiological transformations
   Health inequalities
   Marketisation of goods and services
   Shortage and maldistribution of health human resources

Which ways forward?
  Challenges present opportunities
  Look “south” rather than “north” for innovation
  Move away from sterile debates
Challenge 1:
Changes in the
burden of disease
Future Scenarios for Health Service Delivery
Major Causes of Death in Persons of All Ages in Low- and Middle-Income Regions
Challenge 2: Health
inequalities
Child Health inequalities (from Gwatkin et.al. 2005)
Service utilisation inequalities (from Gwatkin et.al. 2005)
Challenge 3: The
rise and rise of
health markets
Future Scenarios for Health Service Delivery
Non-state health care delivery – an increasing
                       trend

The “non-state” sector provides an increasingly major share of total
service delivery, particularly in Asia (e.g. estimated 80% of limited
curative care in India)
Health markets have spread very rapidly in low and middle income
countries, as have market type relationships, both formal and informal
Most health care paid for “out of pocket” whether “public” or “private”
Rise of markets associated with both rise in market type transactions
generally in all economic sectors, and crises in the capacity and quality
of publicly funded services
Poor increasingly purchase services in the market.
Largest part of this expenditure on drugs, often from unlicensed
providers
This burgeoning marketised health economy raises major issues in
relation to cost, quality, competence and regulation
Future Scenarios for Health Service Delivery
Challenge 4: Health
human resources
Distribution of physician, nurse and dentist per 10,000
population and nurse per physician ratio - Bangladesh
Adapted from Table 3.2, Bangladesh Health Watch Report 2008


                Physician Nurse Dentist      All       Nurse per
                                                     physician ratio

  Location


  Rural           1.1       0.8     0.08     2.1           0.7


  Urban           18.2      5.8      0.8    24.9           0.3


  All             5.4       2.1      0.3     7.7           0.4
  (WHO                                      (2.28/
  recommended
                                            1000)
  ratio)
Distribution of other allopathic providers per 10,000 population - Bangladesh
Adapted from Annex 3: Bangladesh Health Watch Report 2008


                Paramedical allopathic         Unqualified allopathic     Traditional
                     providers*                     providers                 Birth
                     Community Health                                     Attendants,
                          Workers                                          Untrained
                    Govt.   Non-       All   Village    Drug       All    and trained
                            Govt.            doctors    store
                                                       salespe
                                                        ople,
                                                         drug
                                                       vendors


  Location
   Rural             3.6      7.3     10.9    13.8      10.8      24.6       42.2
   Urban             2.0      3.9      5.9     8.8      13.2      22.1       6.0
  All                3.2      6.4      9.6    12.5       11.4      23.9      33.2
Providers in pluralistic health systems

  Health care delivery systems highly pluralistic, practitioners vary
  greatly in their practice settings, type of knowledge, associated
  training, and relationship with the state and legal system
  Informal providers generally first provider of resort in rural areas
  Advantages:
    – convenient, affordable , available, better attitudes to users
  Challenges:
    – no quality control, reluctant to refer, over/misuse of drugs
  BUT
    – these problems are not confined to the informal sector.

Issues of “stewardship” and governance cut across both formal
   and informal service delivery systems
Research needs to respond to some new
                  parameters
Managing both infectious and chronic diseases from a low
resource base – what does this mean for primary health care
services, health human resources and financing of health care
costs?
How should services and interventions respond to the shift to
prevention and long term management of chronic diseases?
People live with them, they don’t just die from them
Particularly in a global economy, markets and pharmaceuticals
likely to intensify spread in the health sector – chronic diseases
will be an increasing market segment
Much greater access to information from multiple sources,
increasing self-treatment through retail pharmacies etc. – the
trend is not going to reverse
Balancing challenges with opportunities for
                 service delivery
           Research in support of policy

Learning from service delivery innovations
 – Using ICTs for training, diagnostics, remote information
 – Learning from other models e.g. ART therapy, DOTS
 – Adapting from market based approaches, e.g. licensing,
   accreditation, franchising
 – Delivering healthier lives, not just delivering health services
Rethinking human resources for health in a changing world
 – Different skill mixes and task combinations are possible
 – Use existing health workforces more effectively
 – Revisit incentives in a pluralistic systems
 – Different approaches to expertise – expert users as well as
   expert professionals
park pict ure .jpg
More challenges and opportunities…..

More equitable financing and access models
 – Moving to universal coverage through leveraging new
   combinations of public, private and external finance, e.g.
   micro-finance, social business models as well as tax
   revenues and external funds. Who pays for the poor?
 – Backing health and nutrition interventions onto anti-poverty
   and sustainable livelihoods programmes – what works?
New models of governance for the sector - “stewardship”
agenda
 – Government with new stakeholder coalitions, citizen
   engagement e.g. Health Watch approaches
 – Learning from other marketised sectors, increasing role for
   consumer protection?
 – Global governance needs for pharmaceuticals, services
THANK YOU!
Future Scenarios for Health Service Delivery

Weitere ähnliche Inhalte

Was ist angesagt?

China healthcare policy_study
China healthcare policy_studyChina healthcare policy_study
China healthcare policy_studyelmoria
 
HEALTH CARE SYSTEM IN CHINA
HEALTH CARE SYSTEM IN CHINAHEALTH CARE SYSTEM IN CHINA
HEALTH CARE SYSTEM IN CHINASayed Sara
 
China's Healthcare System
China's Healthcare SystemChina's Healthcare System
China's Healthcare SystemKatelyn Lutz
 
korean healthcare system overview
korean healthcare system overviewkorean healthcare system overview
korean healthcare system overviewChiweon Kim
 
Overview of Ghana’s National Health Insurance Scheme
Overview of Ghana’s National Health Insurance SchemeOverview of Ghana’s National Health Insurance Scheme
Overview of Ghana’s National Health Insurance SchemeHFG Project
 
Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture
Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine LecturePeter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture
Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lectureuabsom
 
Health Financing Profile: Ghana
Health Financing Profile: GhanaHealth Financing Profile: Ghana
Health Financing Profile: GhanaHFG Project
 
An Introduction of Healthcare Market in China
An Introduction of Healthcare Market in ChinaAn Introduction of Healthcare Market in China
An Introduction of Healthcare Market in ChinaZiqian WANG
 
The study on social impact of free health service in Sri Lanka
The study on social impact of free health service in Sri LankaThe study on social impact of free health service in Sri Lanka
The study on social impact of free health service in Sri LankaRavi Kumudesh
 
China healthcare overview
China healthcare overviewChina healthcare overview
China healthcare overviewTechnomic Asia
 
Public Health Situation in Thailand
Public Health Situation in ThailandPublic Health Situation in Thailand
Public Health Situation in ThailandDr.Choen Krainara
 
Researching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health CoverageResearching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health Coverageresyst
 
Medical Reform - Hong Kong
Medical Reform - Hong KongMedical Reform - Hong Kong
Medical Reform - Hong Kongrexchen007
 
Future Watch: Healthcare in China and opportunities for Finnish technologies
Future Watch: Healthcare in China and opportunities for Finnish technologiesFuture Watch: Healthcare in China and opportunities for Finnish technologies
Future Watch: Healthcare in China and opportunities for Finnish technologiesTeam Finland Future Watch
 
China Healthcare Overview
China Healthcare OverviewChina Healthcare Overview
China Healthcare OverviewAmmar
 
Health Financing Within the Overall Health System
Health Financing Within the Overall Health SystemHealth Financing Within the Overall Health System
Health Financing Within the Overall Health SystemHFG Project
 
Mhc 720 Jh01 Health Care Systems Health Care In China 121307
Mhc 720 Jh01 Health Care Systems Health Care In China 121307Mhc 720 Jh01 Health Care Systems Health Care In China 121307
Mhc 720 Jh01 Health Care Systems Health Care In China 121307Leslie Pirtle, MM, MEd
 
Sri lanka ppt (2)
Sri lanka ppt (2)Sri lanka ppt (2)
Sri lanka ppt (2)bugmenomore
 

Was ist angesagt? (20)

China healthcare policy_study
China healthcare policy_studyChina healthcare policy_study
China healthcare policy_study
 
HEALTH CARE SYSTEM IN CHINA
HEALTH CARE SYSTEM IN CHINAHEALTH CARE SYSTEM IN CHINA
HEALTH CARE SYSTEM IN CHINA
 
China's Healthcare System
China's Healthcare SystemChina's Healthcare System
China's Healthcare System
 
korean healthcare system overview
korean healthcare system overviewkorean healthcare system overview
korean healthcare system overview
 
UHC lesson learn Thailand
UHC lesson learn ThailandUHC lesson learn Thailand
UHC lesson learn Thailand
 
Overview of Ghana’s National Health Insurance Scheme
Overview of Ghana’s National Health Insurance SchemeOverview of Ghana’s National Health Insurance Scheme
Overview of Ghana’s National Health Insurance Scheme
 
Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture
Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine LecturePeter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture
Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lecture
 
Health Financing Profile: Ghana
Health Financing Profile: GhanaHealth Financing Profile: Ghana
Health Financing Profile: Ghana
 
An Introduction of Healthcare Market in China
An Introduction of Healthcare Market in ChinaAn Introduction of Healthcare Market in China
An Introduction of Healthcare Market in China
 
Public financing of healh in developing countries: a cross-national systemati...
Public financing of healh in developing countries: a cross-national systemati...Public financing of healh in developing countries: a cross-national systemati...
Public financing of healh in developing countries: a cross-national systemati...
 
The study on social impact of free health service in Sri Lanka
The study on social impact of free health service in Sri LankaThe study on social impact of free health service in Sri Lanka
The study on social impact of free health service in Sri Lanka
 
China healthcare overview
China healthcare overviewChina healthcare overview
China healthcare overview
 
Public Health Situation in Thailand
Public Health Situation in ThailandPublic Health Situation in Thailand
Public Health Situation in Thailand
 
Researching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health CoverageResearching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health Coverage
 
Medical Reform - Hong Kong
Medical Reform - Hong KongMedical Reform - Hong Kong
Medical Reform - Hong Kong
 
Future Watch: Healthcare in China and opportunities for Finnish technologies
Future Watch: Healthcare in China and opportunities for Finnish technologiesFuture Watch: Healthcare in China and opportunities for Finnish technologies
Future Watch: Healthcare in China and opportunities for Finnish technologies
 
China Healthcare Overview
China Healthcare OverviewChina Healthcare Overview
China Healthcare Overview
 
Health Financing Within the Overall Health System
Health Financing Within the Overall Health SystemHealth Financing Within the Overall Health System
Health Financing Within the Overall Health System
 
Mhc 720 Jh01 Health Care Systems Health Care In China 121307
Mhc 720 Jh01 Health Care Systems Health Care In China 121307Mhc 720 Jh01 Health Care Systems Health Care In China 121307
Mhc 720 Jh01 Health Care Systems Health Care In China 121307
 
Sri lanka ppt (2)
Sri lanka ppt (2)Sri lanka ppt (2)
Sri lanka ppt (2)
 

Ähnlich wie Future Scenarios for Health Service Delivery

Using the case study below, develop a written report of your market .pdf
Using the case study below, develop a written report of your market .pdfUsing the case study below, develop a written report of your market .pdf
Using the case study below, develop a written report of your market .pdfmanjan6
 
A basic understanding o f H I V surveillance
A basic understanding o f H I V surveillanceA basic understanding o f H I V surveillance
A basic understanding o f H I V surveillanceDr.RAJEEV KASHYAP
 
Commercial private health sector
Commercial private health sectorCommercial private health sector
Commercial private health sectorDr.RAJEEV KASHYAP
 
HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care
HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV CareHAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care
HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV CarePhysicians for Human Rights
 
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRAUNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRAHarivansh Chopra
 
Pharma Market in Rural India
Pharma Market in Rural IndiaPharma Market in Rural India
Pharma Market in Rural IndiaAnup Soans
 
Using technology-enabled social prescriptions to disrupt healthcare
Using technology-enabled social prescriptions to disrupt healthcareUsing technology-enabled social prescriptions to disrupt healthcare
Using technology-enabled social prescriptions to disrupt healthcareDr Sven Jungmann
 
Challenges in Indian Healthcare Sector
Challenges in Indian Healthcare SectorChallenges in Indian Healthcare Sector
Challenges in Indian Healthcare SectorPrashant Mehta
 
Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...
Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...
Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...ReportsnReports
 
COUNTDOWN Louis Niessen - Launch 2015
COUNTDOWN Louis Niessen - Launch 2015COUNTDOWN Louis Niessen - Launch 2015
COUNTDOWN Louis Niessen - Launch 2015COUNTDOWN on NTDs
 
Quality health care india
Quality health care indiaQuality health care india
Quality health care indiaAbhilasha verma
 
National health policy 2017
National health policy 2017National health policy 2017
National health policy 2017shalu garg
 
Importance of Population Health Management
Importance of Population Health ManagementImportance of Population Health Management
Importance of Population Health ManagementNous Infosystems
 
FUTURE_OF_HEALTHCARE
FUTURE_OF_HEALTHCAREFUTURE_OF_HEALTHCARE
FUTURE_OF_HEALTHCARES_HIFT
 
Community pharmacy
Community pharmacyCommunity pharmacy
Community pharmacyAhmad Ali
 

Ähnlich wie Future Scenarios for Health Service Delivery (20)

PROJECT REPORT
PROJECT REPORTPROJECT REPORT
PROJECT REPORT
 
Using the case study below, develop a written report of your market .pdf
Using the case study below, develop a written report of your market .pdfUsing the case study below, develop a written report of your market .pdf
Using the case study below, develop a written report of your market .pdf
 
A basic understanding o f H I V surveillance
A basic understanding o f H I V surveillanceA basic understanding o f H I V surveillance
A basic understanding o f H I V surveillance
 
Commercial private health sector
Commercial private health sectorCommercial private health sector
Commercial private health sector
 
HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care
HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV CareHAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care
HAI & PEPFAR: Strengthening Mozambique Health System by Improving HIV Care
 
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRAUNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
 
3
33
3
 
Health System of Bangladesh
Health System of BangladeshHealth System of Bangladesh
Health System of Bangladesh
 
Pharma Market in Rural India
Pharma Market in Rural IndiaPharma Market in Rural India
Pharma Market in Rural India
 
Using technology-enabled social prescriptions to disrupt healthcare
Using technology-enabled social prescriptions to disrupt healthcareUsing technology-enabled social prescriptions to disrupt healthcare
Using technology-enabled social prescriptions to disrupt healthcare
 
Challenges in Indian Healthcare Sector
Challenges in Indian Healthcare SectorChallenges in Indian Healthcare Sector
Challenges in Indian Healthcare Sector
 
Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...
Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...
Tele-Health Carts, Servers, and Monitoring: Market Shares, Strategies, and Fo...
 
Overdiagnosis. astana 2018
Overdiagnosis. astana 2018Overdiagnosis. astana 2018
Overdiagnosis. astana 2018
 
COUNTDOWN Louis Niessen - Launch 2015
COUNTDOWN Louis Niessen - Launch 2015COUNTDOWN Louis Niessen - Launch 2015
COUNTDOWN Louis Niessen - Launch 2015
 
Quality health care india
Quality health care indiaQuality health care india
Quality health care india
 
National health policy 2017
National health policy 2017National health policy 2017
National health policy 2017
 
Importance of Population Health Management
Importance of Population Health ManagementImportance of Population Health Management
Importance of Population Health Management
 
Infiniteinn0vators
Infiniteinn0vatorsInfiniteinn0vators
Infiniteinn0vators
 
FUTURE_OF_HEALTHCARE
FUTURE_OF_HEALTHCAREFUTURE_OF_HEALTHCARE
FUTURE_OF_HEALTHCARE
 
Community pharmacy
Community pharmacyCommunity pharmacy
Community pharmacy
 

Mehr von IDS

Building Institutions for an effective health system
Building Institutions for an effective health systemBuilding Institutions for an effective health system
Building Institutions for an effective health systemIDS
 
Analysis of cross-country changes in health services
Analysis of cross-country changes in health services Analysis of cross-country changes in health services
Analysis of cross-country changes in health services IDS
 
The scale and scope of private contributions to health systems
The scale and scope of private contributions to health systemsThe scale and scope of private contributions to health systems
The scale and scope of private contributions to health systemsIDS
 
Presentation on the literature review of interventions to improve health care...
Presentation on the literature review of interventions to improve health care...Presentation on the literature review of interventions to improve health care...
Presentation on the literature review of interventions to improve health care...IDS
 
Evidence on Improving Health Service Delivery in Developing Countries
Evidence on Improving Health Service Delivery in Developing CountriesEvidence on Improving Health Service Delivery in Developing Countries
Evidence on Improving Health Service Delivery in Developing CountriesIDS
 
Pathways to Scaling up Health Services in Complex Adaptive Systems
Pathways to Scaling up Health Services in Complex Adaptive SystemsPathways to Scaling up Health Services in Complex Adaptive Systems
Pathways to Scaling up Health Services in Complex Adaptive SystemsIDS
 
The Parliamentarians’ Perception of the Public Health Sector in Afghanistan
The Parliamentarians’ Perception of the Public Health Sector in Afghanistan The Parliamentarians’ Perception of the Public Health Sector in Afghanistan
The Parliamentarians’ Perception of the Public Health Sector in Afghanistan IDS
 
Lessons Learned from Case Studies on Effective Service Delivery
Lessons Learned from Case Studies on Effective Service DeliveryLessons Learned from Case Studies on Effective Service Delivery
Lessons Learned from Case Studies on Effective Service DeliveryIDS
 
Learning by Doing and Applying our Learning
Learning by Doing and Applying our LearningLearning by Doing and Applying our Learning
Learning by Doing and Applying our LearningIDS
 
Institutional Analysis of the Ministry of Public Health at Central and Provin...
Institutional Analysis of the Ministry of Public Health at Central and Provin...Institutional Analysis of the Ministry of Public Health at Central and Provin...
Institutional Analysis of the Ministry of Public Health at Central and Provin...IDS
 
Implementing Rapid Medical Security reform in China: Importance of a Learning...
Implementing Rapid Medical Security reform in China: Importance of a Learning...Implementing Rapid Medical Security reform in China: Importance of a Learning...
Implementing Rapid Medical Security reform in China: Importance of a Learning...IDS
 
From research to policy CNHDRC strategies
From research to policy CNHDRC strategiesFrom research to policy CNHDRC strategies
From research to policy CNHDRC strategiesIDS
 
Evaluation of health systems performance: the role of Health Systems Research
Evaluation of health systems performance: the role of Health Systems ResearchEvaluation of health systems performance: the role of Health Systems Research
Evaluation of health systems performance: the role of Health Systems ResearchIDS
 
Making the right to health a reality to Indigenous People in Brazil
Making the right to health a reality to Indigenous People in Brazil Making the right to health a reality to Indigenous People in Brazil
Making the right to health a reality to Indigenous People in Brazil IDS
 
Afghanistan Health Sector Balanced Scorecard
Afghanistan Health Sector Balanced ScorecardAfghanistan Health Sector Balanced Scorecard
Afghanistan Health Sector Balanced ScorecardIDS
 
What must be done? Capacity building for health systems research in low & mid...
What must be done?Capacity building for health systems research in low & mid...What must be done?Capacity building for health systems research in low & mid...
What must be done? Capacity building for health systems research in low & mid...IDS
 
What must be done to ehance capacity for health systems research?
What must be done to ehance capacity for health systems research?What must be done to ehance capacity for health systems research?
What must be done to ehance capacity for health systems research?IDS
 
IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...
IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...
IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...IDS
 
Pathways to scaling up health services Peters and Paina
Pathways to scaling up health services Peters and PainaPathways to scaling up health services Peters and Paina
Pathways to scaling up health services Peters and PainaIDS
 
Beyond technical solutions PRINN in Nigeria
Beyond technical solutions PRINN in Nigeria Beyond technical solutions PRINN in Nigeria
Beyond technical solutions PRINN in Nigeria IDS
 

Mehr von IDS (20)

Building Institutions for an effective health system
Building Institutions for an effective health systemBuilding Institutions for an effective health system
Building Institutions for an effective health system
 
Analysis of cross-country changes in health services
Analysis of cross-country changes in health services Analysis of cross-country changes in health services
Analysis of cross-country changes in health services
 
The scale and scope of private contributions to health systems
The scale and scope of private contributions to health systemsThe scale and scope of private contributions to health systems
The scale and scope of private contributions to health systems
 
Presentation on the literature review of interventions to improve health care...
Presentation on the literature review of interventions to improve health care...Presentation on the literature review of interventions to improve health care...
Presentation on the literature review of interventions to improve health care...
 
Evidence on Improving Health Service Delivery in Developing Countries
Evidence on Improving Health Service Delivery in Developing CountriesEvidence on Improving Health Service Delivery in Developing Countries
Evidence on Improving Health Service Delivery in Developing Countries
 
Pathways to Scaling up Health Services in Complex Adaptive Systems
Pathways to Scaling up Health Services in Complex Adaptive SystemsPathways to Scaling up Health Services in Complex Adaptive Systems
Pathways to Scaling up Health Services in Complex Adaptive Systems
 
The Parliamentarians’ Perception of the Public Health Sector in Afghanistan
The Parliamentarians’ Perception of the Public Health Sector in Afghanistan The Parliamentarians’ Perception of the Public Health Sector in Afghanistan
The Parliamentarians’ Perception of the Public Health Sector in Afghanistan
 
Lessons Learned from Case Studies on Effective Service Delivery
Lessons Learned from Case Studies on Effective Service DeliveryLessons Learned from Case Studies on Effective Service Delivery
Lessons Learned from Case Studies on Effective Service Delivery
 
Learning by Doing and Applying our Learning
Learning by Doing and Applying our LearningLearning by Doing and Applying our Learning
Learning by Doing and Applying our Learning
 
Institutional Analysis of the Ministry of Public Health at Central and Provin...
Institutional Analysis of the Ministry of Public Health at Central and Provin...Institutional Analysis of the Ministry of Public Health at Central and Provin...
Institutional Analysis of the Ministry of Public Health at Central and Provin...
 
Implementing Rapid Medical Security reform in China: Importance of a Learning...
Implementing Rapid Medical Security reform in China: Importance of a Learning...Implementing Rapid Medical Security reform in China: Importance of a Learning...
Implementing Rapid Medical Security reform in China: Importance of a Learning...
 
From research to policy CNHDRC strategies
From research to policy CNHDRC strategiesFrom research to policy CNHDRC strategies
From research to policy CNHDRC strategies
 
Evaluation of health systems performance: the role of Health Systems Research
Evaluation of health systems performance: the role of Health Systems ResearchEvaluation of health systems performance: the role of Health Systems Research
Evaluation of health systems performance: the role of Health Systems Research
 
Making the right to health a reality to Indigenous People in Brazil
Making the right to health a reality to Indigenous People in Brazil Making the right to health a reality to Indigenous People in Brazil
Making the right to health a reality to Indigenous People in Brazil
 
Afghanistan Health Sector Balanced Scorecard
Afghanistan Health Sector Balanced ScorecardAfghanistan Health Sector Balanced Scorecard
Afghanistan Health Sector Balanced Scorecard
 
What must be done? Capacity building for health systems research in low & mid...
What must be done?Capacity building for health systems research in low & mid...What must be done?Capacity building for health systems research in low & mid...
What must be done? Capacity building for health systems research in low & mid...
 
What must be done to ehance capacity for health systems research?
What must be done to ehance capacity for health systems research?What must be done to ehance capacity for health systems research?
What must be done to ehance capacity for health systems research?
 
IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...
IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...
IMPROVING HEALTH SERVICE DELIVERY IN DEVELOPING COUNTRIES: FROM EVIDENCE TO ...
 
Pathways to scaling up health services Peters and Paina
Pathways to scaling up health services Peters and PainaPathways to scaling up health services Peters and Paina
Pathways to scaling up health services Peters and Paina
 
Beyond technical solutions PRINN in Nigeria
Beyond technical solutions PRINN in Nigeria Beyond technical solutions PRINN in Nigeria
Beyond technical solutions PRINN in Nigeria
 

Kürzlich hochgeladen

High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 

Kürzlich hochgeladen (20)

High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 

Future Scenarios for Health Service Delivery

  • 1. Future Scenarios for Health Service Delivery Hilary Standing Date: 01:01:2006 Plenary presentation for the 12th Annual Scientific Conference (ASCON): Health Systems Research: People’s Needs First 10-12 February 2009, ICDDR,B, Dhaka, Bangladesh
  • 2. Acknowledgements Research partners and colleagues: – Future Health Systems Consortium – ICDDRB and BRAC University School of Public Health, Bangladesh – Health and Social Change Programme, Institute of Development Studies, UK Photography – Thanks to Dr Shah Mohammed, BSPH MPH batch 2007-8
  • 3. Health service delivery in low and middle income countries Operational and research challenges for the (not-so- new) Millennium A changing world: Epidemiological transformations Health inequalities Marketisation of goods and services Shortage and maldistribution of health human resources Which ways forward? Challenges present opportunities Look “south” rather than “north” for innovation Move away from sterile debates
  • 4. Challenge 1: Changes in the burden of disease
  • 6. Major Causes of Death in Persons of All Ages in Low- and Middle-Income Regions
  • 8. Child Health inequalities (from Gwatkin et.al. 2005)
  • 9. Service utilisation inequalities (from Gwatkin et.al. 2005)
  • 10. Challenge 3: The rise and rise of health markets
  • 12. Non-state health care delivery – an increasing trend The “non-state” sector provides an increasingly major share of total service delivery, particularly in Asia (e.g. estimated 80% of limited curative care in India) Health markets have spread very rapidly in low and middle income countries, as have market type relationships, both formal and informal Most health care paid for “out of pocket” whether “public” or “private” Rise of markets associated with both rise in market type transactions generally in all economic sectors, and crises in the capacity and quality of publicly funded services Poor increasingly purchase services in the market. Largest part of this expenditure on drugs, often from unlicensed providers This burgeoning marketised health economy raises major issues in relation to cost, quality, competence and regulation
  • 15. Distribution of physician, nurse and dentist per 10,000 population and nurse per physician ratio - Bangladesh Adapted from Table 3.2, Bangladesh Health Watch Report 2008 Physician Nurse Dentist All Nurse per physician ratio Location Rural 1.1 0.8 0.08 2.1 0.7 Urban 18.2 5.8 0.8 24.9 0.3 All 5.4 2.1 0.3 7.7 0.4 (WHO (2.28/ recommended 1000) ratio)
  • 16. Distribution of other allopathic providers per 10,000 population - Bangladesh Adapted from Annex 3: Bangladesh Health Watch Report 2008 Paramedical allopathic Unqualified allopathic Traditional providers* providers Birth Community Health Attendants, Workers Untrained Govt. Non- All Village Drug All and trained Govt. doctors store salespe ople, drug vendors Location Rural 3.6 7.3 10.9 13.8 10.8 24.6 42.2 Urban 2.0 3.9 5.9 8.8 13.2 22.1 6.0 All 3.2 6.4 9.6 12.5 11.4 23.9 33.2
  • 17. Providers in pluralistic health systems Health care delivery systems highly pluralistic, practitioners vary greatly in their practice settings, type of knowledge, associated training, and relationship with the state and legal system Informal providers generally first provider of resort in rural areas Advantages: – convenient, affordable , available, better attitudes to users Challenges: – no quality control, reluctant to refer, over/misuse of drugs BUT – these problems are not confined to the informal sector. Issues of “stewardship” and governance cut across both formal and informal service delivery systems
  • 18. Research needs to respond to some new parameters Managing both infectious and chronic diseases from a low resource base – what does this mean for primary health care services, health human resources and financing of health care costs? How should services and interventions respond to the shift to prevention and long term management of chronic diseases? People live with them, they don’t just die from them Particularly in a global economy, markets and pharmaceuticals likely to intensify spread in the health sector – chronic diseases will be an increasing market segment Much greater access to information from multiple sources, increasing self-treatment through retail pharmacies etc. – the trend is not going to reverse
  • 19. Balancing challenges with opportunities for service delivery Research in support of policy Learning from service delivery innovations – Using ICTs for training, diagnostics, remote information – Learning from other models e.g. ART therapy, DOTS – Adapting from market based approaches, e.g. licensing, accreditation, franchising – Delivering healthier lives, not just delivering health services Rethinking human resources for health in a changing world – Different skill mixes and task combinations are possible – Use existing health workforces more effectively – Revisit incentives in a pluralistic systems – Different approaches to expertise – expert users as well as expert professionals
  • 21. More challenges and opportunities….. More equitable financing and access models – Moving to universal coverage through leveraging new combinations of public, private and external finance, e.g. micro-finance, social business models as well as tax revenues and external funds. Who pays for the poor? – Backing health and nutrition interventions onto anti-poverty and sustainable livelihoods programmes – what works? New models of governance for the sector - “stewardship” agenda – Government with new stakeholder coalitions, citizen engagement e.g. Health Watch approaches – Learning from other marketised sectors, increasing role for consumer protection? – Global governance needs for pharmaceuticals, services