Health service management programme

This section will provide information on health services organization and management; as well as on tools and methodologies employed as part of the technical cooperation provided to countries within the framework of the initiative on strengthening health systems based on Primary Health Care (PHC).

Health Services and Access

Health Services and Access Unit is responsible for the technical support for the AHO member countries for issues related to policies, systems, and health services.  The object is to promote the development and strengthening of health systems of the countries of the Region, promoting advances toward universal coverage in health through the strategic approach to the Primary Health Care (PHC) and the integrated networks of health services.

Universal Health Coverage is to ensure all people have access to needed services (prevention, promotion, curative, rehabilitation, and palliative care) with sufficient quality to be effective and without exposing individuals to financial hardship. It constitutes a comprehensive goal for our health systems, to ensure that all-including the most vulnerable, poor and excluded – have access to quality, integrated services based on primary health care throughout the life cycle. UHC provides renewed focus on addressing the Social Determinants of Health, and engaging all sectors and civil society to promote health and well-being

Population coverage

• Equitable and effective access of the population to health services
• Approach based on Social Determinants of Health
• Multilevel approaches:  individual, family and community
• Community participation

Guarantee of access to health services

• Health care model cantered on people and based on its needs
• First level of care with problem-solving ability of health
• Package of guaranteed services integrated
• Integrated health services delivery networks
• Rational use of resources
• Quality health services

Financial protection

• Health systems financing policies
• Purchase of services and mechanisms of contracting
• Innovation and improvement of the internal efficiency of the system
• National health accounts

Social Protection in Health means “warranty, given by society, through public authorities, for an individual, or group of individuals, can satisfy their health needs and demands obtaining adequate access to Health system or any of the health subsystems in the country, without the ability to pay be a limiting factor. ”

Social Health Protection is a framework for the building of access to adequate health care, understanding it as a right or a preferential good. Social Protection Policies in Health should aim at universality, ensuring access, quality, timeliness and financial protection for individuals, families and community. However, although universal, these policies should be alert to produce special responses to special needs, being permeable to gender approach and proactive in addressing the needs of ethnic and cultural minorities.

Social protection in health is not a static concept. On the contrary, it is evolving, and policies that comprise consolidated progressively, increasing the effective range of the common good in the health field.
To give support to social protection approach in public health policies, It is needed to achieve a certain degree of social agreement. In turn, these processes of social dialogue and agreement contribute to social cohesion based on democratic values through social appropriation of the concept of right to health and roll of the state and citizens in the realisation of this right.

The focus of social protection in health is also quite consistent with the objective of universal health coverage, defined as the situation in which every citizen is has health care services he needs without incurring into financial risk.

From a strategic perspective, social health protection should be implemented following the values and principles of Primary Health Care, namely, right to the highest attainable health, equity and solidarity. This conceptual model integrate social protection, universal coverage and renewed primary health care, can further transform health systems towards more integrated, people-cantered and equitable.

 

Essential Public Health Functions

Essential Public Health Functions (EPHF) are the fundamental set of actions that should be performed in order to achieve public health’s central objective: improving the health of population

EPHF 1: Monitoring, evaluation, and analysis of health status

This function includes:

• Evaluating the country’s current health status, trends, and determinants, with a focus on identifying inequalities in risks, threats, and access to health services.
• Identifying the population’s health needs, which includes evaluating the health risks and assessing demand for services?
• Managing important statistics and the situation of high-risk and/or specific groups.
• Producing information pertinent to the evaluation of health services performance.
• Identifying resources from outside the sector that can improve health promotion and the quality of life.
• Developing technology and methods to manage, interpret, and communicate information to public health’s decision makers, external actors, suppliers, and citizens.
• Defining and developing agencies to evaluate the quality of the collected data.

Indicators:

1. Guidelines to monitor and evaluate health status.
2. Evaluation of the quality of information.
3. Expert support and resources for the monitoring and evaluation of health status.
4. Technological support for the monitoring and evaluation of health status.
5. Advisory services and technical support for sub-national public health entities.

 

EPHF 2: Surveillance, research and control of the risks and threats to public health

This function includes:

• The capacity to carry out research and surveillance of epidemic outbreaks and communicable and non-communicable diseases models, behavioural factors, accidents, and exposure to toxic substances or environmental agents detrimental to health.
• The infrastructure of public health services designed to support the elaboration of population analyses, case studies, and general epidemiological research.
• Public health laboratories capable of performing fast analyses and processing large volumes of tests to identify and control new health threats.
• The development of active programs for epidemiological surveillance and infectious disease control.
• The capacity to connect with international networks that make it possible to better tackle the health problems of greatest concern.
• Strengthening and preparation of the NHA’s ability to conduct surveillance at a local level and produce rapid responses to control health problems or specific risks.

Indicators:

1. Surveillance system that identifies public health threats.
2. Competence and knowledge of epidemiology.
3. Capacity of public health laboratories.
4. Ability to respond to public health problems in a timely and effective manner.
5. Advisory services and technical support for the sub-national entities of public health.

 

EPHF 3: Health Promotion

This function includes:

• Promoting changes in lifestyle and environmental conditions that will promote the development of a health culture.
• Strengthening of inter-sectoral partnerships to make health promotion actions more effective.
• Assessing the impact of public policies on health.
• Developing educational actions and social communication that promote healthy conditions, lifestyles, behaviour, and environments.
• Reorienting health services to develop models of care that support health promotion.

Indicators:

1. Support for health promotion activities and the development of standards/interventions that favour healthy behaviours and environments.
2. Building of sectoral and extra-sectoral partnerships for health promotion.
3. National planning and coordination to inform, educate, and communicate strategies of health promotion.
4. Reorientation of health services towards the promotion of public health.

 

EPHF 4: Social participation in health

This function includes:

• Strengthening the power of citizens to change their own lifestyles and take an active role in developing healthy behaviours and environments, thus giving them influence over the decisions that affect their health and access to adequate public health services.
• Facilitating organized community participation in the decisions and actions related to health programs of prevention, diagnosis, treatment, and rehabilitation, aiming to improve the population’s health status and create an environment that promotes healthy lifestyles.

Indicators:

1. Strength of the influence that citizens have in public health decision-making.
2. Strength of the social participation in health.
3. Advisory services and technical support for sub-national entities to strengthen social participation in health.

 

EPHF 5: Development of policies and institutional capacity for public health planning and management

This function includes:

• The definition of public health objectives at all levels, measurable and consistent with a framework of values that promote equality.
• The development, monitoring, and evaluation of political decisions concerning public health, through a participatory process that is consistent with the political and economic context of the decisions.
• The institutional capacity for managing public health systems, including strategic planning, with a special interest in the processes of construction, execution, and evaluation of initiatives directed to solve the population’s health problems.
• Development of decision-making capacity based on evidence that incorporates planning, evaluation, leadership, effective communication, organizational development, and the management of resources.
• Development of public health management capacity for international cooperation.

Indicators:

1. Definition of national and sub-national public health objectives.
2. Development, monitoring, and evaluation of public health policies.
3. Development of institutional capacity for public health systems management.
4. Management of international cooperation in public health.
5. Technical support to sub-national instances for policy development, planning, and management in public health.

 

EPHF 6: Strengthening of public health regulation and enforcement capacity

This function includes:

• The institutional capacity to develop the regulatory framework necessary to monitor and protect the population’s health.
• The capacity to create new laws and regulations directed towards improving population health and promoting the development of healthy environments.
• The protection of citizens in their relationship with the health system.
• The execution of these activities to ensure compliance with the standards in a timely, correct, congruent, and complete manner.

Indicators:

1. Period review, evaluation, and modification of the regulatory framework.
2. Enforcement of health standards.
3. Knowledge, skills, and mechanisms to review, enhance, and enforce the regulatory framework.
4. Technical advisory and support for sub-national public health agencies to elaborate and enforce laws and regulations.

 

EPHF 7: Evaluation and promotion of equitable access to necessary health services

This function includes:

• The promotion of equitable access to necessary health services for all citizens.
• The development of actions geared toward overcoming access barriers to public health interventions and toward linking vulnerable groups to health services.
• The monitoring and evaluation of access to necessary public and private health services, adopting a multisectoral, multitechnical and multicultural approach in conjunction with various agencies and institutions to resolve the injustices and inequalities in the utilization of services.
• The close collaboration with governmental and non-governmental organizations to promote equitable access to necessary health services.

Indicators:

1. Evaluation of access to necessary health services.
2. Knowledge, skills, and mechanisms to bring the population closer to necessary health services.
3. Promotion of support and actions to improve access to necessary health services.
4. Advisory services and technical support for sub-national public health agencies in promoting equitable access to health services.

 

EPHF 8: Human resources development and training in public health

This function includes:

• The identification of human resource profiles in public health that are adequate to the provision of public health services.
• The education, training, and evaluation of public health personnel in order to identify public health services needs, effectively face pressing public health issues, and adequately evaluate actions in these matters.
• The definition of accreditation requirements for general health professionals and the adoption of continuous quality improvement programs for public health services.
• The construction of active partnerships with professional development programs that expose participants to relevant experiences in public health, as well as continuing human resources education for management and leadership development in the area of public health.
• The development of capacities for interdisciplinary and multicultural work in public health.
• Ethical training for public health personnel, with special attention to the values of solidarity, equality, and respect for the human dignity.

Indicators:

1. Characterisation of the public health work force.
2. Improvement of the workforce quality.
3. Continuing public health education through training and postgraduate programs.
4. Improvement of human resources to focus on the delivery of socially and culturally appropriate services for the public.
5. Advisory services and technical support for the sub-national entities in human resources development.

 

EPHF 9: Quality assurance in personal and population-based health services

This function includes:

• Promoting the implementation and quality improvement of evaluation systems.
• Promoting the development of standards on the basic characteristics of quality assurance and improvement systems, as well as monitoring providers for compliance with these standards.
• The definition, explanation, and guarantee of the user rights.
• An evaluation system for health technologies that can assist in the health system decision making process and that contributes to improving the quality of the health system as a whole.
• The utilisation of scientific methods to evaluate health interventions of various degrees of complexity.
• The implementation of systems to evaluate user satisfaction, and the use of these assessments to improve the quality of health services.

Indicators:

1. Definition of the standards and evaluation for the quality improvement of individual and collective health services.
2. Improvement of user satisfaction with health services.
3. System of technological management and assessment of health technologies to support decision-making in public health.
4. Advisory services and technical support for the sub-national health entities in order to ensure quality of services.

 

EPHF 10: Research in Public Health

This function includes:

• Rigorous research directed to increase the knowledge that supports decision-making in its various levels.
• The execution and development of innovative public health solutions, and the measurement and evaluation of their impact.
• The establishment of partnerships with research centers and academic institutions, from both within and outside of the health sector, to conduct studies to support the NHA’s decision-making process.

Indicators:

1. Development of public health research plans.
2. Development of the institutional capacity for research.
3. Advisory services and technical support for research at the sub-national public health entities.

 

FESP 11: Reduction of the impact of emergencies and disasters on health

This function includes:

• Policy development, planning, and the implementation of measures to prevent, mitigate, reduce, and prepare for the impact of disasters on public health.
• Integrated approach to the threats and the etiology of each possible emergency or disaster within the country.
• Health system-wide participation and broad inter-sectoral/interinstitutional collaboration in reducing the impact of emergencies and disasters.
• The management of inter-sectoral and international cooperation in solving health problems caused by emergencies and disasters.

Indicators:

1. Management of emergency and disaster impact reduction.
2. Development of standards and lines of action to reduce the impact of emergencies and disasters on health.
3. Cooperation and partnerships with other agencies and/or institutions.
4. Advisory services and technical support at the sub-national level to reduce the impact of emergencies and disasters on health.