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Health Systems - Coggle Diagram
Health Systems
"Systems for Health" approach argument in discussions of 'health-system strengthening'
5 Factors shaping access to health
-> through HIV ART perspective
1. Individual-level factors
- Personal dispositions
- Fear (takes time to accept HIV status)
- Acceptability of services
- Embodied experiences
- Perceptions of usefulness
- Satisfaction
- Personal health & well-being
- Co-morbidities
- MH
- Substance use
- Side effects
2. Interpersonal & network factors
- Relationship power & equity
- Disclosure & social support
- Social reasons to self-care or not - (dis)engage w/ HIV care
- Social capital
- Spreading false info, entrenching neg norms & stereotypes
- Critical dialogue, renegotiating harmful social norms, coping with stigma
3. Community-level factors
- Stigmatizing attitudes
- Local leadership
- (Un)supportive HIV progs
- 'Tradi' attitudes towards women & children
- Medical pluralism
- Socio-cult norms
- Gender norms
- Religious & cultural practices
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Medical pluralism
Switching bw multiple modalities of care.
Contributes to:
- Mistrust bw health providers
- Delays & interruptions of care
4. Institutional & health system factors
- Availability of HIV services & res
- Stocks
- Broken equip
- Limited provisions
- Qual of services
- Confidentiality
- Discrimination
- Integrated & differentiated care
- Limited, rigid & inflexible health services
- Knowledge-Attitude-Behavior (KAB) of providers
- Waiting times
- Support tools
5. Structural factors
- Pol context & priorities
- Marginalization & inequities
- Punitive & protective laws
- Health infrastructure
- Slow adaptation of health policies & treatment guidelines
- Funding of interventions
:green_book: Pharma prohibiting drugs from being affordable, available & suitable
- Intellectual property / patent
- Limited supplies & competition
- Limited transparency, making gvt negos difficult
Punitive & protective laws
Out of 100 countries in UNAIDS 2018 report:
- 44 criminalize same-sex intercourse
- 3/4 criminalize some aspects of sex work
- 87% criminalize drug use or possession
- 1/2 have laws criminalizing HIV transmission, nondisclosure or exposure
- 2/3 require parental consent for minors to access HIV testing
- 1/2 require parental consent for HIV treatment
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Multidimensional understanding of health= Health systems + Orgs, actors & actions that influence health
- Activism
*Science
- Private sector
- Formal grps & informal newtorks at community level
- Social policies
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4 Health Systems
Key players
- Pop / Patients
- Providers of services
- Gvt / Pro body
- Financing agents
--> How health systems are financed is key context
5 Sources of financing
- Social health insurance
- Private prepaid plans
- Out-of-pocket
- Territorial gvt
- Other private sources
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1. The Beveridge model
"Socialized Medicine" - Universal
- Financing: SINGLE PAYER - Publically funded through taxes
- Delivery: Public sector providers
--> Fully delivered & paid for by gvt
:globe_with_meridians: Scandinavia, UK, New Zealand, Spain, Cuba:flag-us: Military & veterans + Native Americans-
2. The Bismarck model
- Financing: MULTI-PAYER - for insurance shared by employers & employees, but available to all
- Delivery: Private sector providers
:globe_with_meridians: Germany, France, Netherlands, Japan, some South American countries:flag-us: Inds receiving healthcare through employer
3. The National Health Insurance (NHI) model
- Financing: SINGLE PAYER - Publically funded through taxes (gvt-run health insurance)
- Delivery: Private sector providers
--> All citizens pay into system where gvt is the sole player
:globe_with_meridians: Canada, South Korea, Taiwan:flag-us: Medicare (above 65) & Medicaid (for the poor)
4. The Out-of-Pocket / Charity-based model
- Financing: PRIVATE PAYER
1. Out-of-pocket
- Private insurance (for those who can afford it)
- Informal community-based health insurance (CHI)
- Rotating Savings & Credit Assocs (ROSCAs)
- Accumulating Savings & Credit Assocs (ASCAs)
- Local charity - women's grps, faith-based grps, friends & fam
- Selling-off assets
2. External res (thr gvts or NGOs)
- Free PHC services & removal of user-fees
- Cash transfers - un/conditional
- Incentives - cash, vouchers or other benefits in return for service use, pay of performance
- Delivery: ACCESS REMAINS A CHALLENGE
:globe_with_meridians: In poor nations w/out nationwide health system such as rural India, Africa, South America, China:flag-us: Poor & uninsured inds
Conditional Cash Transfers (CCT) favoured where gvt services are in good supply & where inds are either:
- Unaware of benefits of using services
- Need the bargaining power to change behaviors
- Presented w/ opportunity-costs that make these services unobtainable
:green_book: SA study - Evidence of holistic responses to CASH + CARE + EDUC
Incentives for health
--> Has potential to improve health if targeted correctly
- Motivate patients to change behavior
- HIV testing & return for results, giving birth at hospitals, use of health packages, rewards to health staff
- Often in the shape of vouchers (e.g. food, cash, participation in lottery)
Anthro of health systems
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Medical pluralism
Present in all societies through co-existence of several health systems
--> Esp, in societies w/ a mix of cultural/ethnic pops
Pro = Increases therapeutic choices
Con = Complicates health seeking
WHO Traditional, Complementary and Integrative (TCI) Medicine
Increased efforts made to recognize importance -- creation of designated web page
:flag-dk: TCIM in DK
- Increased use from 23% (1987) to 52.8% (2010)
- Typical user = female, aged 25-64 yo, high educ level (14 years of schooling)
- 23 TCIM modalities offered w/ massage, acu, reflexology & art therapy w/ highest prevalence
- Distributed among 41.5% of DK hospitals
- Offered at 20.6% of hospital departments
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:green_book: Making sense of illness
Merging biomedical w/ tradi
- Child's illness aetiology according to mother after taking her to the hospital for biomed treatment (Zanzibar) = prepared Kombe (the writing of verses of the Quran w/ saffron on a plate or paper, rinsing it off w/ water & dispensing it to the sick person to get ride of the spirit Mdudu -- or insect).
- Cervical cancer aetiology (Tanzania) = co-wife bewitching another out of jealousy, affecting her reproductive parts in order to cause divorce; confirmed by traditional healer
- TB aetiology (Namibia) = emotional stress --> thinking too much --> phy suffering --> TB
- DM aetiology (Mexico) = DM self-mngt when dealing w/ stress & emotional pain due to socio-cult & gender norms of respect, maternal responsibility & submission to men
:green_book: Unani medicine (/Unani tibb, Arabian medicine, Islamic medicine) = a traditional system of healing & health maintenance observed in South & Central Asia among Muslim cultures & originating from Ancient Greece (Hippocrates)=> Similar to Ayurveda in the sense that both are based on natural methods & are largely side-effect free
Anthropologists describe & interpret the variety of hospital cultures / biomed health care institutions in diff societies (through hospital ethno)
- What values, priorities, power-relations govern them?
- What contextual (socio, host, econ...) factors influence them?
- Are hospitals indep entities w/ their own biomed & clinically-shaped culture, norms, priorities & power relations?
- Are hospitals reflecting the culture, norms, priorities & power relations of surrounding society?
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Purpose
Depends on 6 "building blocks"
- Leadership / governance
- Health care financing
- Health workforce (w/ motivated staff)
- Med prdts & technos (equipt & access to essential meds)
- Info & R
- Service delivery
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Good health systems are those that deliver effective, safe, good qual, personal & non-personal care to those who need it, when needed + with minimal waste
Definition
The combination of res, org, financing & mngt that culminates in the delivery of health services to a pop (Roener 1991)
OR
Consists of all orgs, people & actions whose primary intent is to promote, restore or maintain health (WHO)
Delivered in
- home
- community
- workplace
- health facilities
Includes
- promo
- prev'
- treatmt
- rehab
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