The network - Towards Unity For Health

More documents

Recommendations

Info

IMPROVING HEALTHHEALTH AUTHORITIESD E C E M B E R 2 0 0 8N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 718Health Reformin ColombiaColombia is a tropical country, located inthe northern part of South America, with44,000,000 inhabitants; a life expectancyat birth of 72 years (66 years for men and74 for women); a birth rate of 19.86 per1000 inhabitants; and with cardiovasculardisease, murder, cerebrovascular disease,chronic lung disease and diabetes as thefive leading causes of death.Major ChangesSince the ‘90s, the country has initiatedprofound economic and social policies,which resulted in the adoption of a newConstitution (1991). This change establisheda new organisation of national life.In that context there were three majorchanges that affected the healthcare system:• First, the establishment of the rule of law,in which education and healthcare arerecognised as fundamental rights for allpeople, without distinction of any order.• Second, the strengthening of decentralisationprocesses in search of better conditionsfor development of regions andlocalities, seeking equitable access of allpopulation groups to opportunities andbenefits of national development.• Third, the introduction of a model ofeconomic and social development, withthe primary purpose of encouraging institutionalpluralism in various public andprivate fields. The model also incorporatesthe country into the global flows of politicalthinking that led the movement of theso-called ‘modernisation of the state’ andthe trends of globalisation of economies.System General Health InsuranceIn Colombia the ‘health reform’ was a totalchange in the healthcare system. Existingschema fragmented organisation, publicassistance for the poor, financed withtion groups with the capacity to financetheir healthcare. This National HealthSystem turned into a System General HealthInsurance (SGHI) - made up of multiple institutions- which was obliged to ensure, as anindividual and collective right, healthcare forthe whole population.Since the introduction of SGHI in the year1993, there has been considerable progressin the rates of insurance coverage.To date, the Ministry of Social Protectionestimates that over 90% of the Colombianpopulation is affiliated to the System.UnsatisfactoryIn connection with the Provision of HealthServices, various studies show that theplanning, organisation and functioning ofthe healthcare providers have lost the conceptof space-catchment area; they do nottake into account the accessibility of thepopulation to them, nor the geographical,cultural, economic, population and epidemiologicalcondition. They ignore the socialorder in terms of meeting the health needsof the population, which has led to seriousproblems of equity in income and theprovision of benefit plans, and requires theformation of networks to provide servicesto ensure the user the right to attend them.In connection with public health, the BasicCare Plan has been defined. This planfocuses on complementing the communityadvocacy and prevention-defined benefitplans. But there is dispersal of activitiesamong the various actors and territoriallevels and fragmentation of responsibilities.Therefore, the impact of the sharesis dissolved, the attention to people andcommunities is not timely and sufficient,and there is a loss of transparency in themanagement of resources.The fulfilment of the shares of health promotionis unsatisfactory in some of the municipalities;these do not report information onTHE CHARACTER-ISTICS OF THENEW SYSTEM OFHEALTH SERVICESHAVE HAD SIG-NIFICANT IMPACTON THE FORMSOF LINKAGEAND ON THEPERFORMANCEOF HUMANRESOURCESIN HEALTH.Government funds; social insurance for workers,public and private, financed by contributions;and private services for the populaactivitiesof vaccination, or this informationis inconsistent or incomplete.The characteristics of the new systemof health services have had significantimpact on the forms of linkage and on theperformance of human resources in health.Improvement in these key factors in theprocess of healthcare - individually andcollectively - is critical in the implementationand operation efficient, cost-effectiveand quality.The major challenges are getting to universalhealth service, and ensuring the qualityof provision.Miguel Ruiz Rubiano | Dean, Facultyof Medicine, Universidad el Bosque,ColombiaEmail: miguelruiz@hotmail.com
WOMEN’S HEALTHPreventing Paediatric HIVin Rural South AfricaHIV/AIDS treatment has become moreAt each site, we held a brief celebration tocommonplace for adults in some areas incongratulate the staff on their successes,South Africa since the Government approvedapplauded those who contributed to thepublic provision of antiretroviral (ARV) ther-change, and asked what more we could do.apies in 2003. Despite uneven progress, theI helped each team understand its prog-growing local knowledge that desperatelyress in comparison to neighbouring sitesill people can recover rapidly after receivingand trained site mentors to continue thetreatment has created an enormous demandimprovement process and share successfulfor antiretrovirals. In contrast, effectivestrategies between teams.treatment for HIV-positive pregnant womenduring their pregnancies remains a rarity.HIV/AIDS office at Mbazwana clinicFrom 10% to 80%The system designed to prevent mother-to-We are still evaluating the long-termchild transmission of HIV has lagged farbehind gains in treating non-pregnantadults living with AIDS.HIV Transmission to InfantsThe Institute for Healthcare Improvement(IHI) is a US-based NGO that collaborateswith the Umkhanyakude Health District andthe Centre for Rural Health at the UniversityKwaZulu-Natal (KZN) to improve the widespreaddistribution of ARV’s in the rural KZNhealth system. Between June and August of2007, I worked with the physicians, nursesand HIV/AIDS counsellors at two publichospitals and six clinics to strengthen effectivetreatment of pregnant women withAIDS in this district. Our goal was to improveefforts to place eligible pregnant women onHAART (Highly Active ART) treatment, inorder to prevent the transmission of HIV totheir children. The communities served bythese facilities are deeply rural and verypoor. Unemployment hovers near 70% andmore than one of every three pregnantwomen are HIV positive.tem and why many women are not offeredtreatment early enough in their pregnanciesto prevent HIV transmission to their infants.Each clinic’s data was illuminating; thoughmany women learned their HIV status, fewwere having the blood work needed todetermine whether treatment was right forthem. And of those women giving blood forCD4 counts (a method of determining theimmune system’s health), very few wereactually told their test results and evenfewer were referred for lifesaving treatment.Elegantly SimpleWith some coaching, each of these clinicteams began looking for solutions toimprove their success at treating eligiblepregnant women. Each clinic began a ‘livessaved’ campaign, creating a clinic posterthat counts each two lives saved - the childand the mother - for every pregnantwoman put on treatment. The practicalsolutions the teams devised were oftenelegantly simple. Mbazwana Clinic simplymoved its HIV counselling from outsideeffects of this brief intervention. At MseleniHospital, the PMTCT improvement teamconducted an audit of their own labourward. They found that before our collaboration,fewer than 10% of the women presentingfor labour had CD4 lab resultsrecorded in their patient-held medicalrecords. Two months after our pilot projectconcluded, 80% of HIV positive womenpresenting to the labour ward had receivedtheir CD4 lab results. This one blood testdetermines which women and childrenstand to gain the most from ARV treatmentduring pregnancy.Small changes such as these promise tremendousbenefits to communities devastatedby a growing paediatric HIV epidemic.All of the health workers in thisregion are touched personally by HIV andAIDS. Many of the nurses and counsellorsI worked with have children in their ownfamilies who are HIV positive. The will toprotect children is enormous. The simpletools that harness this will are the key toD E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7the clinic in a nearby building to a roommeaningful improvement.Using improvement methods developed byadjacent to where antenatal care is pro-IHI, I helped multi-professional teams ofvided. In one week, the team went fromJessica Greenberg / MD Candidate,clinic and hospital staff to track and evalu-sending blood tests for 20% of pregnant2010, Harvard Medical School, Unitedate their own success at identifying preg-women, to sending 100% of the necessaryStates of Americanant women with AIDS and beginningtests. Mseleni Hospital began to screenEmail: jgreenberg@hms.harvard.eduappropriate treatment. I sat down with thewomen waiting for ultrasound to ensurenurses and counsellors at each clinic tothat all women who had blood drawn forunderstand how pregnant women seekingCD4 counts got their results.antenatal care move through the clinic sys-19
Page 2: CONTENTS03ForewordPrimary Healthcar
Page 7 and 8: BOOK REVIEWAwakeningHippocratesBook
Page 9 and 10: INTERNATIONAL HEALTH PROFESSIONS ED
Page 11 and 12: NEW INSTITUTIONS AND PROGRAMMESLast
Page 13 and 14: Soft Skills Trainingin MalaysiaThe
Page 15 and 16: THE LIKE-MINDED WORKING TOGETHERGlo
Page 17: IMPROVING HEALTHJMHPE: THIRD GROUP
Page 21 and 22: HEALTH PROMOTIONOral Health Promoti
Page 23 and 24: STUDENT INTERVIEWHow do students fr
Page 25 and 26: Fathi Maklady | Vice President forp
Page 27 and 28: Taskforce Carefor the Elderly Gets
Page 29 and 30: REPRESENTED AT INTERNATIONAL MEETIN
Page 31 and 32: INTERNATIONAL DIARYDiary 20091 - 4

The network - Towards Unity For Health

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?