HEALTH CARE DELIVERY CHALLENGES SYNDROME

INTRODUCTION

Health is a common theme in most cultures. In fact, all communities have their concepts of health, as part of their culture. Among definitions still used, probably the oldest is that health is the “absence of disease“. In this article more pain would be taken to discuss the challenges posed in delivering health care services, hence the topic “Health care delivery challenges syndrome”.

DEFINITION

The widely accepted definition of health is that given by the World Health Organization (WHO – 1948) in the preamble to its constitution is as follows: “Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity”. This WHO definition has been criticized as being too broad.

Some argue that health cannot be defined as a “state” at all, but must be seen as a process of continuous adjustment to the changing demands of living and of the changing meanings we give to life. It is a dynamic concept. It helps people live well, work well and enjoy themselves.

Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity – WHO

HISTORY OF HEALTH DEVELOPMENT

Modern medicine is often accused for its preoccupation with the study of disease, and neglect of the study of health. Consequently, our ignorance about health continues to be profound, as for example, the determinants of health are not yet clear; the current definitions of health are elusive; and there is no single yardstick for measuring health. There is thus a great scope for the study of the “epidemiology” of health.

Health continues to be a neglected entity despite lip service. At the individual level, it cannot be said that health occupies an important place; it is usually subjugated to other needs defined as more important, e. g., wealth, power, prestige, knowledge, security-Health is often taken for granted, and its value is not fully understood until it is lost.

At the international level, health was “forgotten” when the covenant of the League of Nations was drafted after the First World War. However, during the past few decades, there has been a reawakening that health is a fundamental human right and a world-wide social goal ; that it is essential to the satisfaction of basic human needs and to an improved quality of life ; and, that it is to be attained by all people.

In 1977, the 30th World Health Assembly decided that the main social target of governments and WHO in the coming decades should be “the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life”, for brevity, called “Health for All“. With the adoption of health as an integral part of socio-economic development by the United Nations in 1979. Health, while being an end in itself, has also become a major instrument of overall socio-economic development and the creation of a new social order.

Health continues to be a neglected entity despite lip service.

HEALTH AND ECOSYSTEM

A full understanding of health requires that humanity be seen as part of an ecosystem. The human ecosystem includes in addition to the natural environment, all the dimensions of the man-made environment-physical, chemical, biological, psychological; in short our culture and all its products. Disease is embedded in the ecosystem of man. Health, according to ecological concepts, is visualized as a state of dynamic equilibrium between man and his environment.

By constantly altering his environment or ecosystem such activities as urbanization, industrialization, deforestation, land reclamation, construction of irrigation canals and dams

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man has created for himself new health problems for example. The greatest threat to human health in developing countries today is the ever-increasing, unplanned urbanization, growth of slumps and deterioration of environment. Such as the Bhopal gas tragedy in 1984 highlights the danger of locating industries in urban area. The nuclear disaster in Soviet Russia in April 1986 is another grim reminder of environmental pollution.

The construction of dams, irrigation systems and artificial lakes has created ecological niches favouring the breeding of mosquitos, snails and spread of filariasis, schistosomiasis and Japanese encephalitis. In fact ecological factors are at the root of the geographic distribution of disease. Therefore it has been said that good public health is basically good ecology.

The greatest threat to human health in developing countries today is the ever-increasing, unplanned urbanization, growth of slumps and deterioration of environment.

HEALTH DETERMINANTS

Education status specially female education. The world map of illiteracy closely coincides with the maps of poverty, malnutrition, ill health, high infant mortality rate, 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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Another important health determinant is the socio-economic conditions of the populace. socio-economic conditions have long been known to influence human health. For the majority of the world’s people, health status is determined by their socio-economic development. e.g. per capita GNP, nutrition, employment, housing and political system of the country.

Those of major importance are economic status. This determines the purchasing power, standard of living, quality of life, family size, the pattern of disease and deviant behavior in the community. It is also an important factor in seeking health care. Ironically, affluence may also be a contributory cause of illness as explained by the high rates of coronary heart disease, diabetes and obesity in the upper socio-economic groups.

Poverty creates ill-health because it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation. – WHO

RIGHT TO HEALTH

Historically, the right to health was one of the last to be proclaimed in the constitutions of most countries of the world. Human Rights established a breakthrough in 1948, by stating in article 25: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family”. The Preamble to the WHO Constitution also affirms that it is one of the fundamental rights of every human being to enjoy “the highest attainable standard of health” inherent in the right to health is the right to health or medical care.

Some countries have used the term “right to health protection” which is assured by a comprehensive system of Social Insurance that provides material security in cases of illness or accident, and free medical education, medicaments and other necessary materials and the right to be cared for by society in old age and invalidity. In an increasing number of societies, health is no longer accepted as a charity or the privilege of the few, but demanded as a right for all.

However, when resources are limited (as in most developing countries), the governments cannot provide all the needed health services. Under these circumstances the aspirations of the people should be satisfied by giving them equal right to available health care services. The concept of right to health has generated so many questions like right to procreate (artificial insemination included), the right to the deceased persons (determination of death, autopsies, discontinuation of life support measures), etc. Many of these ethicists and physicians to formulate a general outline.

In an increasing number of societies, health is no longer accepted as a charity or the privilege of the few, but demanded as a right for all.

HEALTH SYSTEM

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The “health system” is intended to deliver health services ; in other words, it constitutes the management sector a involves organizational matters, e.g., planning, determining priorities, mobilizing and allocating resources translating policies into services, evaluation and health education. The aim of a health system is health development-a process of continuous and progressive improvement of the health status of a population. The goal of the health system had been to achieve “Health for Allby the year 2000.

LEVELS OF HEALTH CARE

Health services are usually organized at three levels, each level supported by a higher level to which the patient is referred. These levels are: (a) Primary health care (b) Secondary health care(c) tertiary health care. The Primary health care is the first level of contact between the individual and the health system where essential “health care (primary health care) is provided. A majority of prevailing health complaints and problems can be satisfactorily dealt with at this level. This level of care is closest to the people. In “DOCOTAL” context, it is to provide health care to all at affordable cost to your door steps with community participation via online.

In “DOCOTAL” context, it is to provide health care to all at affordable cost to your door steps with community participation via online.

PRIMARY HEALTH CARE

The concept of Primary Health Care came into lime-light in 1978 following an international conference in Alma-Ata, USSR. It has been defined as: “Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that every stage of their development in the spirit of self-determination”.

HEALTH FOR ALL

After three decades of trial and error and dissatisfaction of meeting people’s basic health needs, the World Health Assembly, in May 1977, decided that the main social goal for governments and WHO in the coming years should be the “attainment by all the people of the world by the year 2000 AD of a level of health that will permit them to lead a socially and economically productive life”. This goal has come to be popularly known as “Health for All by the year 2000“(HFA).

The background to this “new” philosophy was the growing concern about the unacceptably low levels of health status of the majority of the world’s population especially the rural poor and the gross disparities in health between the rich and poor, urban and rural population, both between and within countries. The essential principle of HFA is the concept of “equity in health”, that is, all people should have an opportunity to enjoy good health.

The essential principle of HFA is the concept of “equity in health”, that is, all people should have an opportunity to enjoy good health.

RESPONSIBILITY FOR HEALTH

Health is on one hand a highly personal responsibility and on the other hand a major public concern. It thus involves the joint efforts of the whole social fabric, viz. the individual, the community and the state to protect and promote health.

INDIVIDUAL RESPONSIBILITY

Although health is now recognized a fundamental human right, it is essentially an individual responsibility, it essentially an individual responsibility. it is not a commodity that one individual can bestow on another. No community or state programme of health services can give health. In large measure, it has to be earned and maintained by the individual himself, who must accept a broad spectrum of responsibilities, now known as “self care“.

In large measure, health has to be earned and maintained by the individual himself, who must accept a broad spectrum of responsibilities.

SELF CARE IN HEALTH

A recent trend in health care is self care. It is defined as “those health-generating activities that are undertaken by the persons themselves“. It refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health.

These activities are undertaken without professional assistance, although individuals are informed by technical knowledge and skills. The generic attribute of self care is its non-professional, non-bureaucratic, non-industrial character; its natural place in social life.

CHALLENGES IN HEALTH CARE DELIVERY

The challenges posed in delivering health care system can be expressed in analogy as “The tip of Ice berg phenomenon” which presented a gloomy picture. Health continues to be a neglected entity despite important service. At the individual level, it cannot be said that health occupies an important place; it is usually subjugated to other needs defined as more important, e.g., wealth, power, prestige, knowledge, security etc. Health is often taken for granted, and its value is not fully understood until it is lost.

Hence, the patients are not willing to pay for health care services. More so, the determinant factors play major roles in health care delivery challenges such as socio-economic, education and environmental factors. The world map of illiteracy closely coincides with the maps of poverty, malnutrition, illhealth and high infant mortality rates.

Health continues to be a neglected entity despite important service.

CONCLUSION

In conclusion, it is quite shocking and very gloomy the challenges posed by inequalities in the delivery of health care services in developing countries. On the other hand the health system is being subjugated to other needs; hence people are not willing or feel reluctant to spend more on their health.

However, it is of important to note that health care delivery of more of our responsibility than our right. This brings us to the concept of “Self care in health”, It refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health.

In order to bring solution to this challenges and abridge this gap of inequalities in health delivery, the international community came up with the concept of primary health care which is to provide the essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that every stage of their development in the spirit of self-determination.

In view of these great challenges posed to health care delivery system, the DOCOTAL has come up with a system to essentially deliver a smooth world class primary health care service to the people with community participation.

References

  • WHO (1948)
  • Textbook of Preventive and Social Medicine by K. Park. 19th EDN 2007.

HEALTH CARE DELIVERY CHALLENGES SYNDROME was written by our foremost Dr. LB Basaru. You can follow him on Social media

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