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HIV/TB Stakeholder Meeting. Dr Hans Kluge Director Health Systems and Public Health Special Representative of the Regional Director on MXDR-TB Kiev, Ukraine 06 May 2014. From policy to action: HSS operational approach. Removal of health system bottlenecks. Expected results. Core - PowerPoint PPT Presentation
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WHO Regional Office for Europe
HIV/TB Stakeholder Meeting
Dr Hans KlugeDirector
Health Systems and Public HealthSpecial Representative of the
Regional Director on MXDR-TB
Kiev, Ukraine06 May 2014
WHO Regional Office for Europe
WHO Regional Office for Europe
Removal of health system bottlenecks
Removal of health system bottlenecks
Core services
Core services
Population levelIndividual level
Population levelIndividual level
Population levelIndividual level
Population levelIndividual level
Expected results
Expected results
Maternal and child health outcomes
Cardiovascular health outcomes
Tuberculosis
Others
From policy to action: HSS operational approach
WHO Regional Office for Europe
Health systems in times of global economic crisis: an update, 17-18 April, Oslo, Norway
Aligned health workforce
Aligned health workforce
Financial Protection
WHO Regional Office for Europe
Policy responses to economic crisis in the EU
WHO Regional Office for Europe
All people have access to needed health services (incl. prevention) of good quality
Derived from World Health Report 2010, p.6 & World Health Assembly Resolution 58.33, 2005
What is Universal Health Coverage?
The use of services does not expose any user (or family members) to undue financial hardship
WHO Regional Office for Europe
Ten leading sources of inefficiencyRef: World Health Report 2010, Chapter 4
Medicines: under-use of generics and higher than necessary prices
Medicines: use of sub-standard and counterfeit medicines
Medicines: in appropriate and ineffective use
Services: inappropriate hospital size (low use of infrastructure)
Services: medical errors and sub-optimal quality of care
Services: inappropriate hospital admissions and length of stay
Services & products: oversupply and overuse of equipment, investigations and procedures
Health workers: inappropriate or costly staff mix, unmotivated workers
Interventions: inefficient mix / inappropriate level of strategies
Leakages: waste, corruption, fraud
Continual focus on improving efficiency
WHO Regional Office for Europe
Response to the crisis in Latvia
• Major cuts with concurrent structural reforms to health system
– priority given to primary health care, coverage of essential medicines and outpatient specialist services
– reduced hospital capacity and increased day care capacity
– pharmaceutical reimbursement budget cut less than in-patient care budget
• Significant price reductions of pharmaceuticals
– based on cost effectiveness evaluations and international comparisons
– enabled treatment for an increasing number of patients for the same amount of money
– WB funded Social Safety Net subsidy
– provides 100% reimbursement of medicinal products for the poor
WHO Regional Office for Europe
Major restructuring in Latvia: 35% reduction of expenditure on hospital in-patient care in two years
2010: 21 emergency care hospital, , 6 care hospitals, 12 specialized hospitals
Number of patients in Day Care Number of Home Care visits
Data source: The Centre of Health Economics data review, Latvia
WHO Regional Office for Europe
Shifting from hospital to ambulatory care of TB in the Republic of Moldova
Facilitating factors
1. Higher costs of hospital care
2. Significant risks of re-infection and nosocomial transmission of MDR TB
3. Socio-economic impact related to patients’ long absence from the household
Main obstacles
1. Resistance of medical personnel due to overburden and lack of proper incentives
2. Lack of experience of personnel working at PHC care level in monitoring TB treatment
3. Challenges in ensuring adequate nutrition and additional support in case of adverse effects
Key success factors
1. Introducing bonuses for PHC personnel
2. Ensuring adequate nutritional and other support
3. Important role of NGOs and Community TB centres
4. Rapid diagnostic tools in place
WHO Regional Office for Europe
35th Anniversary of Alma-Ata Declaration on PHC,6-7 November 2013
WHO Regional Office for Europe
People-centeredness as a cornerstone of sustainable health systems
Services Settings • Health Protection
• Health Promotion
• Disease Prevention
• Diagnosis
• Treatment
• Long-term care
• Rehabilitation
• Palliative care
• Public health
• Primary care
• Secondary care
• Specialist care
• Community, home & social care
• Pharmacies
The management and delivery of health services such that people receive a continuum of services through the different levels and sites of care within the health system, and according to their needs.
“When they change my physician that means that something is going wrong. The first thing I thought was that I wasn’t doing so well
anymore”
“I have a disease that is called COPD (…) no one told me, I found out over time by myself, reading the package inserts of the drugs they
prescribe me.”
“We feel like there are people who really care about us here” [Patient receiving integrated HIV/injection drug services, Ukraine]
WHO Regional Office for Europe
Sustainable Human Resources for Health
BMJ, 314, 24May1997
Nurses/ Midwives
WHO Regional Office for Europe
120 000 lives and US$ 12 billion saved by implementing the Consolidated Action Plan
The goal is to contain the spread of drug-resistant TB by:
•decreasing M/XDR-TB cases among previously treated cases by 20 percentage points;
•detecting 85% (or 225 000) M/XDR-TB patients;
•successfully treating at least 75% (127 000) of them.
WHO Regional Office for Europe
HOW DOES IT FEEL TO TRANSFORM?
WHO Regional Office for Europe
(HLC HIA Dec 2013)
• Harvard change mgt steps
WHO Regional Office for Europe
Eight Steps to Transforming Your Organization
Institutionalizing New ApproachesArticulating the connections between the new behaviors and corporate successDeveloping the means to ensure leadership development and succession
Forming A Powerful Guiding CoalitionAssembling a group with enough power to lead the change effortEncouraging the group to work together as a team
Creating a VisionCreating a vision to help direct the change effortDeveloping strategies for achieving that vision
Communicating that VisionUsing every vehicle possible to communicate the new vision and strategiesTeaching new behaviors by the example of the guiding coalition
Empowering Other to Act on the VisionGetting rid of obstacles to changeChanging systems or structures that seriously undermine the visionEncouraging risk taking and nontraditional ideas, activities, and actions
Planning for and Creating Short Term WinsPlanning for visible performance improvementsCreating those improvementsRecognizing and rewarding employees involved in the improvement
Consolidating Improvement and Producing Still More ChangeUsing increased credibility to change systems, structures, and policies that don’t fit that visionHiring, promoting , and developing employees who can implement the visionReinvigorating the process with new changes, themes, and change agents
Establishing a Sense of UrgencyExamining market and competitive realitiesIdentifying and discussing crises, potential crises, or major opportunities 1
2345678
WHO Regional Office for Europe
http://www.euro.who.int/en/what-we-do/health-topics/Health-systems
THANK YOU