Learning Unit 7Health systems and inter-sectoral

and cross-border collaboration14 August 2014

Part 1

Dr. Leonard I. OrtegaRegional Adviser, Malaria

WHO-SEARO

Learning ObjectivesBy the end of this Unit, the Participant should be able to:

• Explain how the different components of the health systems relate to effective malaria control and elimination

• Give examples of common weaknesses in health systems that constrain malaria elimination and identify ways to overcome those weaknesses

• Describe measures for re-orienting the health system towards the needs of malaria elimination

• Determine the roles of different actors including the private sector, the community, different sectors and inter-country collaboration

• Identify suitable topics for operational research related to elimination

Introduction

“Malaria elimination is war!”

“We have the responsibility but we do not have the authority”

“Health system”

“Systems thinking”

Health system: definition and building blocks

Health System (1)

(1) Governance: ensuring strategic policy frameworks combined with effective oversight, coalition building, accountability, regulations, incentives and attention to system design

(2) Health workforce: responsive, fair and efficient given available resources and circumstances, and available in sufficient numbers

Health System (2)

(3) Health financing: raising adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them

(4) Medical technologies: including medical products, vaccines and other technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use

Health System (3)

(5) Health information: ensuring the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status

(6) Service delivery: including effective, safe, and quality personal and non-personal health interventions that are provided to those in need, when and where needed (including infrastructure), with a minimal waste of resources.

Analyzing and improving quality of service delivery

The Health System and Malaria Elimination

Health system component Malaria elimination

1. Governance

2. Workforce

3. Financing

4. Technologies

5. Health information

6. Service delivery

People

Public Health Service Delivery System in MyanmarSource: Health in Myanmar 2014

Township Public Health Department (under consideration)

Township Public Health Officer (Assistant Director)

Deputy Township Public Health Officer (Public Health)

Deputy Township Public Health Officer (Disease Control)

Deputy Township Public Health Officer (Admin)

Team Leader (Medical Officer)

Team Leader (Medical Officer) Administrative Officer

Maternal/ Child/ School Health, Nutrition, Environmental Sanitation, Basic Health and Health promotion services

Malaria, TB, HIV/AIDS, Leprosy, Trachoma & PoB, EPI diseases, NCD

- Admin:/ Management - Auditing - Finance

Public Health System in Viet Nam

The private health care sector

• Who?• What are their roles?• Some examples…

Malaria elimination in the GMS: key interventions1. Case detection and

management2. Disease prevention in

transmission areas3. Malaria case and

entomological surveillance

Inter-sectoral collaboration

• Malaria is not just a health problem; it is a socio-economic development issue

• Collaboration with other sectors is important; some examples:– Business/corporate sector (in Bhutan; Cambodia; Indonesia;

Myanmar; the Philippines; etc )– The military (in Sri Lanka; Thailand; etc)– Civil societies/FBO/NGOs (in Cambodia, Lao PDR, Myanmar; the

Philippines; Thailand; etc)– Other government sectors (in Bhutan; the Philippines, Thailand)

Inter-country collaboration• Multi-country

– ASEAN– Asia Pacific Malaria Leaders Alliance (APLMA)– Greater Mekong Sub-region – BBINMS (Bangladesh, Bhutan, India, Myanmar, Nepal, Sri Lanka)– South Pacific Community– Mekong Basin Disease Surveillance– Lower Mekong Malaria Initiative (Cambodia, Myanmar, Thailand)– ACTMalaria– Asia Pacific Malaria Elimination Network

• Bilateral– Myanmar-Thailand– India-Nepal– India-Bhutan

Learning Unit 7Health systems and inter-sectoral

and cross-border collaboration14 August 2014

Part 2 – Inter-sectoral Collaboration

Dr. Risintha PremaratneDirector, Anti-Malaria Campaign

Sri Lanka

http://au.news.yahoo.com/thewest/a/-/breaking/16053899/sri-lanka-rescues-138-stranded-on-sinking-boat/

Cluster of vivax malaria among pakistani immigrantsOver 1000 immigrants screened23 cases identifiedRegular screening continues

Learning Unit 7Health systems and inter-sectoral

and cross-border collaboration14 August 2014

Part 3 – Group Exercise

Group 1 – Exercise 7.1 and 7.2

Group 2 – Exercise 7.3 and 7.4

Group 3 – Exercise 7.5