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The Health District
Learning objectives
• What is a health district• Why do we focus on the health district• What are the tasks of a health district• What is the role of the HIS in the health
district
What is a health district?
Primary, secondary, tertiary care
• Primary care: community level, first point of consultation for all patients
• Secondary care: provided by medical specialists who in general do not have first contact with patients. Referrals; for example cardiologists
• Tertiary care: specialized health care for inpatients in hospitals
What is a health district?
• It is the point of implementation for primary health care (Alma Ata, 1978)
• What does this mean?
The health district
• It is the point of the national health system where people can get comprehensive health care
• It is a clearly defined geographical/administrative area
• It is the optimal operation unit for the identification of the excluded from health care and for the implementation of health improving strategies (Harare, 1987)
What are the characteristics of a health district ?
Population between 30,000 and 500,000 (most cases)
Clearly delineated geographical area
Identifiable form of local government
Managed by few officers
Balance between population size and availablity of technical specialised staff
Why do we focus on the health district?
What advantages presents the health district ? 1/2
It is the most appropriate level for coordinating top-down and bottom-up planning
It is close enough to the community to understand and act on its problems and constraints
It has easier communication with the community to ensure its participation in planning and organization
What advantages presents the health district ? 2/2
It presents large potential for effective collaboration with other sectors towards the health of the community
It has the ability to handle decentralisation of resources and of decision-making
It is the most suitable place to provide support to health workers in the health posts and health centres
What are the tasks of a health district?
What are the tasks of the health district ? 1/2
Implementation of all community based health programmes
Supervision and control of all community health workers in the district
Organization and operation of district hospital services
Management of all other public health facilities
Coordination and supervision of all public, non-government and private health systems
What are the tasks of the health district ? 2/2
Promotion of active links with local government entities
Promotion of community participation in the local health service planning
Preparation of annual health plan
Raising additional local funds
In-service training of health workers
Collection, compilation and dissemination of routine health information
Why size matters ?
....greater number of health districts, then...
more management structures and systems
cohesion and co-ordination more difficult at a national or provincial level
it will cost more and fail to capture economies of scale
If the health districts are too small...1/2
district hospitals will be managed as separate entities from the rest of primary level health care
could create a further dislocation between primary level services and district hospital services (many health districts without a district hospital)
If the health districts are too small...2/2
district-level management can become unwieldy and bureaucratic
the DHS loses its “service delivery" functions
The DHS becomes too remote from the community.
If the health districts are too large...
Community involvement
Comprehensive services
Population size
Geographic size
The required balance
Technical autonomy
more or less self-contained segment of the national health system
it comprises first and foremost a well-defined population
within a clearly delineated administrative and geographical area
it includes all the relevant health care activities in the area, whether governmental or otherwise.
needs to to ensure as comprehensive a range as possible of promotive, preventive, curative and rehabilitative health activities
What is a District Health System (DHS)? 1/2
ideally contains a network of primary health units and a district hospital for referral of cases
What is a DHS ? 2/2
it is the point and level at which different health service activities are integrated into a comprehensive and holistic approach to health care
it is able to accept the transfer of responsibility, resources, authority and seniority from central levels of management to the periphery
- the many responsibilities of the district health team
- the need to carefully allocate the scarce resources
- the necessity of sound health management
obvious need for adequate information BUT
Why the focus on DHS ?
the main constraint for implementing the primary health care approach in practically all countries:
...inadequate information for the managerial processes !
The district health information system needs to make available...
• the right information and the right knowledge
• to the right persons and institutions
• in the right form
• at the right time
• in the right place
Why the focus on DHS ? 3/3
What is the role of the HIS in the health district?
25
EpidemiologyEpidemiology: who, where, : who, where, when ?when ?
HEALTH CARE LEVEL
HEALTH CARE LEVEL
PRIMARYPRIMARY
SECONDARYSECONDARY
OTHER SECTORS:-Environment-Civil Administration-Transport-Education
OTHER SECTORS:-Environment-Civil Administration-Transport-Education
Routine Health Information System
Routine Health Information System
Community LevelCommunity Level
TERTIARYTERTIARY
Patient/Client
contact
Patient/Client
contact
Referred patientsReferred patients
First level care unit
First level care unit
District HospitalDistrict Hospital
Referred patientsReferred patients
Regional HospitalRegional Hospital
Regional Health
Management Team
Regional Health
Management Team
Referred patientsReferred patients
National Hospital
University Hospital
National Hospital
University Hospital
Ministry of Health
Universities Other Health Institutions
Ministry of Health
Universities Other Health Institutions
INDIVIDUAL CARE
MANANAGEMENT
INDIVIDUAL CARE
MANANAGEMENT
HEALTH UNIT MANAGEMEE
T
HEALTH UNIT MANAGEMEE
T
SYSTEM MANAGEMEN
T
SYSTEM MANAGEMEN
T
DISTRICT LEVEL
DISTRICT LEVEL
REGIONAL LEVEL
REGIONAL LEVEL
NATIONAL LEVEL
NATIONAL LEVEL
HEALTH CARE SERVICESHEALTH CARE SERVICES
HEALTH SERVICES SYSTEMHEALTH SERVICES SYSTEM
HEALTH SYSTEMHEALTH SYSTEMN
ON
-RO
UTIN
E D
ATA
C
OLLEC
TIO
N M
ETH
OD
SN
ON
-RO
UTIN
E D
ATA
C
OLLEC
TIO
N M
ETH
OD
S
CATCHMENT AREA POPULATIONCATCHMENT AREA POPULATION
District Health
Management Team
District Health
Management Team
• Districts have been identified as the most efficient level of managing primary and secondary health services
• For this management to be possible and efficient, access to comprehensive district health information is necessary
Summary points
