Community Health Nursing–I

(2:1) BSc. Nursing (4–Years

Program)

Health Care
Delivery
System
 Objectives..,
• At the completion of this unit, students will be able to:
• Define the terms, system, and health care delivery system.
• Identify health services available to community by Pakistan
Government Health Care System.
• Explain roles of health care team members within health care system.
• Discuss the Devolution Plan of 2000
 Health Care Delivery
System
• It is often used to describe a way in which health care is provided to
people.

• Health system is defined as comprising all organizations, institutions

& resources that are devoted to produce health related actions.

• Programs aimed by govt. at promoting health, developmental need,

drawn policy & financial support from national plans for development

with increasing allocations & resources within the population.

• A good health system delivers quality services to all people, when &
where they need them. The exact configuration of services varies from
country to country, but in all cases requires:
• A vigorous financing mechanism
• A well-trained & adequately paid workforce
• A reliable information on which to base decisions & policies
• A well maintained facilities & logistics to deliver quality medicines
& technologies. (WHO)
 Health Care
System
An organized plan of health services.

It refers to the system or program by which health care is made

available to population & financed by government, private enterprise,

or both. In a larger sense, elements of a health care system embrace

the following:
1. Personal health care services for individuals & families, available at
hospitals/clinics/community centers/similar agencies/physicians' offices,
& in clients' own homes.
2. The public health services needed to maintain a healthy environment,
like control of water/food supplies/regulation of drugs, & safety
regulations intended to protect a given population.
3. Teaching & research activities r/t prevention/detection/treatment of
disease.
4. Third party (health insurance) coverage of system services.
(CDC)
WHO Building Blocks of Health Care
System
 Factors Affecting the Delivery of Health Care
Services
• Several factors have contributed to growth & complexity of health
care

delivery system.

• Health care as a right:

• Technological advances:

• Rising Consumerisms:
 COMPLEX MIXED HEALTH
SYSTEM
• Publicly financed govt. health system.
• Fee-levying private health sector.

Health Care
Services
PUBLI PRIVAT
C 20% E
Percentage 80%
of GNP
Percentage of GNP spent on private health care:2-
spent
3% on the
health: 3-
 Health Infrastructure in
Pakistan
• In past 15 years there has been a 14% increase in total health
infrastructure.
• 14% decrease in maternal and child health centers. MMR in 2015
was 178/100,000 live births & IMR was 66/1000 live births.
• Population per bed in Pakistan is currently 1613, the ratio being
large compared to other countries.
• Tertiary care units in Pakistan are overburdened. In 2015 the number
of hospitals in Pakistan was 1167 while the total population was
191.71 million. Number of hospitals grew by 33% over last 15 years
 Integrated Health System
Health Care Providers Population Served
Tertiary
Specialists, Doctors, Hospital Referral Centers
Nurses, Paramed. Staff s
District
Specialists, Headquarter 100,000 – 300,000
Doctors, Nurses, s Hospital
Paramedical Staff
Tehsil
Headquarters 50, 000 – 100,000
Hospital
MO,LMO, Dentist &
Paramed. Staff
Rural Health 25,000 – 50, 000
Center
Medical officer &
Paramed. Staff Basic Health 5,000 – 10,000
Units
 Key Components of A Well
Functioning Health
System
A well functioning health system responds in a balanced way to
a population’s needs & expectations by:

‾ Improving the health status of individuals, families &

communities
‾ Defending the population against what threatens its health
‾ Protecting people against the financial consequences of ill-
health
‾ Providing equitable access to people-centred care
 Staff of an Ideal Primary Health
Care Facility
An ideal health care facility in our setup should have following
staff:

• A family medicine qualified doctor to head the setup.

• A female doctor.
• A qualified registered nurse & maternity trained lady health
visitor.
• A lab technician.
• A medical assistant.
 Health Care System in
Pakistan
Pakistan has a wide network of healthcare infrastructure,
including:
• 1217 hospitals
• 5334 Basic Health Units (BHUs) & Sub-Health Centers
• 600 Rural Health Centers (RHCs)
• 5377 Dispensaries
• 905 Maternal & Child Health (MCH) Centers
• 288 Tuberculosis Centers
Pakistan is listed as one of 57 countries with critical health
workforce deficiency in the World Health Report 2006.
 Health Manpower in
Pakistan
• Registered Doctors –
175,223
• Registered Dentists – 15,106

• Registered Nurses – 90,276

www.pbs.gov.pk/sites/default/files/50_years_statistics
 Devolution Plan 2000

• GoP introduced a devolution plan in year 2000 to reform all social sectors,
including health.

• Following this plan, administrative & financial powers were transferred to

districts of all provinces through an ordinance in 2001.

• “Basic Democracies”, Local Government Ordinance 1979, “Devolution

Plans” also known as “5Ds”, “Decentralization” National Reconstruction
Bureau (NRB) & Local Government Ordinance 2000.
The Local Government Plan 2000 was first end product of National

Reconstruction Bureau (NRB), which was designed on five

fundamentals:

• Ø Devolution of political power,

• Ø Decentralization of administrative authority,

• Ø Decentralization of management functions,

• Ø Diffusion of the power-authority nexus

• Devolution in health sector was aimed at enhancing financial & management

authority at district & dominant level of decision making level to improve

service delivery & increase healthcare utilization at grassroots level.

• It was seen as an opportunity to re-exert the agenda of providing

primary healthcare to all & achieving MDG’s 2015.

 Reference
• Community Health Nursing:sBT Basvanthappa, 2nd Ed. 2008-reprint
2013, Jaypee Publishers, New Delhi
• Community Medicine. Ilyas. Ansari. 2008
• Excel Community Medicine: M. Naveed Alam, 8th Ed. 2015,
Faisalabad
• Community Medicine for All. Brig. Javed Iqbal. 2014.
• apps.who.int/medicinedocs/documents/s17305e/s17305e.pdf
• gallup.com.pk › Services › Gallup Pakistan Program