HYGIENE AND PREVENTIVE MEDICINE

CORE COMPETENCIES

Define and describe the main objectives of the

public health
Define and describe the different levels of the
prevention
Describe the main characteristics of the
healthcare delivery system
Describe and identify the effects of major
environmental agents on human health and safety
Define and describe epidemiological and
preventive aspects of the main infectious
diseases
Define and describe the healthcare associated
infections
 Health Systems

“The organizations, institutions, resources

that are devoted to producing health
actions”

(WHO, 2000)
 Health Systems

Missions
1. Population health improvement
2. Capacity and sensitivity to respond to
the needs (non-health) of patients
3. Equity in the funding of the system
 The Italian healthcare system
• established in 1978 (SSN)
• increased responsibility and autonomy of
regional authorities – 1992
• decentralisation process – 1998

Regions  increasing autonomy, are

responsible to plan and provide health and
social services preventive activities,
treatment, rehabilitation
 PRINCIPLES
Universal coverage
Everyone has access to health care, and primary and
inpatient care are free of charge at the point of use
of use
Universality of the guarantees
Ensures the protection of health in different context
and in different forms (promoting lifestyles, disease
prevention, treatment, rehabilitation)
Financing
Taxes on citizens and companies and additional
regional income tax
 Equity in access to health services
Any individual must have access to the health care
system with no differentiation or discrimination
among citizens and no barrier at the point of use
Allocation/management of the resource
Services managed and provided primarily by state
employees (public sector)
Status of Health Care Workers
Employees or paid capita share (GP, P)
Infrastructure
Hospitals are owned by the state
Role of the State

Determines and controls the operating policies

 Three levels
• National
General objectives & principles
Essential levels of care (LEA, minimum statutory
health services offered)
Regulatory function for drugs & medical equipment
• Regional
Management & organization: target orientation,
delegating management to LHU and structures
Coordination and control
Financially accountable
Legislative & administrative functions
Planning
• Local
Management & delivery
 Primary health care

• The “first” level of contact between

the individual and the health system
• Essential health care (PHC) is provided
• A majority of prevailing health
problems can be satisfactorily
managed
• The closest to the people
• Provided by the primary health
centers
 What is Primary Health Care?
Essential health care
socially appropriate
universally accessible
scientifically sound first level care
gives priority to those most in need,
maximises community and individual self-
reliance and participation and involves
collaboration with other sectors
 health promotion
 illness prevention
 care of the sick
 advocacy
 community development
▪ WEAK PRIMARY HEALTH CARE

In 2019, WHO will work with partners to

revitalize and strengthen primary health care
in countries, and follow up on specific
commitments made by in the Astana
Declaration.
The COVID-19 pandemic has had a substantial impact
on primary care throughout Europe and globally.

The COVID-19 pandemic has considerably impacted on

primary care at both service and patient levels, and various
strategies to mitigate these impacts have been described.
Future research examining the pandemic’s ongoing impacts on
primary care, as well as strategies to mitigate these impacts, is
a priority.
How are Health Services Organized and Financed?
• Primary/ambulatory care
GPs or Ps are paid via a combination of capitation
and fee-for-service, sometimes related to
performance, and are regulated under national and
regional contracts
They are in charge for providing most primary
care, referring to specialists, and prescribing
diagnostic interventions and drugs
The majority operate in solo practices, although
the government and regions have offered
economic incentives to encourage group practice
and integration with social care, home care, health
education, and environmental health services
 Secondary health care
• More complex problems are dealt with
• Comprises curative services
• Provided by the district hospitals
• The 1st referral level
How are Health Services Organized and Financed?
• Outpatient specialist care
Generally provided by LHU or by public and private
accredited hospitals under contractual agreement
with a LHU

Once referred, patients are given free choice of

any public or private accredited hospital

Ambulatory specialists are generally paid on a per

hour basis, while hospital-based physicians are
salaried employees
 How are Health Services Organized and Financed?
• After-hours care
 Guardia medica is a free telephone health service
for emergency
 Night and on weekends, and the doctor usually
provides advice in addition to home visits if needed
 Following examination and initial treatment, the
doctor can prescribe medication, issue employee’s
medical certificates, and recommend hospital
admission
 To promote coordination among HCWs and the
accessibility of primary care, government and GP
associations have agreed to implement a model
where GPs, specialists, and nurses coordinate to
ensure 24-hour access and avoid unnecessary use of
hospital emergency departments
 Tertiary health care
• Offers super-specialist care
• Provided by regional/central level
institution
• Provide training programs