1. Health Systems in the Developing World Stephen J. Spann, M.D., M.B.A. Professor of Family and Community Medicine SVP and Dean of Clinical Affairs

2. What is a health system? A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health- improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behavior change programs; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health. WHO. Everybody’s Business. Strengthening Health Systems to Improve Health Outcomes.

3. WHO. Everybody’s Business. Strengthening Health Systems to Improve Health Outcomes.

4. WHO. Everybody’s Business. Strengthening Health Systems to Improve Health Outcomes.

5. Health Services How are the basic sanitation and public health services? How are health care services organized and delivered? What is the number, infrastructure and distribution of health care facilities? How are the different health indices of the country? What are the key health problems (morbidity and mortality), what is the epidemiology of disease, including infectious diseases and chronic diseases?

17. Health Workforce What types of healthcare professional and how many are available? What is the medical education system like? How are healthcare professionals remunerated? How significant is the brain drain of healthcare professionals?

22. Health Information System What type of medical records are kept (paper vs. electronic)? What are the requirements for keeping separate statistical data (patient demographics, diagnoses, procedures, prescriptions, etc)? How/where is statistical data recorded and stored? What is the reliability and validity of this data?

23. Health Financing Public vs. private insurance? Who pays the premium? How many don’t have coverage, where do they receive care, and who pays?

24. Sierra Leone Health System System in disarray after long war Severely under resourced Patients have to pay out of pocket

25. Honduran Health System Ministry of Public Health: 60% of the population Honduran Social Security Institue: 12% of the population Private Health Insurance: 10% of the population

26. Norwegian Public Health System Financed by taxation Designed to be equally accessible to all residents, independent of social status With its 220 000 employees, the public health sector is one of the largest sectors in Norwegian society Under the jurisdiction of the Ministry of Health and Social Affairs, which is responsible for devising and monitoring national health policy Responsibility for provision of services is decentralized to the municipal and regional level The municipalities are in charge of providing primary health services such as general practitioner clinics The counties and the five health regions provide the more specialized medical services, such as hospitals \A number of authorized private hospitals and health services have also been established in addition to the public facilities.

27. Canadian Health Care System Publicly funded, universal coverage Most services covered (not pharmaceuticals) Services provided through private entities Administrative simplicity (health card)

36. Medical Products, Vaccines and Technologies What is the availability and cost of pharmaceuticals and vaccine, and who pays for them? What is the availability of diagnostic technologies, who pays for them?

37. Leadership and Governance Understand the key institutions: ministry of health, social security, private insurers, etc, and their leadership Understand the governanc at the national, state, regional and local levels Understand how primary, secondary and tertiary care services are delivered

38. Primary Health Care Center, Botswana

39. Primary Hospital, Botswana

40. District Hospital, Botswana