1. UNIT 6: HEALTH SYSTEMS IN RELATION TO MALARIA ELIMINATION Allan Schapira Elimination course, Luxor, 19/11/12

2. Learning objectives Explain how the different components of the health systems relate to effective malaria control and elimination. Give examples of common weaknesses in health system that constrain malaria elimination and demonstrate competence in making proposals to overcome these weaknesses. Describe measures necessary for re-orienting the existing health system towards the needs of malaria elimination Discuss the roles of different players of the health system including the private sector, community, different sectors and inter-country collaboration.

3. Definition of 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; behaviour change programmes; 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. WHO (2007). Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action

4. The vertical horizontal dichotomy VerticalHorizontal

5. From PHC to UC/UA

6. Health system components Systems thinking. Systems are more than the sum of the parts, and “systems thinking” as developed and used for other complex systems needs to be applied in health. Applied to problem solving, systems thinking addresses the dynamic, mainly non-linear linkages, interactions and behaviours among the elements of the entire system.

7. The Health System and ME Health system componentMalaria elimination 1. Governance 2. Workforce 3. Financing 4. Technologies 5. Health information 6. Service delivery People

8. Phases of Malaria elimination and HS Malaria elimination phaseOrganization in relation to health system Malaria control Pre-elimination Elimination phase Prevention of reintroduction

9. Indicators for service delivery IndicatorGood value (Standard) Number of doctors plus nurses per 10,000 inhabitants. 23? Number of community health workers /volunteers per village or per 1000 pop. 1? Number of out-patient consultations per person per year. Must include authorized private, community services 1-2? Coverage of DTP-3 immunization>90% Proportion of expected new cases of tuberculosis found >90% ABER Percentage of fever episodes tested for malaria (household surveys)

10. District Y Foreign country α Exercise 6.7.1