Week 23
Core Domain: Primary Healthcare
What are some of the key philosophical arguments underpinning primary healthcare?
The philosophy of primary healthcare rests on its ability to promote health through various methods such as health education and awareness campaigns to encourage health consciousness among communities. Furthermore, primary healthcare also takes into account the social view of health and aims to redress inequalities in healthcare. Moreover, primary healthcare is one of the vehicles with which Universal health Coverage can be achieved.
In South Africa, the philosophy of primary healthcare is regarded as the cornerstone to health transformation. Many strides have been made by the post-apartheid government to improve equity in health through various means such as health literacy.
How is education used as a tool to achieve primary healthcare?
Education is an important component of primary health care, which is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. Health education can help people understand their health problems and the methods of preventing and controlling them, promote healthy behaviours and lifestyles, and increase their participation in health care decisions.
Some examples of health education topics in primary health care are:
Nutrition and food safety
Maternal and child care, including family planning and immunization
Environmental, emotional, and sexual health
First aid, safety, and disaster preparedness
Health education at the Primary Health Care (PHC) level helps to address issues related to disease prevention, consumer health, environmental, emotional, sexual health, first aid, safety and disaster preparedness, substance abuse prevention, human [2]. The importance of health education impacts many areas of wellness within a community, including chronic disease awareness and prevention, maternal and infant health promotion, tobacco use and substance abuse prevention, injury and violence prevention, mental and behavioural health promotion, nutrition, exercise and obesity prevention and the reduction of risky behaviors [3]. Health education tends to be more effective when it is taught by qualified teachers, connects students to health services, engages parents and community partners, and fosters positive relationships between adolescents and adults who are important to them [4].
To achieve the ideals of primary healthcare, what are some of the tensions that exist?
Some of the tensions that exist are:
The gap between policy and practice in implementing PHC principles [2].
The lack of resources, infrastructure, and human resources to provide PHC services [2][3].
The challenges of integrating PHC with other levels of care and sectors [1][3].
The diversity of needs, preferences, and expectations of different communities and populations [1].
Competency: Communication & Teamwork
What do you need to work on as a team in preparation for your final presentation?
My team has overcome many challenges throughout the year. We have seen exponential growth in communication skills, time management, allocation of tasks and presentation skills which permit me to be confident in my team for our final presentation.
Contextual Content: COPC
In what ways does COPC apply the philosophy of PHC?
Primary Health Care (PHC) is concerned with engaging communities and allowing people to define their health and social problems to implement effective health promotion and illness prevention strategies. PHC is both a philosophy of health care and a model for providing services that support health. Effective PHC is community-based, promotes healthy lifestyles as a pathway to disease and injury prevention, provides continuing care of chronic conditions and recognises the importance of the broad determinants of health. PHC as a philosophy requires community engagement and participation. COPC is one of several broad strands making up the fabric of PHC – it is a structured way of practicing PHC.
What are some of the challenges with implementing COPC?
"Factors related to governance, finances, community health workers, primary care facilities, community participation, health information and training that influence the implementation of COPC."
What can we learn from the history of social medicine that might be relevant for our current NHI context?
Social medicine is a scientific field that studies the relationships between society, disease, and medicine. It began in the early 19th century in response to the health problems of industrial workers. It aims to create a new social role for medicine that addresses the social determinants of health.
One possible lesson from the history of social medicine that might be relevant for the current NHI context is the importance of interdisciplinary collaboration between medicine and social science to understand and address the complex health issues of different populations. Another possible lesson is the need for social justice and equity in health care delivery and financing.
Week 24
Core Domain: Primary Health Care
What factors should be considered when developing strategies for PHC?
Accordingly, the development of strategies and the strategic focus requires interventions that ensure an equitable distribution of health services to all, in a manner that these services can be provided in a cost-effective way so that all countries and citizens can afford them.
Strategies should not be formulated in isolation, but should rather encompass inter-sectoral collaboration and coordination. This is an important factor in primary health care, as this approach can help maximise the benefits of the intervention.
Accordingly, the complexity of the health intervention determines which sectors, departments, agencies, community individuals and academic disciplines (and other roleplayers) should be involved in the process of strategy development and implementation.
Another factor in considering the strategy development for implementing primary health care is the appropriate use of technology. Technology must be adapted to meet local needs, should be easily accessible and affordable to use.
What are some of the reasons that good strategies fail at the point of implementation?
Community Involvement was not prioritised during the planning and implementation phase. The skills and resources needed are not available. Leadership is incompetent. Changes in the external environment that make the strategy obsolete or irrelevant.
How can community engagement promote the effectiveness of PHC?
The process of community engagement is a powerful model that can be used to improve population health and also their determinants of health. Stakeholders involved in community engagement can include government agents or departments, experts in the field such as academic researchers, local and international health agencies, individual community members and local leaders.
Engaging the community is an important element that is required for primary health care to be implemented successfully. Involving communities can help ensure the provision and access of health care services to poorly resourced settings. Furthermore, it can play a crucial role in reducing the burden and transmission of diseases, and in improving health awareness, in turn improving the health system.
The concept of community engagement plays a role in health promotion or preventative care. Engaging communities in health interventions such as community-based participatory research, health promotion, and policy-making has been used as an effective strategy to improve health care delivery. Furthermore, community engagement is an important tool for tackling social health inequalities (Whitehead et al., 2006). Sacks, et al. (2019) provide an expanded framework of the building blocks which focus on promoting community engagements throughout the health system.
Whitehead, M., Dahlgren, G., Europe, W.H.O.R.O. for, 2006. Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health.
Sacks, E., Morrow, M., Story, W.T., Shelley, K.D., Shanklin, D., Rahimtoola, M., Rosales, A., Ibe, O. and Sarriot, E., 2019. Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all. BMJ global health. [online] Available at: https://gh.bmj.com/content/bmjgh/3/Suppl_3/e001384.full.pdfLinks to an external site. [Accessed 30 Oct. 2023].
Competency: Scholarship
How can you improve your e-Portfolio of learning?
Homepage:
Describe how to navigate my site.
Create a logical order to my website.
General:
Well-organised & clearly described work.
What is the difference and relationship between hard and soft systems?
In Hard Systems Thinking/Methodology, a system is considered to have a clear purpose with well-defined goals, and solutions are designed to achieve these goals (Kirk, 1995). Hard systems are usually described and expressed in quantitative terms which allow for mathematical models to be developed (Hasan, 2011).
In Soft Systems Thinking/Methodology, a situation is viewed as complex and messy, and that humans are part of the systems and not merely observers (Burge 2015). Instead of the approach to viewing the world as systematic, that is used in hard systems thinking, soft systems methodology using a systematic process of inquiry to understand the situation (Checkland, 2000).
Hasan, R. (2011). Hard and Soft Systems Thinking. Hausarbeit. [online] Available at: https://www.hausarbeiten.de/document/208273Links to an external site. [Accessed 30 Oct. 2023].
Kirk, D. (1995). Hard and soft systems. International Journal of Contemporary Hospitality Management. [online] Available at: https://www.emerald.com/insight/content/doi/10.1108/09596119510090708/full/html Links to an external site.[Accessed 30 Oct. 2023].
Burge, S. (2015). An Overview of the Soft Systems Methodology. [online] Available at: https://www.burgehugheswalsh.co.uk/Uploaded/1/Documents/Soft-Systems-Methodology.pdf Links to an external site.[Accessed 30 Oct. 2023].
Checkland, P. (2000). Soft systems methodology: a thirty-year retrospective. Systems research and behavioral science, 17(S1), S11-S58. [online] Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.395.556&rep=rep1&type=pdf Links to an external site. [Accessed 30 Oct. 2023].
Why is it important to identify the root causes of problems in complex challenges?
It is important to identify the root causes of problems in complex challenges because they can help you avoid short-term solutions that may not address the underlying issues.
https://www.boldbi.com/blog/unravelling-complexity-tackling-challenges-with-root-cause-analysis
Complementary: Rural Health
How do we define rurality?
There are a variety of definitions on the concept of rurality which reflect the multi-dimensional nature of the concept. Accordingly, there is no single or widely agreed upon definition to describe the concept of rurality. It is thus necessary to select definitions appropriate to the context and intended uses of the term (Cloke, 1977).
Cloke, P.J., 1977. An index of rurality for England and Wales. Regional Studies, 11(1), pp.31-46. [online] Available at: https://www.tandfonline.com/doi/abs/10.1080/09595237700185041Links to an external site. [Accessed 30 Oct. 2023].
What is rural proofing all about?
“Rural-proofing is an approach to the development and review of government policy and strategic planning that recognises that the needs of rural areas and communities are different to those of their urban counterparts” (RHAP, 2015, p4).
Rural-proofing is a crucial element supporting the strategic response to addressing the disparities amongst populations.
Rural Health Advocacy Project. (2015). Rural-proofing for health: guidelines - a guide to accounting for rural contexts in health policy, strategic planning and resourcing. [online] Available at: https://www.hst.org.za/publications/NonHST%20Publications/2015-01-13-RHAP-Rural-Proofing-Guideline-A4-Email-1.pdfLinks to an external site. [Accessed 30 Oct. 2023].
Week 25
Core Domain: Hospital Reform
How did the structure of the hospital as an institution evolve over time?
According to Van Rensburg (2012), in the medieval era, hospitals were regarded as places for hospitality, but later the hospital became a place where people who were sick or injured would go for care.
Majorossy and Szende (2008), further suggest that early hospitals were also used as refugee camps for those in need. The concept was used as a framework for Christianity during the 10th and 11th century. Since the hospital was also used as refugee camps for those in need, patients suffering from leprosy in the middle ages found refuge in hospitals when they were kicked out of their homes and segregated from society.
Modern hospitals have significantly evolved from those of the medieval times. They have transformed to become healthcare institutions responsible for providing various kinds of care such as rehabilitation, treatment and emergency assistance to both inpatients and ambulatory patients. Compared to clinics, hospitals are more complex and comprise various specialised equipment, better trained and skilled medical specialists in order to address predefined conditions.
Hospitals operate 24 hours/day and 7 days a week. They are also a place where research and education or training of students. Modern-day hospitals collaborate with research institutes and academic institutes for their research.
Different hospitals are set up differently in terms of their size, objective, care programme, type of patients it attends to, type of illness, social structure (Van Rensburg, 2012). Additionally, the structure of the hospital is also divided into various wards.
Van Rensburg, H. (2012).A history of health and health care in South Africa: 1652–1994.Pretoria: Van Schaik Publishers. [Chapter 10, page 535 - 591].
Majorossy, J. and Szende, K. (2008). Hospitals in Medieval and Early Modern Hungary, in: Scheutz, M., Sommerlechner, A., Weigl, H., Weiss, A.S. (Eds.), Europäisches Spitalwesen. Institutionelle Fürsorge in Mittelalter Und Früher Neuzeit. Böhlau Verlag, Wien, pp. 409–454. [online] Available at:https://doi.org/10.7767/boehlau.9783205160885.409Links to an external site.[Accessed 30 Oct. 2023].
In what ways has a hospicentric health system perpetuates inequalities in our current health system?
Hospitals in poor settings still remain under-resourced and underfunded; this consequently results in them not being able to properly support comprehensive primary health care services, which are at the cornerstone of providing equity health care.
What future trends in hospital reform can support the attainment of social justice?
The trend of implementing universal healthcare systems, universal health care systems advocate for health equity which means that the building blocks of health systems will be restructured in a manner that benefits social justice efforts.
Cross-cutting: Evaluation
What is the difference and relationship between monitoring and evaluation?
M&E are at the core of managing any successful programme. The main difference between monitoring and evaluation is that monitoring is an ongoing process, while evaluation takes place at specific stages in any programme.
How can you apply the 5 stages of evaluation to improve health systems?
Evaluations can be conducted internally (internal or self evaluation) where people within a program fund, conduct and control the evaluation. External evaluations are where someone from beyond the program acts as the evaluator and controls the evaluation.
Evaluations can be conducted on various aspects of the health system. These include:
Processes, which are the organizational operations of a continuous and supporting nature (e.g. personnel procedures, administrative support for projects, distribution systems, information systems, management operations).
Services which are based on a permanent structure, and, have the goal of becoming, national in coverage, e.g. Health services, whereas programmes are usually limited in time or area.
Projects which normally consist of a set of activities undertaken to achieve specific objectives within a given budget and time period.
Conditions which are particular characteristics or states of being of persons or things (e.g. disease, nutritional status, literacy, income level).
Programs which are organized sets of projects or services concerned with a particular sector or geographic region.
What are the important characteristics of measurement indicators that ensure an accurate evaluation of a health intervention?
Within each of the above five aspects, evaluations can focus on:
Inputs, which are there sources provided for an activity, and include cash, supplies, personnel, equipment and training.
Processes which transform inputs into outputs.
Outputs which are the specific products or services, that an activity is expected to deliver as a result of receiving the inputs.
A service is effective if it “works”, i.e. it delivers outputs in accordance with its objectives.
A service is efficient or cost-effective if effectiveness is achieved at the lowest practical cost.
Outcomes refer to peoples’ responses to a programme and how they are doing things differently as a result of it. They are short-term effects related to objectives of the programme under evaluation.
Impacts refer to the effects of the service on the people and their surroundings. These may be economic, social, organizational, health, environmental, or other intended or unintended results of the programme. Impacts are more long-term.
This ensures an accurate evaluation of a health intervention.
Complementary: Rural Health
How would you define the concept of rurality?
I would define rurality, according to the leadership that exists in the area, proximity to essential services, living conditions and employment Oppurtunites.
Why is it important to rural-proof new policies for rural communities?
To guarantee that policies implemented are not causing any unintended harmful effects on the community and to ensure that all obstacles are accounted for ensuring the policies effectiveness when implemented.
Week 26
Core Domain: Hospital Reform
What are some of the lessons learned from the reforms over the course of history?
The importance of health equity over equality.
The importance of ensuring health systems building blocks function to benefit good health outcomes.
What strategies could be put in place to ensure the sustainability of hospitals?
How money is raised, it should be according to how much the person is able to afford and not according to the health needs.
Why is it important for policymakers to consider the experiences of health workers in the field?
Health workers respond to the needs of patients; therefore, it is important for policymakers to ensure that policies enable healthcare workers to provide the patient with the best care possible in an effective, timely and efficient manner.
Competency: Advocacy
What role do you see yourself playing as a change agent in the health system?
As a Health Systems Sciences student, you will hold a position of influence, accordingly, your words and actions have a direct impact on society. As a health advocate, you responsibly use your expertise and influence to advance the health and well-being of the workforce, individuals, communities and populations. You act as a change agent in advocating for the needs of people within the health system as well as those who use healthcare services. You create a voice for both the needs of the workforce and the patient. You enable change by influencing policies, procedures and decision making.
Your voice plays an important role in influencing economic and social inequities to achieve social justice.
What barriers are stopping you from bringing about change in health systems? How can these be addressed?
I did not think about advocating for anything before i joined HSS i did not recognise that anyone's voice including mine can be beneficial in bringing about change. After HSS, I did't know where to start to become an advocate. Next year i plan to join UNICEF or WHO clubs in wits and hope to be able to contribute positively.
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