The Health District Learning objectives What is a health district Why do we focus on the health...

The Health District

Learning objectives

• What is a health district• Why do we focus on the health district• What are the tasks of a health district• What is the role of the HIS in the health

district

What is a health district?

Primary, secondary, tertiary care

• Primary care: community level, first point of consultation for all patients

• Secondary care: provided by medical specialists who in general do not have first contact with patients. Referrals; for example cardiologists

• Tertiary care: specialized health care for inpatients in hospitals

What is a health district?

• It is the point of implementation for primary health care (Alma Ata, 1978)

• What does this mean?

The health district

• It is the point of the national health system where people can get comprehensive health care

• It is a clearly defined geographical/administrative area

• It is the optimal operation unit for the identification of the excluded from health care and for the implementation of health improving strategies (Harare, 1987)

What are the characteristics of a health district ?

Population between 30,000 and 500,000 (most cases)

Clearly delineated geographical area

Identifiable form of local government

Managed by few officers

Balance between population size and availablity of technical specialised staff

Why do we focus on the health district?

What advantages presents the health district ? 1/2

It is the most appropriate level for coordinating top-down and bottom-up planning

It is close enough to the community to understand and act on its problems and constraints

It has easier communication with the community to ensure its participation in planning and organization

What advantages presents the health district ? 2/2

It presents large potential for effective collaboration with other sectors towards the health of the community

It has the ability to handle decentralisation of resources and of decision-making

It is the most suitable place to provide support to health workers in the health posts and health centres

What are the tasks of a health district?

What are the tasks of the health district ? 1/2

Implementation of all community based health programmes

Supervision and control of all community health workers in the district

Organization and operation of district hospital services

Management of all other public health facilities

Coordination and supervision of all public, non-government and private health systems

What are the tasks of the health district ? 2/2

Promotion of active links with local government entities

Promotion of community participation in the local health service planning

Preparation of annual health plan

Raising additional local funds

In-service training of health workers

Collection, compilation and dissemination of routine health information

Why size matters ?

....greater number of health districts, then...

more management structures and systems

cohesion and co-ordination more difficult at a national or provincial level

it will cost more and fail to capture economies of scale

If the health districts are too small...1/2

district hospitals will be managed as separate entities from the rest of primary level health care

could create a further dislocation between primary level services and district hospital services (many health districts without a district hospital)

If the health districts are too small...2/2

district-level management can become unwieldy and bureaucratic

the DHS loses its “service delivery" functions

The DHS becomes too remote from the community.

If the health districts are too large...

Community involvement

Comprehensive services

Population size

Geographic size

The required balance

Technical autonomy

more or less self-contained segment of the national health system

it comprises first and foremost a well-defined population

within a clearly delineated administrative and geographical area

it includes all the relevant health care activities in the area, whether governmental or otherwise.

needs to to ensure as comprehensive a range as possible of promotive, preventive, curative and rehabilitative health activities

What is a District Health System (DHS)? 1/2

ideally contains a network of primary health units and a district hospital for referral of cases

What is a DHS ? 2/2

it is the point and level at which different health service activities are integrated into a comprehensive and holistic approach to health care

it is able to accept the transfer of responsibility, resources, authority and seniority from central levels of management to the periphery

- the many responsibilities of the district health team

- the need to carefully allocate the scarce resources

- the necessity of sound health management

obvious need for adequate information BUT

Why the focus on DHS ?

the main constraint for implementing the primary health care approach in practically all countries:

...inadequate information for the managerial processes !

The district health information system needs to make available...

• the right information and the right knowledge

• to the right persons and institutions

• in the right form

• at the right time

• in the right place

Why the focus on DHS ? 3/3

What is the role of the HIS in the health district?

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EpidemiologyEpidemiology: who, where, : who, where, when ?when ?

HEALTH CARE LEVEL

HEALTH CARE LEVEL

PRIMARYPRIMARY

SECONDARYSECONDARY

OTHER SECTORS:-Environment-Civil Administration-Transport-Education

OTHER SECTORS:-Environment-Civil Administration-Transport-Education

Routine Health Information System

Routine Health Information System

Community LevelCommunity Level

TERTIARYTERTIARY

Patient/Client

contact

Patient/Client

contact

Referred patientsReferred patients

First level care unit

First level care unit

District HospitalDistrict Hospital

Referred patientsReferred patients

Regional HospitalRegional Hospital

Regional Health

Management Team

Regional Health

Management Team

Referred patientsReferred patients

National Hospital

University Hospital

National Hospital

University Hospital

Ministry of Health

Universities Other Health Institutions

Ministry of Health

Universities Other Health Institutions

INDIVIDUAL CARE

MANANAGEMENT

INDIVIDUAL CARE

MANANAGEMENT

HEALTH UNIT MANAGEMEE

T

HEALTH UNIT MANAGEMEE

T

SYSTEM MANAGEMEN

T

SYSTEM MANAGEMEN

T

DISTRICT LEVEL

DISTRICT LEVEL

REGIONAL LEVEL

REGIONAL LEVEL

NATIONAL LEVEL

NATIONAL LEVEL

HEALTH CARE SERVICESHEALTH CARE SERVICES

HEALTH SERVICES SYSTEMHEALTH SERVICES SYSTEM

HEALTH SYSTEMHEALTH SYSTEMN

ON

-RO

UTIN

E D

ATA

C

OLLEC

TIO

N M

ETH

OD

SN

ON

-RO

UTIN

E D

ATA

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OLLEC

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N M

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CATCHMENT AREA POPULATIONCATCHMENT AREA POPULATION

District Health

Management Team

District Health

Management Team

• Districts have been identified as the most efficient level of managing primary and secondary health services

• For this management to be possible and efficient, access to comprehensive district health information is necessary

Summary points