The underlying dynamics of health care systems in developing countries: Health policy, planning and the Impact of Social Economic Status (SES) on Health Disparities
©2014
Textbook
68 Pages
Summary
The impact of health policy and planning are tremendous remedies through which the health care systems derive their primary potentials in the health promotion ventures and interventions. The programs designed in the health arena are tentatively equivocal and submissive to the implications influenced by the policy development criteria and much more open to the planning process. <br><br>Every day, healthcare organizations are faced with crucial decisions about improving their systems of care and a lack of critical information to guide them. The research they need should be designed to help them provide better care to the patients in their organization, effectively and efficiently.<br><br>Where does the Medicaid and the medical care strategies, as pursued in the United States of America, have their remedies through policy structure and together with the political culture associated to the system, or perhaps how possible is it that japan has the highest life expectancy co-efficient.<br><br>The book is more of a fact file as results were generated by the health care research from suitable sectors and comparisons derived from the well-off health care states mainly from the OECD fraternity, as these bare differences due to policy even when their economic bases differ by small percentages. This work should be helpful in directing and providing us with traceable landmarks to follow while seeking to avert the challenges that weaponize the communicable disease prevalence in the society for both the developed and the low developed states.
Excerpt
Table Of Contents
4
Index of Figures
Figure 1: TEH vs. Health Inequalities in OECD Countries
9
Figure 2: Standard of living Vs. Salary (Ug.x) for Urban Residents (2007-2012) Uganda
18
Figure 3: Propositions of the Macro and Micro-Level Health Inputs
23
Figure 4: Life Expectancy At Birth For OECD Countries (1990-2005)
46
Figure 5: PYLL per 100,000 all Causes of Mortality for OECD Countries. (1990-2005)
46
Figure 6: Generated financing contributions towards health care in the OECD states
(2005) 48
Figure 7: Percentage Health Risks In Relation To the Occupational Classes As
Registered In Main Referral Hospitals of Uganda (2008-2010)
54
5
Abstract
The main purpose for this research accomplishment is to expose chronologically the key
findings and core results that emerged from the research study that aimed at analyzing the
significant and cardinal role played by both the policy setting and the planning undertaking in
the elevation of the health care systems for the developing countries.
The WHO has at so many times defined health care systems as individuals, groups and state
entities involved or has an astounding stake in the restoration, upholding and elevating the
health prevalence of the community. Under this perspective, paradventually the analysis
considered the trend of correlation between these different stakeholders and the extent to which
they impact the planning and policy development given the access to effect fundamental
changes.
However, with further elaborations as key findings from the interviews and rigorous research
undertakings the different health disparities as they are distributed along the global demographic
gridlines have been analysed and comparisons drawn out in order to correlate and relate the
impact of the different determinants of health with socio-economic status as a frontier.
7
Introduction
The driving forces that determine the impact of the health care systems originate from the
contributions of the policy setting and the planning process as involved subsequently in public
health programs. Nevertheless, the influence and the strength of the health care systems can
easily be described at any particular time in health interventions and programs on parameters of
efficiency, efficacy and availability.
Since policy and planning are core foundations that support the strength of the health care
systems, the extent at which they meet the determinants of efficiency, values of efficacy and the
implications of availability can alternatively provide ideal means by which such systems are to
be assessed (MacRae, 1985).
Under this study; planning undertakings together with the policy settings are idealized as co-
partners sharing the same position of effecting the strategic measures for promoting health in
the developing world. Henceforth, this study places these two domains in the fluent control
position of the astounding strategies which perhaps as normally conceptualized will enhance the
achievement of advantages in the health care systems such as those outlined below;
i.
Provision of health care services to the population
ii.
Generating the instrumental resources as the need may demand
iii.
Promotion of reliable financing criteria
iv.
Ensure stewardship in all the stake holders
The dynamic trends of health care service delivery in the developing countries is certainly non-
uniform and this sort of abnormal distribution correlates with adjustments that are associated
with the socio-economic status of the populations
(
GTZ-ILO-WHO). What happens is that while
arranging the demographic associations with health prevalence for the various global regions,
healthy advantaged clusters of settlements are localized within proximal vicinities and this sort
of rendering on the other hand of impoverished health statuses the reverse is true thereby
unraveling the effects of the normally blinded factor. Emphasis has barely been directed
8
towards socio-economic status as one of the principle determinant of health not only in the poor
states but much more in the states with giant economies.
Much of the policy speculation unfortunately has been focused on the promotion of health
through establishment of health care service providing facilities to the remote regions of the
poor states which ideally can be considered to yield the same fruits as the process of elevating
the social and economic bases of the populations
(
BARROS, 1998). However, this
conceptualization is merely ideal and theoretical with little practical reliability and for this
reason; the anticipated results may materialize more from the adjustments of the socio-
economic status of the population than it would from the direct health interventions.
Poor infrastructures in developing and poor states are responsible for the detrimental socio-
economic class distribution as they allow in the influx of increased accidents due to
automobiles, problems associated with suburb congestion in urban regions, low standard
employment that increases the risks of occupation hazards and the other shortcomings.
Therefore, the distribution of health wellness is hardly uniform and yet worst still, the inflow of
the negative externalities of socio-economic status causes implicative disparities which at so
many times affect the largest population
(LIGHT, 2001).
Nevertheless, from the statistics as provided from the OECD states relating to their health care
expenditures and budgetary spending in comparison with the quality of health care service
delivery in states, a reasonable pattern of this relationship is shown from the extract below
(figure 1).
9
Figure 1: TEH VS Health Inequalities in OECD Countries
Source: WHO Data
Health systems: www.who.int/health systems
(2011)
Health inequalities are determined by assessing the distribution of various factors that contribute
to health wellness and risk such as Nutrition and diet, occupation and environmental health
risks. However, direct measurements of health inequalities are determined through statistical
research results showing the trends and patterns for the distribution of morbidity rates and the
also for the mortality rates as caused by disease infections rather than accidental.
Despite of these sharp depictions in the above figure that are so evident and requiring less
articulation, this study venture into the health care systems outweighs the burden presented by
the dynamic trends caused by both policy and planning. Further still, with comparatively a more
elaborative exposition it shows how this pair of factors are less effective when the impact of
social economic status is neglected.
More effectively under the scope of this research is the political and effects of foreign
capitalistic policies as they correlate with policy and planning though this relationship is of
0
1000
2000
3000
4000
5000
6000
1990
1994
1998
2002
2006
2010
Expenditure
Health Inequalities
10
great importance in the developing and the poor states little is based on its impacts. Political
systems in most of the poor states are unpredictable and have been so much victimized by
foreign influence and interruption in which case any institutional analysis oriented towards them
is vulnerable to bias.
Prospectively, the research has been arranged systematically with various chapters that
transcend with background literature, conceptualization and research outcomes.in brief these
aspects of this research follow the trend as thus; the theoretical dimension of the topic is
discussed after the introduction, which then is followed by the conceptual framework where
eventually the resulting hypothesis is descriptively enacted. The fourth section of this research
mainly expose the outcomes of the research undertaking involved in this study context and these
results obtained will be used to analyse and propose a precise operational and dynamic
framework that can cause fundamental changes in the health care systems for the poor states.
The fifth chapter also commences with the further analysis into the patterns and trends
generated from the research as regards to the health dynamics determinants and the social
economic status dimensions both towards health and the economic development. Implications
and prospects will further be diagnosed in the proceeding chapters before the summarizing and
concluding section of the whole research.
11
Theory
2.1 Conceptual Approach in the Analysis of the Health Care Systems
Dynamics
2.1.0 Definitions: Health care Systems, Health Planning, Policy setting and SES
2.1.1 Health Care Systems
The general perspective from the analytical point of view will align health care systems among
social sectors that seek to elevate social wellbeing through health wellness and strategic
planning and undertakings to strengthen efficient health care support for the communities.
Being regarded as formal social settings in the community, the health care systems are therefore
open-ended in objectives at least for the current situation and at the same time equivocal to both
public health wellness and policy settings.
The current global advocacy for health promotion has sown the seed of interest in a number of
entities and individuals with a passion for reducing the health inequalities and minimizing the
side effects of the disparities caused. Such influx of numerous stake holders with the majority
being non-government organizations and world bodies have enacted a new branding on the
outlook of health care systems from being merely evolutional to revolutionary extents.
From the ambitions of such multiple entities and numerous stakeholders the health care systems
can therefore be described or defined as institutions, individuals, organizations, governments
and government agencies that peruse the prevalence of health wellness. Such entities and
individuals or societies uphold the strategies through modifying policy settings and planning
undertakings while streamlining these arenas towards core measures of achieving health
wellness goals for the global community.
From an international point of view, health care systems are the core underlying facilities in the
public health arena that strengthen the various dimensions of;
·
Health care cost
·
Health care coverage
12
·
Consistency of the health care services to the target group in the community
· Complexity
· Chronic
illness
In other words, it is either through the health care systems and their operational strategy that the
costs of health care services are enacted and modified for the good of the current health status or
for purposes of achieving the policy demarcations as initially intended
(NEWHOUSE, 1992a).
The rest of the great five "C"s follows the same channel of systematic objectivity though these
emphatically are controllable only through the gridlines already set through policy setting and
planning.
The operational framework of the health care systems have a great deal in determing the
structural outlook and dynamic functionality and this has always been attributed to the
administrative rendering yet in so many cases it has its great dependency on the political
environment. A majority of regional governments such as those in Africa has a complete grip
and autonomous control on the health care sectors and exercises their significance by setting
and enacting health care policies, carryout progressive planning for health care facilities and
programs, enforce regulation of the other private entities.
In this case, therefore, the frameworks are ideal to the favoring outlines of the government
system at the time and public or universal inclusion in the objectivity of health care services is a
primary concern.
2.1.2 Health Planning
Planning in its essence collectively embeds the systematic and chronological stepwise
arrangement of objectives and goals for pursuit within an entity mainly for purposes of
achieving them using the already streamlined channels (BARROS, 1998). Planning performs
the role of a compass but with an accomplishing objectivity and not merely exploratory as this
may be a passive undertaking and less instrumental for organization that seeks to achieve
specified goals.
13
Health planning touches the health faculty of strategizing and lay out of measures and
undertakings through which the prevalence and health promotion are to be achieved in a
community. Health care systems are multiple individual entities and here the faculty of planning
is not only entitled to a specified quorum of personnel though this in most cases is the real
approach followed which at one point has associated short comings. Further still, such a blinded
approach also affects a conceptual interpretation as it renders a misinforming picture of the clear
extent on how true planning should be handled in an organization where there are various stake
holders and most especially in a scenario where they originate from different dimensions of
professions and social exclusion aspects.
The best conceptual description can only originate from the point of view in which this event is
handled possibly whether it is a mere desk work requiring analyzing data, interview objectives
from
the stake holders, and finalizing the process by writing down the approved or set
objectives and committing them to the channels through which they are to be executed. And if
this is the perspective of the analysis and observation then it will swiftly be decided that
planning is only the drawing frameworks requiring to be executed for the entity to achieve its
prospects.
However, from another point of view if the process is scrutinized beyond the intellectual
drawing boards to a more pragmatic approach where it involves research and extended analysis
of trends and comparing those of the past with those in the current and execute the outcomes.
Then in this case, these will certainly be a composite of analysis, comparison, objectivity, policy
deterministic, and fundamental changes of all possible aspects that pertains health prevalence.
From this rendering health planning is an act of practical undertaking involving a series of
processes such as scrutinizing the situation to discover the need and designing the strategies for
checking the weakness and finding all possible means through which execution of the strategies
can materialize or to be transferred from the drawing board into practice.
Hence, concisely, health planning will aim at achieving health prevalence through the stepwise
approaches chronologically attended in the likely hood as;
14
1.
Setting up or adapting the primary or principal objective for the program
2.
Analyzing the environment or the current situation of the area under target
3.
Collecting and checking data of the past, current, related entities for comparisons
4.
Evaluating the resources available, those needed and their appropriate allocation
5.
Organization structuring and involvement of the stakeholders
6.
Designing the measures, and structural impressions to depict the objective
7.
Selecting the channels and parameters for execution of strategies
8.
The execution stage
Nevertheless, strategic planning must be directed by indicators of need in an organization or
system and these prompts or arouse the fundamental innovations and renovations accordingly
which further generates the targets so that the strategies are not blinded but astounding in
eliminating all discrepancy
(Jee, 1999). The targets generated are of various implications and
require non-uniform measures because their makeup can be dependant of unique factors such
as;
-
Demographic distribution of factor
-
Information and data dimensions
- Resource
availability
- Policy
settings,
etc
2.1.3 Policy
Policy is a set or compositional arrangement of rules, guidelines, operational demarcations for
an entity and they act to regulate and streamline the smooth and proper running of activities as
they should be. For within policy is included the institutional statutes, that can act as the
operational manual guides so that the activities of the entity protected from irregularities that
normally cause distortion of the set objectives.
15
The faculty of policy is a wide section within an organization most especially like in the health
sector where health is a public service that embeds a lot of stake holding entities and
individuals. Policy is very instrumental streamlining the key issues and activities of the public
health sector and without it more difficulties and negative externalities will be unraveled.
Policy setting involves a series of processes all of which are core and equally important for the
whole objectives to be achieved. The basic step by step stages in policy setting include;
Agenda selection which mainly involves outlining the core problems in relation to the
objectives of the health care entity. At first, multiple factors and predicaments are taken into
consideration, their impact and implications on health wellness of the target population checked
with an intention of proving their efficacy as underlying factors for the prevalence of poor
health care services in the communities.
Formulation is another stage in the policy setting criteria which involves a number of
professionals and technocrats from the associated entities and the society all with the stake in
the health care promotion process. The main activity under this stage is for the technical team to
compare the challenges discovered, assess the current situation of the population and then
decide schemes and criteria through which the sector can advance over these challenges through
the set approaches while observe certain regulations.
Implementation follows certain considerations and phenomenon by which the set and
formulated policy demarcations are executed as decided on. The stage is an important one calls
for enforcement and observation as induced by the authorities either institutional, individual or
state dictated.
Policy evaluation and assessment then is enacted as an axillary process that checks the
loopholes, strengths and weaknesses in the set policy. This process can be carried out through
various ways such as overviewing the achievements of the entity and their correlation with the
set objectives or selected agenda. Evaluation of the policy helps to iron out the whole poor
policies or in some cases helps to interject or enact amendments within the already existing
policy for excellent accomplishments of its purpose.
16
The policy setting process is an important one during directing public health interventions as it
formally mobilize public patent and helps to meet with statutory requirements of both the state
and for the sector or health care entity.
2.1.4 Interplay of Policy Implications and Program Evaluation on Health Care Systems
Efficiency
Policy settings in public health care systems plays an effective function in the objective
operations and act as core forces that enable the implementation of strategies to promote the
health welfare of communities. However, as important as it may look to be that policy has an
impact of objective streamlining and then a regulatory role that seeks to guide and control the
activities of the health care entities be it private based or under government management.
The main difference of the policy implications when compared to the impacts caused on either
the government and the private health care entities is that objectivity and regulation
demarcations are limited to different extents in these two orientations (LIGHT, 2001). Private
health care entities have objective set according to the dictated policies of the state that are even
more or less advantageous related to the goals of the entity in which case they are of restrictive
nature than being remedies.
Despite of the limitations that policy could impose onto private entities at some extent even
though such are not the primary intentions of these undertakings, the policy work plan and the
analysis part of it act as remedies for resetting operational and activity work processes which in
so many cases are good for innovation.
However, policy outlines on their own are sidelined and are therefore, imbalanced advantages or
undertakings, which require for counterbalancing factors or items that will effectively boost
their significant role in promoting health care service delivery. In program design and
interventional development for purposes of redeeming health care outcries policy settings will
plot the demarcations of the operations and activities whereas the role of the evaluation process
will certainly be to check the areas of weakness and enlist the impacts of the policy settings onto
the target population.
17
At so many cases a blunder has been committed by the health care technocrats who barely study
the post and pre-policy implementation effects from the different regions the same types of
policies have been enacted and so the process becomes blinded with a lot of bias. Sensitive
policies such as the decisions on who is to carry the expense of the health care insurance, how
are the re-imbursements to be generated, channels through which the financing resources are to
be directed and other driving forces in health care financing are not satisfactory. Therefore, with
time they will generate loopholes in process which if neglected could cause a manifold
breakdown in the service delivery for the health services towards the community
(
Glied, 2008).
2.1.4 The Socio-Economic Status (SES)
If the economic status of the general national population is to be analysed the scope shows
without fault that the economic status of individuals are non-uniform but though this is not so
shocking as it is further elaborated that those with better economic status also have better of life
styles.
The socio-economic status event also corresponds to the distribution of better conditions of
living to individuals in regard to their economic status. In other words those that are more
advantaged economically are also entitled to the better condition privileges.
The statistical board of Uganda (UNBS) for instance revealed that the largest number of
individuals in poor conditions of accommodation, inadequate access to health care services,
poor education status and conditions, and other statuses is more prevalent with the individuals
of poor economic bases.
