CHS 241 HEALTH CARE PROFESSIONS &
SYSTEMS
SECOND SEMESTER 1425 / 1426 H
(( UNIFIED COLLEGE CORE ))
241 صحة – مهن ونظم الرعاية الصحية
الفصل الدراسي الثاين 1142 / 1142 ه
)) (( الربنامج املىحد
COURSE INSTRUCTOR : DR. ABDALLA A.WAHID SAEED
مدرس املقرر : عبد اهلل عبد الىاحد سعيد
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DEPT. OF COMMUNITY HEALTH SCIENCES
SECOND SEMESTER 1425/1426H
COURSE NUMBER : CHS 241
COURSE TITLE : HEALTH CARE PROFESSIONS AND SYSTEMS.
CREDIT HOURS : 3 + 0 = 3
PREREQUISITES : NONE
COURSE INSTRUCTOR : Dr. Abdalla Abdel Wahid Saeed
OFFICE : ROOM NO.1A16 TEL 4355010 EXT 504
e-mail : asaeed@37.com
abdsaeed@medu.net.sa
COURSE OBJECTIVE :
To acquaint the student with a broad range of basic health and health
related sciences and the range of career opportunities in the health field as well
as an understanding of the health care systems and organization .
COURSE DESCRIPTION :
A summary of health care programs and opportunities in the health field
and the characteristics ,roles , responsibilities and relationships between and
among health professions . Basic Health Science Terminology, and fundamentals
of Epidemiology will be presented along with Introduction to the organization
and structure of the governmental and private health sectors in terms of their
planning, functions responsibilities , constraints and operations .
Specific Course Objectives :
1. Define health and discuss determinants and indicators of health status
2. Discuss the different aspects of Environment family and their role in the
causation and solution of health and health related problems .
3. Define the levels of health care and discuss the concept and rationale of the
primary health care program in the Kingdom.
4.Define Health Team and Health Professions and discuss their characteristics
careers , roles and problems .
5.Outline the different types of National Health Systems and discuss their
determinants, understand the basic Organization and Management Models in
Health Facilities.
6.Understand and use the basic health science terminology
7.Understand the role of the International Health and Health Related
Organizations .
8.Understand , discuss and use Epidemiologic Methods in the study and solution
of health and health related problems.
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TOPICAL OUTLINE :
SERIAL TOPIC
1 Introduction
Definitions of health
Determinants of health status
Sociological aspects of health
2 Health Professions / Health careers
Health Team
3 Health Indicators
4 Health Science Terminology
5 Levels of health care / levels of prevention
Primary Health Care : concept and programmes
International Health Organizations
6 Health Systems Analysis.
7 Health System in the Kingdom
8 Comparative Health Systems
9 Definition and uses of Epidemiology
Descriptive and Experimental Epidemiology
10 Analytic Epidemiology.
Ecological, cross-sectional studies
11 , 12 Retrospective , prospective studies
13 Screening Programmes
14 Infectious Diseases Epidemiology
15 Non infectious diseases epidemiology
16 REVISION
TEACHING METHODS :
Formal lectures with active student participation
EVALUATION : Three Semester Tests
TEST 1 25 % TEST 2 25 % FINAL 50 %
COURSE TEXT BOOKS :
1.Smolensky J. Principles of Community Health . W.B. Saunders
Company , Philadelphia , 2001.
2. Mausner and Kramer . Epidemiology : Introductory Text
W.B. Saunders Company , Philadelphia 1990.
3. Medical Terminology : a self-learning module
by: Jacqueline Joseph Birmingham
Mcgraw -Hill Book Company , 1991.
4.Other References : Handouts
MID TERM TEST 1 ( 25 %)
MALES : SATURDAY 9/2/1426H ( 12.3.2005)
FEMALES : TUESDAY 12 /2/ 1426H ( 15.3.2005)
MID TERM TEST 2
MALES : SATURDAY 21 / 3/ 1426H (23.4.2005)
FEMALES : TUESDAY 24 /3 /1426H ( 26.4.2005)
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READ THE FOLLOWING
CAREFULLY :
PLEASE TAKE COURSE SERIOUSLY , ATTEND
ALL LECTURES AND EXAMS- NO RETAKE
EXAMS- NO DOUBLING OF GRADES- NO
ADDITIONAL ASSIGNMENTS OR QUIZZES TO
IMPROVE GRADES.
EXAMS WILL BE SOLVED AT END OF EXAM.
PERIOD, YOU SHOULD ATTEND TO KNOW THE
CORRECT ANSWERS WHICH WILL NOT BE
DISCUSSED WITH INDIVIDUAL STUDENTS
GRADES WILL BE DISTRIBUTED TO
STUDENTS AT THE BEGINNING OF THE
FOLLOWING LECTURE.NO STUDENT WILL BE
ALLOWED TO REVIEW HIS PAPER
INDIVIDUALLY THE TEACHER IS READY TO
REVISE STUDENTS ANSWER PAPER TO
CORRECT ANY MISTAKES. STUDENT HAS TO
FILE A COMPLAINT IF NOT CONVINCED
AFTER THE REVISION . QUESTIONS WILL NOT
BE ANSWERED FOR INDIVIDUAL STUDENTS .
THIS WILL ONLY BE FOR ALL STUDENTS IN
THE CLASS AT THE SAME TIME , USUALLY
IMMEDIATELY AFTER EXAM.
OFFICE HOURS :
SATURDAY 12 - 2 PM 6 -7 PM
SUNDAY 10 - 1 PM
MONDAY 10 - 12 NOON
TUESDAY 12 -2 PM
WEDNESDAY 8 -10 AM 12 -1 PM
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FACTORS AFFECTING HEALTH STATUS
DEFINITIONS OF HEALTH :
1-W.H.O. definition of health :” health is the complete state of physical, mental
and social wellbeing and not only the absence of disease or infirmity”
the definition presents an unattainable and unmeasurable ideal but it
emphasizes a comprehensive concept of health.
2-ECOLOGICAL DEFINITION:
“health is a state of optimal physical, mental and social adaptation to one’s
environment.”
3-OPERATIONAL DEFINITION OF HEALTH:
“a healthy person is how is living an economically and socially active live"
FACTORS AFFECTING HEALTH STATUS :
1-INTERNAL ENVIRONMENT :
hereditary, congenital personal behaviour - acquired risk factors :smoking ,
eating , driving habits attitudes, values
2-EXTERNAL ENVIRONMENT :
More important than internal environment
PHYSICAL , geographical , place, man made – housing , transportation,
communication, work environment, pollution
BIOLOGICAL , living agents microorganisms, macro organisms, animals, plants
SOCIO/ECONOMIC , education, income, health services availability,
accessibility, utilization. This is the most important environment.
SOCIOLOGICAL ASPECTS OF HEALTH AND DISEASE
DISEASE : patient , sickness
" professional definition of a pathological process "
ILLNESS : ill-health
" individual perception of loss of function ( not feeling well) "
ILLNESS BEHAVIOUR :
" differential perception , evaluation of symptoms and
actions taken for them " :
- no action
- consult family / relatives / friends
- non professional actions
- self medical care , self referral
- health professional care
SICK ROLE : ( if person is diagnosed as patient by health professional or
considered ill by family or community ) – such person has TWO RIGHTS is
expected to perform TWO DUTIES
RIGHTS :
1- exempt from responsibilities.
2- not expected to take care or get well by himself
DUTIES :
1 -should want to get well
2- should seek expert advice and make effort to get well
SPECTRUM OF ILLNESS EPISODES
out of 1000 adults at risk IN PERIOD OF 2 – 4 WEEKS :
- 750 report a sickness episode ( ILLNESS )
- 250 of them consult health professionals ( the other 500 persons took other
actions)
- 9 of the 250 persons are admitted to general hospitals
- 5 of them referred to a specialized hospital
- 1 of them admitted in the Intensive Care Unit
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So as can be seen the majority of sickness episodes are not seen by health
professionals , and those seen by health professionals are mild .
EPIDEMIOLOGY
“ IS THE STUDY OF THE FREQUENCY, DISTRIBUTION AND
DETERMINANTS OF HEALTH AND DISEASE AMONG HUMAN
POPULATIONS”
TYPES :
A- OBSERVATIONAL ( NON INTERVENTIONAL – NON EXPERIMENTAL)
1-DESCRIPTIVE ( DISTRIBUTION – WHO , WHERE, WHEN)
2-ANALYTIC ( DETERMINANTS) ( STUDY OF CAUSE AND EFFECT)
2.1 CROSS-SECTIONAL ( PREVALENCE)
2.2. ECOLOGICAL STUDIES
2.3.CASE-CONTROL ( RETROSPECTIVE ) MATCHED OR NON
MATCHED
2.4.COHORT ( PROSPECTIVE – INCIDENCE ) CONCURRENT OR NON
CONCURRENT (HISTORICAL)
B- EXPERIMENTAL – INTERVENTIONAL – CLINICAL TRIALS:
1- PROPHYLACTIC ( PREVENTIVE) ( PROTECTIVE)
2- THERAPEUTIC ( CURATIVE ) ( TREATMENT)
DESCRIPTIVE EPIDEMIOLOGY
Distribution of health and disease according to : person , place , time
a- Who? – person:
NATURAL ATTRIBUTES: age, sex( gender) ,race,
Some diseases are more common in children ( childhood diseases) such as
Measles, Chicken pox, Polio- others more common in elderly ( degenerative-
aging diseases) such as Dementia, Osteoarthritis, most chronic diseases- some
diseases are commoner in adolescents and young adults such as Acne Vulgaris,
Sexual Diseases, Car and Sports Accidents. Some diseases are common in both
children and elderly such as some Nutritional Problems, Dental and Bone
problems
Diseases common in females include Breast Cancer, Aneamia, some
psychological disturbances- diseases more common in men include Alopecia
(balldness), Colour Blindness,
Diseases common in blacks include hypertension, cancer of cervix- in whites
include breast and skin cancer
ACQUIRED ATTRIBUTES:
Education, ( educated are healthier) Occupation ( according to occupational
hazards- higher income better health status) , Marital Status ( married best
health status – divorced worst health status ), Family Size ( larger family have
poorer health status) , Maternal Age( very old or very young have more diseases
in their born children- Down’s, low birth eight, neurological diseases)
In general morbidity is more in Females , Mortality is more common in Males.
b- Where ? place
1- Geographical boundaries- geographical location ( altitude, desert,
climate)
2- Political , health policies ( health policy and health services, accessibility)
c- When? time:
1- Short time pattern ( cyclic, periodic) hours of day, days of week, weeks
and months of years- acute diseases- influenza, accidents, climate changes
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2- Long time pattern ( secular , trend ) pattern over several years – chronic
diseases- TB, Cancer,
EXPERIMENTAL ( INTERVENTIONAL - TRIALS )
Experiments if conducted properly give the best and strongest evidence but
sometimes it is not possible to conduct experiments on humans because of
religious, ethical, medical , legal , social or economic considerations.
In experiment the investigator is actively intervening by manipulating the
situation by adding or subtracting something and not only observing what is
happening.
types of experimental studies :
1-Therapeutic ( treatment - curative)
2-Prophylactic ( preventive- protective)
EACH OF THESE CAN BE :
1-Non Blind - 2-Single Blind 3-Double Blind 4-Triple Blind
Steps in conducting experimental studies:
1-identify reference population ( who will benefit from outcome)
these can be all population or a certain part of it
2-identify study population ( experimental population)
( these usually a representative part of reference population but can be humans
from outside the reference population or can be animals)
3- divide the study population(experimental population) using appropriate
randomization into two groups :study group and control group.
4-then conduct the experiment on the experimental population
STUDY GROUP CONTROL GROUP
4.1 Non Blind give experimental agent give nothing
4.2.Single Blind give experimental agent give placebo
4.3.Double Blind give experimental agent give placebo
4.4 Triple Blind give experimental agent give placebo
PLACEBO is an agent which has no biological effect
in non blind experiment :
(1-Experimental Population 2- Investigator 3-Statistician) all of these who are
personally involved in the experiment know all what is being done
in Single Blind experiment : Experiment Population is BLIND
in Double Blind experiment : Investigator is ALSO BLIND
in Triple Blind experiment : Statistician is ALSO BLIND
Advantages and disadvantages of each type relate to each of :
(Accuracy, Cost, Time, Safety, Easiness, Personal Interests, Ethics )
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ANALYTIC EPIDEMIOLOGY
Study of cause( factor, susceptible person, at risk, exposed ) and
effect( disease, case, patient).
such studies are mostly for chronic non communicable diseases where
experiments are difficult to conduct because of :
1- lack of specific causative agent
2- Indefinite onset of disease
3- Long latent period
4- Multiple possible etiological factors
Types Of Analytic Epidemiology
Ecological studies ( population comparison )
Cross Sectional ( prevalence ) studies
Case-Control ( retrospective ) studies - matched or non matched
Cohort ( prospective ) studies concurrent or non concurrent
1- ECOLOGICAL:
Comparing population characteristics with disease patterns. populations which
consume high cholesterol diet have high cardiovascular diseases.
Ecological Fallacy : this does not necessarily mean that individuals will show the
same pattern and you can not be sure that the patients are those who consumed
high cholesterol and you can not decide causation.
such studies are easy , cheap , quick if reliable data are available
2-CROSS-SECTIONAL ( prevalence ):
Study of factor and disease at the same point in time. you can not decide
causation because of unknown temporal relation ( time relation – you can not be
sure that the factor preceded the disease) but they are easy, cheap, quick, safe
and can study several factors and disease at the same time
3- COHORT ( PROSPECTIVE, INCIDENCE ):
You can directly calculate risks and decide causation but is more expensive,
takes long time, not suitable for rare diseases
STEPS :
1- Select a healthy cohort
2- Divide into exposed and non exposed ( factor + or __ )
3- Follow up :
3.1. From Now ( present ) to Future ( CONCURRENT)
3.2. From Past to Present ( now) ( NON CONCURRENT-HISTORICAL)
4-.Put data in two by two table
DISEASE
PRESENT ABSENT TOTAL
FACTOR
PRESENT A B A + B
ABSENT C D C +D
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TOTAL A+C B +D A+B+C+D
5- Calculate Risks:
5.1. Relative Risk (R.R)
= Incidence among Exposed divided by Incidence among Non Exposed
5.2- Attributable Risk ( A.R.)
= Incidence among Exposed minus Incidence among Non Exposed
2- CASE- CONTROL ( RETROSPECTIVE):
You can estimate the risk and hence may be able to arrive to causation but it is
easy, quick, cheap, very suitable for rare diseases
STEPS :
1-Choose cases ( from health facilities , community ….)
2-Choose controls ( from health facilities , community
(controls can be non matched or matched with cases - who ? age ,
sex, race - confounding variables - may be related to both disease and
factor)
3- Check your factor in both cases and controls
4- Put data if two by two table:
DISEASE
PRESENT ABSENT TOTAL
PRESENT A B A + B
FACTOR
ABSENT C D C +D
TOTAL A+C B +D A+B+C+D
5- Estimate Risk by calculating Odds Ratio (O.R)
= A X D DIVIDED BY B X C FOR NON MATCHED
= B DIVIDED BY C FOR MATCHED
hence we try to find the causative agent in these diseases using analytic
epidemiology by answering three questions:
Q.1 is there any ASSOCIATION ( relationship) between the disease and the
suggested causative factor ? YES if R.R or O.R is not equal to
one
If Answer Is No , Then Suggest Another Factor To Study
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IF ANSWER IS YES , THE ANSWER QUESTION 2:
Q.2 What is the STRENGTH of the association? strong if R.R. or O.R.
equals 2 or more
If The Association Is Week , Then Suggest Another Factor
IF ANSWER IS YES THEN ANSWER QUESTION 3:
Q.3. IS THIS STRONG ASSOCIATION CAUSATIVE?
If answer is YES then we consider the factor is a cause for this disease if
Additional Criteria Are Satisfied . IF THESE ADDITIONAL CRITERIA ARE
NOT SATISFIED THEN SUGGEST A NEW FACTOR TO STUDY.
strong association can be :
*By Chance ( repeat or calculate p value 64 years
DIVIDED Population 20 - 64 years of age
2.10.Gross National Product GNP = Total Economic activity of country in one
year( all income from inside and outside country)
2.11. Gross Domestic Product GDP ( all income inside the country)
2.12.GNP or (GDP) PER CAPITA = GNP or(GDP) DIVIDED by Total
Population
2.13.GINI INDEX distribution of GNP or GDP among population ( range 0 -
1 Zero means almost all have equal income , ONE means few have almost all
income )
2.13. HOUSING: Ownership, rent, area, rooms, facilities etc…
2.14. Work Condition ( occupational health and Industrial Hygiene services)
2.12. Adult Literacy Rate ALR = Number of LITERATE (educated ) persons
DIVIDED by Total Population
3. INDICATORS FOR THE PROVISION OF HEALTH CARE :
3.1. Coverage By Primary Health Care ( Percentage of coverage)
3.2. Coverage By Referral Care ( Percentage of coverage)
4. HEALTH STATUS INDICATORS :
4.1. Life Expectancy Average Number of Years Lived Beyond a Certain Age
4.2 MORBIDITY RATES ( Diseases , Health Problems)
4.2.1 INCIDENCE RATE:
Number of New Cases DIVIDED by Population at Risk in a Period of Time
4.2.2 PREVALENCE:
Total Number of Cases DIVIDED by Total Population
4-2.2.1 PERIOD PREVALENCE : during a specific PERIOD of time
4.2-2.2 POINT PREVALENCE : at a specific POINT in time ( specific day)
Incidence is used mostly for studying risks and causative factors nd hence in
controlling nd preventing the disease
Prevalence is used mostly in planning health services because it contains ALL the
persons affected by the disease and not only NEW cases as in incidence
4.3 MORTALITY INDICATORS ( Deaths)
Mortality indictors re more accurate than morbidity indictors because of
dependable registration, consistency, full agreement.
4.3.1.Infant Mortality Rate IMR in a year per 1000 live births
Number of Deaths in Infants ( Less than ONE year) DIVIDED by Total Live
Births
4.3.2 Child Hood ( 1 - 4 years of age ) mortality rate CMR equals
Children Deaths DIVIDED by Total Children 1 - 4 years of age per 1000 in a
year
4.3.3. Under Five Mortality Rate = UNDER 5MR =IMR + CMR per 1000 in a
year
4.3.4.. Maternal Mortality Rate MMR = Number of Deaths in Mothers DUE to
Pregnancy DIVIDED by Total Live Births per 1000 in a year
4.3.5. CAUSE MORTALITY RATE
Number of Deaths from a CERTAIN disease DIVIDED by Total Population
4.3.6. CASE MORTALITY RATE
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Number of Deaths from a CERTAIN disease DIVIDED by ALL CASES of the
disease
4.3.7. PROPORTIONAL MORTALITY RATE
Number of Deaths from a CERTAIN disease DIVIDED by ALL DEATHS
Mortality more ACCURATE than Morbidity
Each of these mortality rates gives specific information
All Indicators give information about the Availability, Utilization and
Effectiveness of Health Services. If these are good then indictors will be of low
values , if there are problems with availability, utilization or effectiveness then
these indicators will be of higher values
COMAPARTIVE INDICATORS
INDICATOR KSA KWAIT EGYPT YEMEN SUDAN
CBR* 35.2 25.4 27.5 52.6 39.7
CDR* 7.6 2.2 6.3 21 12.2
ALR % 75 88 51 45 53
GNP/CAPITA 6880 18340 660 260 330
EXP/CAPITA 277 1030 125 NA 36
MOH/CAPITA 110 510 10 4 3
%GNP/CAPITA 8(6.5) NA 4.2 4.6 1
LIFE EXPECT 71.4 74.8 64.7 57.5 54
IMR* 21 12 25 83 108
< 5 MR* 29 14 55 122 157
MMR** 1.8 0.9 17.4 100 36.5
DOCTORS** 16.6 18.3 20.2 2.3 0.9
DENTISTS** 1.6 2.7 2.5 0.16 0.1
NURSES** 28.9 48.5 23.3 5.1 6.4
HOSP BED** 23 28.4 20.1 6.9 8.5
PHHCS** 1 0.4 0.6 0.9 1.1
* per 100 ** per 10 000
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EXAMPLES OF PREVIOUS EXAMS. QUESTIONS :
RATE = NUMERATOR
_______________ PER CONSTANT IN SPECIFC PERIOD
DENOMERATOR
IMR = total infants death divided by Total live birth
IMR = 100 DIVIDED BY 2000 = 1/ 20 = 0.05 = 5 % = 50 / 1000
THERE ARE THREE FIGURES IF YOU HAVE ANY TWO OF THEM ,
THEN YOU CAN CALCULATE THE THIRD
SUPPOSE THE IMR WAS 50 PER 1000 AND THE TOTAL DEATHS IN
INFANTS IS 100, WHAT IS THE TOTAL LIVE BIRTH?
IMR 50/100 = 100 DIVIDED BY Z ( Z = TOTAL LIVE BIRTH)
THEN X ( TOTAL LIVE BIRTH) = (1000 x 100) DIVIDED BY 50
EQUALS 2000
IF TOTAL POPULATION IS 60000 , WHAT IS THE NUMBER OF
CHILDREN UNDER 5 YEARS OF AGE IF THEY CONSTITUTE 20% OF
THE TOTAL POPULATION.
= ( 60000 x 20 ) DIVIDED BY 100 = 12000
IN A CERTAIN AREA THE TOTAL POPULATION WAS 180 000 .THE TOTAL
LIVE BIRTHS WERE 7560. THE CRUDE DEATH RATE WAS 19/1000.
DEATHS IN CHILDREN LESS THAN ONE YEAR OF AGE WERE 378. WOMEN
AGED 15 – 49 YEARS WERE 42% OF THE TOTAL POPULATION.NEW
CASES OF DISEASE X WERE 45 AND WOMEN WHO DIED FROM
PREGNANCY WERE 14. TOTAL NUMBER OF CASES OF DISEASE X IN THE
YEAR 1422H WERE 396. THE EXPOSED PERSONS TO DISEASE X WERE 25%
OF THE TOTAL POPULATION. FOUR PERSONS WHO DIED FROM DISEASE
X IN THE YEAR 1422H.. NUMBER OF CASES WHICH WERE PRESENT AT
THE END OF RAJAB 1422H WERE 216.
Q.1 : STUDY THE ABOVE DATA CAREFULLY , THEN CIRCLE THE
CORRECT ANSWER :
1.THE INFANT MORTALITY RATE IS :
A-2.2 PER 1000 B- 25 PER 1000 C- 40 PER 1000 D- 19 PER 1000
E-NON OF THE ABOVE
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Q.2. CALCULATE :
3.1. IMR
3.2. MMR
3.3. INCIDENCE RATE
3.4. GFR
3.5. NET POPULATION GROWTH
3.6. PROPORTIONAL MORTLITY RATE
HEALTH SYSTEMS
SYSTEM : Mechanism of Transforming INPUTS via THROUGHPUT(process)
into OUTPUTS in form of Health Services ( Personal , Family and Community)
to Restore , Maintain and Improve Health Status
OUTCOME IS THE IMPACT OF THE SYSTEM ON HEALTH STTUS OF
THE COMMUNITY
INPUTS : 3 Ms
Manpower
Money
Material
PLANNING : " RATIONAL ALLOCATION OF RESOURCES TO SOLVE
HEALTH PROBLEMS "
TYPE OF PLANNING : Central or Regional
PLANNING STEPS :
1. Identify ( diagnose ) health problems by population survey ( data collection,
data analysis , data interpretation to reach conclusion)
2. Prioritize problems ( according to mortality, disability , morbidity, social and
economic and demographic impact )
3. Choose the most important problems) to solve
Steps on solving problems :
- Identify goals ( Final Objective) and Objectives ( Sub-Goals)
- Refine them( make them, clear, specific, measurable, period of time)
- Describe Possible Courses Of Actions ( List all methods you can perform to
achieve objective and goal)
- Choose The Most Appropriate Course of Action(time, cost, etc… )
-Implement ( execute , do , perform , carry out the plan)
-Evaluate ( assess to what degree you achieved objectives and goal-problems)
FACTORS TO BE CONSIDERED IN PLANNING :
Religious, Social , Economic, Historic, Demographic, Technologic
PREREQUISITE FOR SUCCESSFUL PLANNING :
Economic Stability , Political Stability, Political Commitment and Competent
Administration
3. FINANCE : ( Money )
GNP and GNP / CAPITA
Health Expenditures
Total Annual Budget And Its Distribution
Percentage Of GNP Spent On Health Services
Per Capita Expenditure On Health ( for one person)
3.1. GOVERNMENT
3.2. TAXATION
3.3. FEES FOR SERVICE
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3.4. DONATIONS
3.5 HEALTH INSURANCE : ( COVERAGE by health services total or partial-
PREMIUM ( money to be paid for the coverage,)
COPAYMENT(COINSUARNCE) additional money to be paid each time the
services are used) money can be paid by person himself, his employer,
government , or any other agent or organization.
2- MANPOWER :
QUNATITATIVE AND QUALITATIVE ASPECTS ( Numbers, Rates,
Categories, Sociodemographics, Professional Attributes, Distribution)
3- PHYSICAL RESOURCES :
QUALITATIVE AND QUANTITATIVE ASPECT ( Numbers, Categories,
Rates, Accreditation, Distribution)
THROUGHPUT (PROCESS ):
HEALTH CARE ORGANIZATION
1. ORGANIZATION :
" Development of a framework divided into manageable
Components to facilitate Achievement of objectives "
ORGANIZATIONAL STRUCTURES
1- line organization 2- Line and staff organization
3-Matrix organization
1. LINE ORGANIZATION :
A
B C
D E K L
A has the overall authority and responsibility
B and C report only to A , they have authority delegated
them by A .
D and E report only to B and they have responsibility
delegated by B
Number Of Layers : THREE
Span Of Control : TWO
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THIS IS SUITABLE FOR SMALL ORGANIZTIONS SUCHS AS HEALTH
CENTRES, POLYCLINICS .
2. LINE and STAFF ORGANIZATION :
A
X
B C
Z Y
D E K L
- AUTHORITY, RESPONSIBILITY , REPORTABILITY AS ABOVE
- A , B , C , D , E , K , L CAN TAKE DECISION , THEY ARE KNOWN
AS LINES
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- X , Y , Z HAVE NO AUTHORITY , CAN NOT TAKE DECISIONS BUT
THEY CAN ADVISE ONLY . THEY ARE KNOWN AS STAFF .
3. MATRIX ORGANIZATION :
A
B C D
E F G
HORIZONTAL AND VERTICAL COMMUNICATION
ONE WORKER CAN HAVE MORE THAN ONE BOSS
THIS IS USED MOSTLY IN COMPETITIVE ORGANIZATIONS AIMING AT
INCRESING THEIR PROFITS SUCH AS PRIVATE HOSPITALS,
FACTORIES.
OUPUTS:
HEALTH SERVICES :
( PRIMARY, SECONDARY, TERTIARY)
equity, effectiveness ( achieving objectives), efficiency,( cost ) quality
UTILIZATION ( VISITS, RATES, CATEGORIES, NON UTILIZERS)
HEALTH OUTCOMES : ( IMPACT ) can be assessed by :
A_ New Approach:
( Environment, Life-style , Health knowledge, attitudes and
practice ( behaviour)
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B- Traditional Approach :
(Health Status Indicators: 3 Ds (Death, Disease, Disability)
Two other Ds can be also be assessed :
Discomfort and Dissatisfaction
HEALTH SYSTEM IN THE KINGDOM :
The health system in Saudi Arabia started as organized preventive services in
early 1950s by MOH , ARAMCO, WHO with Malaria control program in
Eastern Region ( Qatif, Hassa) . Rapid increase occurs during 1965 – 1985 but
services were mostly CURTIVE. In early 1980s the Concept of Primary Health
Care became popular ( Health for All)
ORGANIZATION : Saudi Arabia is a welfare state with health services is right
to every citizen . Ministry of Health (MOH) and about 20 other government
agencies and the Private Health Sector. MOH is the most important providing
60% of hospital services, 50% of Health centres services. Private Sector employs
28% of physicians, 19% of nurses and provides 19% of all hospital services
CENTRAL ORGANIZATION:
Minister appointed by King for 4 years renewable. Two Deputy Ministers and
four Assistant Deputy Ministers appointed by Council of Ministers at the
recommendation of the Minister .
Deputy Minister for Executive Affairs has two Assistants ( Preventive and
Curative health services)
Deputy Minister for Planning and Development has two Assistant ( Planning &
Research and Manpower Development)
There are several Directors General and Directors ( such as Nutrition, Primary
Care, Laboratories, etc…)
Regional Health Organization : ( 19 offices)
13 regions headed by Director General ( Riyadh, Makkah, Gassim, Assir, Gizan,
Medina, North Border,Eastern Region, Hail, Tabuk, Baha, AlJouf, Najran ) 6 or
Director of Health Affairs ( Holy Capital ( Makkah City), or Director of Health
Services in Provinces ( Jeddah,Taif, Hafr Al Batin, Al Ehssa, Bisha ) appointed
by Minister of Health
PLANNING : CENTRAL ( Ministry of Planning) in co-operation with MOH,
every five years , current is the Eighth ( emphasis on PHC, Co-ordination,
Manpower saudization and development )
FINANCE : GOVERNMENT
MINISTRY OF HEALTH BUDGET
YEAR BUDGET SALARIES OPERATION PROGECTS
BILLION AND
RIYLS ( % ) MAINTENA
NCE
1999 /2000 12.8 51.4 46.1 2.5
2000 /2001 13.8 52.8 42.3 4.9
2001 /2002
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2003 /2004
2004 / 2005
FACILITIES: Primary , Secondary, Tertiary
HEALTH MANPOWER
Problems : mostly expatriate( non Saudis ) , gross mal-distribution
of Saudi manpower ( mostly in big cities and in hospitals)
Measures to solve manpower problem : Manpower Council
Deputy Minister for Planning and Development
ADM for health Manpower Development
SECTOR PHYSICINS NURSES HOSPITAL
BEDS
MOH 49 % 55.5% 60.8%
OTHER GOVT. 22.8 % 25.8 % 20.0 %
PRIVATE 28.2 % 18.7 % 19.2 %
PER 1000
POPULATION
1993 10.4 22.8 27.0
1998 17.1 33.4 23.3
UTILIZATION : Visits per person per year, Operations, Procedures etc…
Nurs- Phar Allied Hosp PHC Dent Quar Smk Bud- Visit
Doct- es -mac Healt beds Cent -al antin Get Per
ors. Ists h res centr es Capi
es ta
15000 37000 950 22000 188 1766 18 24 11 11.9 4.8
39 Bill per
75 6.5% year
HEALTH SYSTEM IN DEVELOPING COUNTRIES
ORGANIZATION : MOSTLY AS IN KINGDOM
PLANNING : MOSTLY AS IN KINGDOM
FINANCE : GOVERNMENT, TAXATION, INSURANCE, DONATIONS
FACILITIES : MOSTLY PHCCS AND GENERAL HOSPITAL. NO OR
LIMITED TERTIARY CARE
MANPOWER : MOSTLY NON PROFESSIONLA, MALDISTRIBUTION
HEALTH SYSTEM IN DEVELOPED COUNTRIES ( USA )
ORGANIZATION
PLANNING : NON
FINANCE : INSURANCE, FEES FOR SERVICE ,
GOVERNMNET : MEDICAID , MEDICARE, MILITARY, PREVENTION
FACILITIES : ALL LEVELS
MANPOWER : PROFESSIONALS , HIGH LEVEL NON PROFESSIONAL
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LEVELS OF HEALTH CARE
PRIMARY , SECONDARY , TETTIARY
PRIMARY HEALTH CARE
" First contact of persons with the health system"
This is usually in PHC units found near residence or work
Secondary health care is referral care from PHC
This takes place in hospitals
Tertiary health care is specialized / rehabilitation care
ALMA ATA CONFERENCE : " PHC is essential heath care made universally
accessible to individuals and families through their full participation , by means
acceptable to them at a cost that the country can afford and it forms an integral
part of the national health system of which it is the nucleus and of the overall
social and economic development"
ORGANIZED BY W.H.O. AND U.N.C.E.F. IN 1978 IN ALMA ATA IN
KAZAKHASTAN
SOLOGAN " HEALTH FOR ALL BY YEAR 2000" HFA/2000
COMPONENTS :
1- FOOD / NUTRITION
2- BASIC SANITATION/ WATER SUPPLY
3- HEALTH PROMOTION
4- MATERNAL AND CHILD HEALTH CARE
5- CONTROL OF COMMON DISEASES
6- IMMUNIZATION
7- TREATMENT OF COMMON DISEASES AND INJURIES
8- PROVISION OF ESSENTIAL DRUGS
IMPORTANCE OF PHC :
- solves majority of health problems
- cheap
- convenient . near home or work suitable working hours
- family record / socioeconomic data
- hospitals will concentrate on secondary care
MINIMUM GLOBAL INDICATORS FOR PHC PROGRAMMES:
(( These are the minimum requirements for successful PHC programme)
1. HFA received endorsement ( approval) as policy by highest
official level.( KING, PRESIDENT, COUNCIL OF MINISTERS)
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2. Formation , strengthening and actually functioning
mechanisms for involving people in implementation of
strategies ( PHC friendship societies and committees)
3. At least 5 % of GNP is spent on health .
4. A reasonable amount of the GNP is spent on primary health care.
5. Resources are Equitably Distributed .( ACCORDING TO NEEDS)
6. PHC is available to the whole population with at
least :
-Safe Water Supply in home OR within 15 minutes walking
distance
-Adequate Sanitary Facilities ( refuse collection and disposal ) in home or
vicinity ( near home )
-Immunization with DPT , MMR , BCG.
- Primary Health Care (PHC) with at least 20 drugs within one
hour walk.
-Trained Attendants (Midwives) for pregnancy, delivery ,infants
health.
7. Adequate Nutritional Status of Children :
- At Least 90 % newborns have birth weight of 2.5 kg +
and 90 % of children have within normal weight for age
8..Infant Mortality Rate Not Exceeding 50 / 1000 live births.
9. Life Expectancy at birth Not Less than 60 years .
10. Adult Literacy Rate Exceeding 70 % .
11. GNP/capita us $5000 +
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INTERNATIONAL HEALTH AND HEALTH RELATED ORGANIZATION
( ALL THESE ARE UNITED NATIONS ORGANIZATIONS )
NAME ABBREVIA HEADQUARTER ACTIVITIES
TION
WORLD HEALTH W.H.O GENEVA HEALTH
ORGANIZATION SWITZERLAND PROMOTION
HEALTH
LEGISLATION
CONTROL OF
DISEASES
PUBLICATIONS
RESEARCH
CONSULTATION
UNITED NATIONS U.N.I.C.E.F. NEW YORK,USA CHILD AND MOTHER
CHILDREN FUND HEALTH
FOOD AND AGRICULTURE F.A.O. ROME, ITALY FOOD PRODUCTION
ORGANIZATION NUTRITION
UNITED NATIONS U.N.E.S.C.O PARIS, HEALTH EDUCATION
EDUCATION, SCIENTIFIC, FRANCE TRAINING
AND CULTURAL
ORGANIZATION
INTERNATIONAL I.L.O. GENEVA, OCCUPATIONAL
LABOUR ORGANIZATION WSITZERLAND HEALTH AND
HYGIENE
W.H.O :
GENERAL ASSEMBLY : ALL MEMBER COUNTRIES ( CURRENTLY 198)
EXECUTIVE BOARD: ( CONSULTANTS – ELECTED BY ASSEMBLY)
SECRETARIAT ( HEADED BY DIRECTOR GENERAL , ELECTED BY
ASSENBLY EVERY FIVE YEARS)
SIX REGIONAL OFFICES , HEADED BY REGIONAL DIRECTORS
ELECTED BY ASSEMBLY EVERY FIVE YEARS
1- AMERICAN REGIONAL OFFICE – IN WASHINGTON D.C. , USA
2- EUROPEAN REGIONAL OFFICE - IN COPENHAGEN, DENAMARK
3- AFRICAN REGIONAL OFFICE - IN BRAZAVILLE, CONGO
4- EAST MEDITERRANEAN REGIONAL OFFICE- IN CAIRO, EGYPT
5- SOUTH EAST ASIAN REGIONAL OFFICE – IN NEW DELHI, INDIA
6- WESTERN PACIFIC REGIONAL OFFICE – IN MANILA ,
PHILLIPINES
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SAMPLES OF EXAM. QUESTIONS :
CIRCLE THE CORRECT ANSWER :
1-.THE FOLLOWING ORGANIZATION DEALS MOSTLY WITH OCCUPATIONAL
HEALTH:
A- W.H.O B- UNESCO C- ILO D- FAO E- UNICEF
2. THE PRESENT FIVE YEARS HEALTH PLAN IN THE KINGDOM IS THE :
a- third b- fifth c- eighth d- sixth e- non of them
3. THE FOLLOWING IS A COMPONENT OF A SYSTEM EXCEPT :
a- inputs b- process c- outcome d- output e- non of them
4 .UNESCO IS CONCERNED WITH HEALTH OF :
a- women b- children c- both children and mothers
d- at risk groups e- non of the above
5 - THE GINI INDEX IS AN INDEX FOR :
a- distribution of health services d- distribution of salaries
c -distribution of population d- distribution of health manpower e- non of the above
6. Health professions are characterized by All of the following Except:
A. Large body of knowledge B- working in health Team
C- Professional organizations d- accreditation
E - teachable techniques
7. Working an a health Team:
A- Reduces health costs B- is essential because of specialization
C-can cause problems D- all of The above e- non Of the above
8.. A Minimal global indicator for phc Is :
A. Safe water supply in Home b- at Least 60% of adult Literacy rate
C- Equal distribution of services d- at Least 5% of gnp spent on phc
E non of the above
9. .Primary health care :
A- Can be in hospitals B- Cheaper than tertiary care
C- Is comprehensive care d- all of the above e- non of the above
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