|Plenary session PL01, Monday, April 19 2010, 9:00-10:30, Room 2|
|Chair(s): Yibeltal Assefa, Medical Services Directorate, Federal Ministry of Health, Ethiopia, Bruno Marchal, Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium|
|Summary: The aim of this session is to introduce some of the complex challenges that countries face in meeting health-related needs in contexts of rapid economic and social change. The recent financial crisis and the increased involvement of several African, Asian and Latin American countries in global negotiations have highlighted the global nature of many of these challenges. It also underlines the importance of strengthening communications and learning between researchers and policy actors in different regions. Three thinkers from India, China and Brazil will introduce key issues that are taking on growing importance, followed by discussion and reflexions by a discussant from Africa to reflect on efforts to address major public health problems in that continent.|
|The Private-not-for-Profit Healthcare Sector in Uganda|
|Josefien van Olmen, Research Officer and Coordinator, Network Health Systems, Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium|
|Training of Medical Doctors in DR Congo: Consequences of Uncontrolled Explosion of Medical Schools|
|Sara van Belle, Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium|
|Experience with People-Centred Care in Thailand: From Demonstration Diffusion to Policy Transformation|
|Yongyuth Pongsupap, National Health Security Office, Nonthaburi, Thailand (via visioconference)|
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Submitted by: Promila Kapoor-Vijay (ICVolunteers); Contributors: Nan Hsin Chang (ICVolunteers)
The opening session of the 2010 Global Health forum addressed health issues in the context of globalisation, crisis and health systems. These issues are currently affected by food and fuel supply, economics and natural disasters. Chairperson Dr Yibeltal Assefa of Ethiopia, from the Institute of Tropical Medicine Antwerp, Belgium, provided an Introduction to regional perspective of health system representing countries of the south based on studies from Uganda, Thailand and the Democratic Republic of Congo (DRC).
Dr Josefien van Olmen, coordinator for the Network Health Systems of the Institute of Tropical Medicine Department, Antwerp, gave an overview of the World Health Organization (WHO) framework of six building blocks and provided a regional perspective based on network experience in African countries. Resources (financial, human, administrative and information), core health care services (organized and influenced by the local authorities) and have shared values and principles with the beneficiaries. Interaction with the population is key. Dr van Olmen outlined the models from Uganda, DRC and Thailand to illustrate existing health systems, their strengths and challenges, and true lessons to learn.
Private, not-for-profit organizations are an important factor in health care delivery in Uganda. Their motto is “Health is not a business, health is a calling”. The sector is coordinated by faith-based religious medical bureaus. Dr van Olmen, representing Dr Sam Orochi Orach (Executive Secretary of Uganda Catholic Medical Bureau), described the system as having community approval in its target communities, most of which are deprived. Finance is the main constraint in providing health delivery: since funds from churches are drying up, the gap is being filled with resources from private donors. Uganda’s government does not have the resources to support this category of health care. Dr van Olmen emphasised that the key strengths of this health care derive from decentralization and the principle of subsidiarity. The values and objectives of this system need to be recognised and rewarded.
Another imbalance in a health system model was discussed by Dr Sara Van Belle, based on the studies of Dr Chenge Mukalenge of Congo, describing the consequences of the recent explosion in the number of medical schools in the country. An increase in the number of medical faculties is a source of profit to politicians, but has resulted in an excess of poorly trained medical workers practicing low-standard medicine. The current dependence of the population on badly equipped private clinics demands quality assurance mechanisms.
A model of a system implemented recently in Thailand seems to be working smoothly, according to Dr Yongyuth Pongsupap, who presented the people-centred-care health strategy. This reform from the hospital-centred system happened thanks to political pressure from the population for universal health coverage. Family doctors train in rural areas, primary health facilities absorb the whole community and integration with district hospitals is made by referrals from rural centres. A new approach based on listening/understanding/negotiating has been stressed and tools for the proper flow of patients have been created, including registration, information, payment and community meetings. These policy changes have made it possible to provide primary care to 600,000 community residents. Remaining challenges are to consolidate family practice, maintain quality and access, and ensure synergy between the different parties.
Lack of economic resources, retention of qualified professionals and the acceptance of tools to improve health services were the main problems discussed in this session. Key factors in achieving success could include an insurance system to make healthcare affordable for the population, decent remuneration and good living conditions for the employees, and strong government. In short, the commitment from every sector is vital for strengthening health care. Suggestions from the audience included investing in rural development and giving consideration to the role of private, for profit healthcare.
Regional perspectives of health systems show the use of differing approaches and models. Strengths demonstrated included tapping into local community resources and local leadership, assimilation with local values, the use of faith based religious organizations and not-for-profit health care systems. Weaknesses included poor funding, poor absorptive capacity, lack of infrastructure and poor quality training of medical professionals.