The Solomon Islands HiT determines that the country’s health system has significant weaknesses but also considerable strengths. Despite the range and difficulty of issues facing policy-makers in the Solomon Islands, there have been significant achievements in health, including considerable progress in advancing population health status. The performance of the health system is positive, achieving high coverage, high satisfaction levels, and steady progress on health outcomes. Nonetheless, the country faces important health challenges that could undermine development gains made to date
- Lawrence Weed first described the concept of electronic medical records in the 1960s as a way to automate and organize patient records to improve care. Early systems like POMR were developed in the 1970s and refined in later decades.
- Today, most medical practices use electronic systems to record patient information like medical history, medications, test results, and billing data. Adoption has increased but fewer than half of physicians fully utilize digital records.
- Benefits include increased efficiency, reduced errors, better access to information, and potential financial incentives. Challenges include costs of implementation and use, user resistance, and privacy concerns over confidential patient data.
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
1. The document analyzes India's health workforce, including numbers and distributions of doctors, nurses, and other medical professionals. It finds imbalances between urban and rural areas.
2. There are over 680,000 allopathic doctors and 72,000 dentists registered in India, but their distribution is uneven with more located in urban versus rural areas. The private sector employs the majority of specialists and technology-based services.
3. In addition, there are over 700,000 practitioners of Ayurveda, Unani, and other traditional medicine, as well as millions of nurses, pharmacists, and other paramedics. However, adequate data is lacking about some types of health professionals.
The infant mortality rate (IMR) is the number of infant deaths per 1000 live births. IMR is an important indicator of a country's development level and standard of living. Globally, IMR has significantly declined since 1960 due to improved healthcare, though it remains much higher in less developed countries. Common causes of infant mortality include low birth weight, respiratory issues, SIDS, and lack of essentials like food, shelter and water. Reducing behaviors like smoking during pregnancy and improving literacy, prenatal care, and access to health services can help lower IMR.
Health Aspect of 12th five year plan in IndiaVikash Keshri
India's 12th Five year plan is widely believed to be Health Plan. Presentation summarizes the major highlights from Health chapter of 12th Plan of India.
This document discusses health care financing. It begins by defining key terms related to health care financing sources, including public expenditures, external aid, and private expenditures. It then outlines the main mechanisms of health care financing: general revenue, social insurance contributions, private insurance premiums, community financing, and direct out-of-pocket payments. For each mechanism, it provides a brief definition and description. The document concludes by stating that the role of health financing should be recognized, that it cannot be dealt with separately from other factors like governance and economic growth, and that governments need to actively participate to avoid market failures.
India faces challenges in effectively managing its large vaccination program, including improving coverage, expanding vaccines, and ensuring quality of vaccines and cold chain. The Electronic Vaccine Intelligence Network (eVIN) was implemented to address issues of poor record keeping, lack of real-time stock visibility and temperature monitoring. eVIN digitizes vaccine data, monitors temperature at storage points, and provides real-time visibility and analytics on vaccine availability. It has led to reduced stockouts, lower stockout durations, and cost savings. The system has expanded across multiple states in India and has the potential to be scaled globally to help other nations strengthen their vaccination programs.
Vital statistics in India provide information on births, deaths, marriages and other demographic events. The collection and dissemination of vital statistics involves several organizations under different ministries. Key organizations include the Central Statistical Organization, National Sample Survey Organization, and Registrar General and Census Commissioner of India. Vital statistics data is used for administrative, legal and public health purposes like analyzing disease patterns and justifying health programs. Factors like population census, civil registration and sample registration systems contribute to India's vital statistics.
- Lawrence Weed first described the concept of electronic medical records in the 1960s as a way to automate and organize patient records to improve care. Early systems like POMR were developed in the 1970s and refined in later decades.
- Today, most medical practices use electronic systems to record patient information like medical history, medications, test results, and billing data. Adoption has increased but fewer than half of physicians fully utilize digital records.
- Benefits include increased efficiency, reduced errors, better access to information, and potential financial incentives. Challenges include costs of implementation and use, user resistance, and privacy concerns over confidential patient data.
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
1. The document analyzes India's health workforce, including numbers and distributions of doctors, nurses, and other medical professionals. It finds imbalances between urban and rural areas.
2. There are over 680,000 allopathic doctors and 72,000 dentists registered in India, but their distribution is uneven with more located in urban versus rural areas. The private sector employs the majority of specialists and technology-based services.
3. In addition, there are over 700,000 practitioners of Ayurveda, Unani, and other traditional medicine, as well as millions of nurses, pharmacists, and other paramedics. However, adequate data is lacking about some types of health professionals.
The infant mortality rate (IMR) is the number of infant deaths per 1000 live births. IMR is an important indicator of a country's development level and standard of living. Globally, IMR has significantly declined since 1960 due to improved healthcare, though it remains much higher in less developed countries. Common causes of infant mortality include low birth weight, respiratory issues, SIDS, and lack of essentials like food, shelter and water. Reducing behaviors like smoking during pregnancy and improving literacy, prenatal care, and access to health services can help lower IMR.
Health Aspect of 12th five year plan in IndiaVikash Keshri
India's 12th Five year plan is widely believed to be Health Plan. Presentation summarizes the major highlights from Health chapter of 12th Plan of India.
This document discusses health care financing. It begins by defining key terms related to health care financing sources, including public expenditures, external aid, and private expenditures. It then outlines the main mechanisms of health care financing: general revenue, social insurance contributions, private insurance premiums, community financing, and direct out-of-pocket payments. For each mechanism, it provides a brief definition and description. The document concludes by stating that the role of health financing should be recognized, that it cannot be dealt with separately from other factors like governance and economic growth, and that governments need to actively participate to avoid market failures.
India faces challenges in effectively managing its large vaccination program, including improving coverage, expanding vaccines, and ensuring quality of vaccines and cold chain. The Electronic Vaccine Intelligence Network (eVIN) was implemented to address issues of poor record keeping, lack of real-time stock visibility and temperature monitoring. eVIN digitizes vaccine data, monitors temperature at storage points, and provides real-time visibility and analytics on vaccine availability. It has led to reduced stockouts, lower stockout durations, and cost savings. The system has expanded across multiple states in India and has the potential to be scaled globally to help other nations strengthen their vaccination programs.
Vital statistics in India provide information on births, deaths, marriages and other demographic events. The collection and dissemination of vital statistics involves several organizations under different ministries. Key organizations include the Central Statistical Organization, National Sample Survey Organization, and Registrar General and Census Commissioner of India. Vital statistics data is used for administrative, legal and public health purposes like analyzing disease patterns and justifying health programs. Factors like population census, civil registration and sample registration systems contribute to India's vital statistics.
The document discusses Ayushman Bharat-Health and Wellness Centres, which aims to transform India's primary healthcare system by providing comprehensive and affordable primary care services close to communities through Health and Wellness Centres. It outlines key issues with the current selective primary healthcare package and low utilization of public health facilities. The initiative will establish 150,000 Health and Wellness Centres by upgrading Sub Health Centres and Primary Health Centres to provide expanded services covering maternal and child health to non-communicable diseases and geriatric needs. It focuses on developing a continuum of care through these centres, community involvement, and leveraging technology for service delivery.
NPCDCS, NP-NCDs, recent updates in national program for non-communicable diseases, components under NPCDCS, Objectives, strategies, behavioral changes, health activities at sub-center, at community health center, at district hospital, urban health check up scheme, cancer component, tobacco control legislation, provisions under COTPA act, NTCP.
This document outlines the essential components of a Health Management Information System (HMIS). It discusses the inputs, processes, and outputs of an HMIS and how it provides decision support. Key aspects covered include data collection, standardization, indicators, uses for planning, management, and assessment, and sources of health information such as vital events, infectious diseases reporting, and health facilities records. The document also defines health institutions and care providers and discusses data collection instruments and transmission of reports from facilities to higher levels.
The document provides a community health assessment of Cuyahoga County, Ohio. It finds that the county faces several health challenges, particularly in the city of Cleveland and inner ring suburbs, including high rates of poverty, cardiovascular disease, cancer, diabetes, and obesity. It also identifies issues with access to healthcare, food security, and the physical environment. The assessment concludes that addressing the needs of Cleveland and inner suburbs should be a priority and that stakeholder groups need to collaboratively prioritize issues and allocate available resources from organizations throughout the county.
The document provides an overview of the Indian healthcare system, including key trends, growth drivers, and challenges. It notes that the size of the Indian healthcare industry is $35 billion and growing at 17% annually, faster than any other country. The industry employs over 4% of the population and includes 229 medical colleges, 600,000 doctors, and over 800,000 hospital beds. However, healthcare infrastructure and access remains inadequate, with 80% of healthcare spending being out-of-pocket. The government is taking steps to improve access through initiatives like the National Rural Health Mission and increasing healthcare spending.
Health technology assessment- Dr. Saraswathy MD, PGIMERYogesh Arora
This document provides an overview of health technology assessment (HTA), including its need, scope, and current status. It discusses:
1. The growing need for priority setting and efficient resource allocation in health systems has led to the rise of HTA globally and in India.
2. HTA involves systematically evaluating medical, economic, social, and ethical aspects of health technologies to inform policy decisions. It aims to maximize health benefits within limited budgets.
3. India has established the Health Technology Assessment Board to conduct HTAs and provide recommendations to guide public health programs and policies. However, developing local evidence and building capacity remains an ongoing challenge.
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
Ayushman Bharat Yojana (ABPM-JAY) provides a health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families. It aims to fulfill the demand for universal healthcare. Key features include paperless and cashless access to healthcare, portability of services across the country, and flexibility for states to implement through insurance, trusts, or mixed models. Implementation is supported through technology modules for beneficiary identification, hospital empanelment, and claims management. Pradhan Mantri Arogya Mitras are trained healthcare facilitators who help beneficiaries navigate the scheme and access services.
This document discusses health management information systems (HMIS). It outlines the objectives of HMIS as providing reliable health information to health officers and administrators, informing health policies, and increasing efficiency and quality of health management. It describes the characteristics, domains, sources, subsystems, challenges, and benefits of HMIS. Nursing management information systems are discussed as a subsystem that can help with workload measurement, staff scheduling, personnel management, and fiscal resource management. The advantages of nursing information systems are also summarized as helping with evaluation, research, documentation, and developing the nursing process.
The document discusses various national health programs in India, including the National Family Welfare Program and the National AIDS Control Program. It provides details on the goals, approaches, and components of these programs over different five-year plans. For the National Family Welfare Program, it describes the targets and initiatives under different plans to reduce population growth and improve maternal and child health. For the National AIDS Control Program, it outlines the phases of the program and their objectives to slow the spread of HIV/AIDS.
The document discusses public health competencies, outlining key terminologies, core competency domains, and issues regarding competency-based training of public health professionals. It summarizes the core competency framework developed by the Public Health Foundation, which defines competencies in 8 domains and 3 tiers of increasing responsibility. However, issues are identified in Nepal regarding inadequate and outdated curricula, lack of faculty expertise, and poor linkage between training and professional needs, limiting the ability of graduates to address health challenges. The way forward emphasizes revising curricula based on competencies, strengthening accreditation, collaboration between stakeholders, and providing job opportunities to strengthen the public health workforce.
The Kingdom of Bhutan has made great achievement in establishing and sustaining public financed and managed health system in the past five and a half decades. As enshrined in the Constitution, health services are free in the integrated traditional and allopathic medicines. The report also notes the epidemiological and health system challenges and the way forward to overcome in line with achieving SDGs.
The document discusses key concepts related to health management information systems including definitions of data, information, records, and information systems. It describes the components and purpose of health information systems in supporting decision making, policymaking, and evaluating health programs. The document also covers data sources, attributes, collection tools, and the different information needs at various decision making levels.
The National Rural Health Mission (NRHM) was launched in India in 2005 to improve healthcare in rural areas. It aims to provide accessible, affordable, and reliable primary healthcare through programs like creating Accredited Social Health Activists (ASHAs) at the village level. The NRHM seeks to strengthen infrastructure by upgrading primary health centers, community health centers, and improving staffing and resources at sub-centers. It also aims to reduce mortality rates and achieve other health goals by integrating vertical health programs at the district level. The mission is monitored through community involvement and quality assurance committees.
The Integrated Disease Surveillance Project (IDSP) is a decentralized, state-based project that aims to establish a disease surveillance system for timely public health action. It integrates disease surveillance at state and district levels, improves laboratory support, and provides training. The IDSP oversees surveillance of diseases like malaria, diarrhea, tuberculosis, measles, and more. It has a strong organizational structure from the national to district levels to monitor diseases and respond to outbreaks. The IDSP reporting system utilizes forms to report suspect, probable and confirmed disease cases weekly from health centers to the state and national levels.
Intorduction to Health information system presentationAkumengwa
This document outlines the importance and components of a health information system (HIS). It defines an HIS as an information processing and storage subsystem of a healthcare organization. The importance of an HIS is that it produces information needed by various stakeholders to better manage health programs and services, detect health problems, and monitor progress towards health goals. The key components of an HIS include inputs like resources, processes like data collection and management, and outputs like information products and dissemination. The document also discusses assessing an HIS using the Health Metrics Network tool and provides an example assessment of Cameroon's HIS.
Public health information systems and data standards are essential for public health informatics. The birth of modern vital records systems in the 19th century in England and the U.S. established standards for collecting data on births, deaths, and diseases. This data has been critical for analyzing health trends, identifying disease outbreaks, and informing public health policy. Today, electronic systems have largely replaced paper-based reporting and allow more robust analysis and sharing of surveillance data. Standards ensure consistency and interoperability in collecting and aggregating this important public health information.
The document summarizes recommendations from the High Level Expert Group on achieving Universal Health Coverage in India. It discusses expanding health coverage to all citizens through a national health package, increasing public spending on health to 3% of GDP, strengthening primary healthcare and developing norms for facilities at each level of care. It also emphasizes improving human resources for health, community participation, and access to medicines. The overall vision is to ensure equitable access to quality health services for all Indians.
The document summarizes a survey report from nursing students who were posted in a rural village in India. Some key findings:
1) The village population was 801 with 61.6% between 6-18 years old. Nuclear families made up 64% of households.
2) Students visited homes to conduct health assessments, provide education on topics like hygiene and conducted a village census.
3) Available health facilities included a SHC and ASHA workers. Transportation and roads in the village need improvement.
4) The report concludes the posting helped students understand community healthcare and the importance of serving rural populations.
The document provides a review of Tonga's health system. It summarizes that Tonga has a decentralized health system managed through 4 districts, with the majority of primary care and 90% of hospital services provided by the public sector. Key achievements include control of infectious diseases, high immunization coverage, and prioritization of non-communicable diseases. However, challenges remain such as high rates of non-communicable diseases and their risk factors. The health workforce faces issues of limited education opportunities and brain drain overseas. Infrastructure and medical equipment also require significant upgrades.
The Kingdom of Tonga has had one of the best overall levels of health within the Pacific as a result of a dramatic reduction in communicable diseases and maternal and child mortality since the 1950s. It is also on target to achieve the Millennium Development Goals (MDG) around maternal and child mortality. Adapting its strong primary health-care system to deal with the large financial burden associated with chronic and noncommunicable diseases and ensuring quality primary health-care services in remote areas are the main health sector challenges facing Tonga.
The document discusses Ayushman Bharat-Health and Wellness Centres, which aims to transform India's primary healthcare system by providing comprehensive and affordable primary care services close to communities through Health and Wellness Centres. It outlines key issues with the current selective primary healthcare package and low utilization of public health facilities. The initiative will establish 150,000 Health and Wellness Centres by upgrading Sub Health Centres and Primary Health Centres to provide expanded services covering maternal and child health to non-communicable diseases and geriatric needs. It focuses on developing a continuum of care through these centres, community involvement, and leveraging technology for service delivery.
NPCDCS, NP-NCDs, recent updates in national program for non-communicable diseases, components under NPCDCS, Objectives, strategies, behavioral changes, health activities at sub-center, at community health center, at district hospital, urban health check up scheme, cancer component, tobacco control legislation, provisions under COTPA act, NTCP.
This document outlines the essential components of a Health Management Information System (HMIS). It discusses the inputs, processes, and outputs of an HMIS and how it provides decision support. Key aspects covered include data collection, standardization, indicators, uses for planning, management, and assessment, and sources of health information such as vital events, infectious diseases reporting, and health facilities records. The document also defines health institutions and care providers and discusses data collection instruments and transmission of reports from facilities to higher levels.
The document provides a community health assessment of Cuyahoga County, Ohio. It finds that the county faces several health challenges, particularly in the city of Cleveland and inner ring suburbs, including high rates of poverty, cardiovascular disease, cancer, diabetes, and obesity. It also identifies issues with access to healthcare, food security, and the physical environment. The assessment concludes that addressing the needs of Cleveland and inner suburbs should be a priority and that stakeholder groups need to collaboratively prioritize issues and allocate available resources from organizations throughout the county.
The document provides an overview of the Indian healthcare system, including key trends, growth drivers, and challenges. It notes that the size of the Indian healthcare industry is $35 billion and growing at 17% annually, faster than any other country. The industry employs over 4% of the population and includes 229 medical colleges, 600,000 doctors, and over 800,000 hospital beds. However, healthcare infrastructure and access remains inadequate, with 80% of healthcare spending being out-of-pocket. The government is taking steps to improve access through initiatives like the National Rural Health Mission and increasing healthcare spending.
Health technology assessment- Dr. Saraswathy MD, PGIMERYogesh Arora
This document provides an overview of health technology assessment (HTA), including its need, scope, and current status. It discusses:
1. The growing need for priority setting and efficient resource allocation in health systems has led to the rise of HTA globally and in India.
2. HTA involves systematically evaluating medical, economic, social, and ethical aspects of health technologies to inform policy decisions. It aims to maximize health benefits within limited budgets.
3. India has established the Health Technology Assessment Board to conduct HTAs and provide recommendations to guide public health programs and policies. However, developing local evidence and building capacity remains an ongoing challenge.
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
Ayushman Bharat Yojana (ABPM-JAY) provides a health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families. It aims to fulfill the demand for universal healthcare. Key features include paperless and cashless access to healthcare, portability of services across the country, and flexibility for states to implement through insurance, trusts, or mixed models. Implementation is supported through technology modules for beneficiary identification, hospital empanelment, and claims management. Pradhan Mantri Arogya Mitras are trained healthcare facilitators who help beneficiaries navigate the scheme and access services.
This document discusses health management information systems (HMIS). It outlines the objectives of HMIS as providing reliable health information to health officers and administrators, informing health policies, and increasing efficiency and quality of health management. It describes the characteristics, domains, sources, subsystems, challenges, and benefits of HMIS. Nursing management information systems are discussed as a subsystem that can help with workload measurement, staff scheduling, personnel management, and fiscal resource management. The advantages of nursing information systems are also summarized as helping with evaluation, research, documentation, and developing the nursing process.
The document discusses various national health programs in India, including the National Family Welfare Program and the National AIDS Control Program. It provides details on the goals, approaches, and components of these programs over different five-year plans. For the National Family Welfare Program, it describes the targets and initiatives under different plans to reduce population growth and improve maternal and child health. For the National AIDS Control Program, it outlines the phases of the program and their objectives to slow the spread of HIV/AIDS.
The document discusses public health competencies, outlining key terminologies, core competency domains, and issues regarding competency-based training of public health professionals. It summarizes the core competency framework developed by the Public Health Foundation, which defines competencies in 8 domains and 3 tiers of increasing responsibility. However, issues are identified in Nepal regarding inadequate and outdated curricula, lack of faculty expertise, and poor linkage between training and professional needs, limiting the ability of graduates to address health challenges. The way forward emphasizes revising curricula based on competencies, strengthening accreditation, collaboration between stakeholders, and providing job opportunities to strengthen the public health workforce.
The Kingdom of Bhutan has made great achievement in establishing and sustaining public financed and managed health system in the past five and a half decades. As enshrined in the Constitution, health services are free in the integrated traditional and allopathic medicines. The report also notes the epidemiological and health system challenges and the way forward to overcome in line with achieving SDGs.
The document discusses key concepts related to health management information systems including definitions of data, information, records, and information systems. It describes the components and purpose of health information systems in supporting decision making, policymaking, and evaluating health programs. The document also covers data sources, attributes, collection tools, and the different information needs at various decision making levels.
The National Rural Health Mission (NRHM) was launched in India in 2005 to improve healthcare in rural areas. It aims to provide accessible, affordable, and reliable primary healthcare through programs like creating Accredited Social Health Activists (ASHAs) at the village level. The NRHM seeks to strengthen infrastructure by upgrading primary health centers, community health centers, and improving staffing and resources at sub-centers. It also aims to reduce mortality rates and achieve other health goals by integrating vertical health programs at the district level. The mission is monitored through community involvement and quality assurance committees.
The Integrated Disease Surveillance Project (IDSP) is a decentralized, state-based project that aims to establish a disease surveillance system for timely public health action. It integrates disease surveillance at state and district levels, improves laboratory support, and provides training. The IDSP oversees surveillance of diseases like malaria, diarrhea, tuberculosis, measles, and more. It has a strong organizational structure from the national to district levels to monitor diseases and respond to outbreaks. The IDSP reporting system utilizes forms to report suspect, probable and confirmed disease cases weekly from health centers to the state and national levels.
Intorduction to Health information system presentationAkumengwa
This document outlines the importance and components of a health information system (HIS). It defines an HIS as an information processing and storage subsystem of a healthcare organization. The importance of an HIS is that it produces information needed by various stakeholders to better manage health programs and services, detect health problems, and monitor progress towards health goals. The key components of an HIS include inputs like resources, processes like data collection and management, and outputs like information products and dissemination. The document also discusses assessing an HIS using the Health Metrics Network tool and provides an example assessment of Cameroon's HIS.
Public health information systems and data standards are essential for public health informatics. The birth of modern vital records systems in the 19th century in England and the U.S. established standards for collecting data on births, deaths, and diseases. This data has been critical for analyzing health trends, identifying disease outbreaks, and informing public health policy. Today, electronic systems have largely replaced paper-based reporting and allow more robust analysis and sharing of surveillance data. Standards ensure consistency and interoperability in collecting and aggregating this important public health information.
The document summarizes recommendations from the High Level Expert Group on achieving Universal Health Coverage in India. It discusses expanding health coverage to all citizens through a national health package, increasing public spending on health to 3% of GDP, strengthening primary healthcare and developing norms for facilities at each level of care. It also emphasizes improving human resources for health, community participation, and access to medicines. The overall vision is to ensure equitable access to quality health services for all Indians.
The document summarizes a survey report from nursing students who were posted in a rural village in India. Some key findings:
1) The village population was 801 with 61.6% between 6-18 years old. Nuclear families made up 64% of households.
2) Students visited homes to conduct health assessments, provide education on topics like hygiene and conducted a village census.
3) Available health facilities included a SHC and ASHA workers. Transportation and roads in the village need improvement.
4) The report concludes the posting helped students understand community healthcare and the importance of serving rural populations.
The document provides a review of Tonga's health system. It summarizes that Tonga has a decentralized health system managed through 4 districts, with the majority of primary care and 90% of hospital services provided by the public sector. Key achievements include control of infectious diseases, high immunization coverage, and prioritization of non-communicable diseases. However, challenges remain such as high rates of non-communicable diseases and their risk factors. The health workforce faces issues of limited education opportunities and brain drain overseas. Infrastructure and medical equipment also require significant upgrades.
The Kingdom of Tonga has had one of the best overall levels of health within the Pacific as a result of a dramatic reduction in communicable diseases and maternal and child mortality since the 1950s. It is also on target to achieve the Millennium Development Goals (MDG) around maternal and child mortality. Adapting its strong primary health-care system to deal with the large financial burden associated with chronic and noncommunicable diseases and ensuring quality primary health-care services in remote areas are the main health sector challenges facing Tonga.
The Cambodia HiT reports that the national health sector reforms initiated two decades ago have had a positive impact on Cambodia’s health sector. The country’s health status has substantially improved since 1993 and is on track to achieve the Millennium Development Goal targets. Improving the quality of care is now the most pressing imperative in health-system strengthening.
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
The document outlines India's national health policy. It notes that while India has made progress on health outcomes, gaps remain between states and communities. It analyzes India's disease burden, health system challenges, and the growth of private healthcare. The policy aims to improve health systems, promote universal access to quality care without financial hardship, and leverage partnerships across sectors to achieve health equity and inclusion. It establishes principles of equity, universality, patient-centered care, inclusive partnerships, pluralism, and subsidiarity to guide the health system transition.
The People’s Republic of China has made great achievements in improving health status over the past six decades, mainly due to the government’s commitment to health, provision of cost effective public health programmes, growing coverage of health financial protection mechanisms and investments in an extensive health-care delivery network.
Indonesia has a mixed health system with both public and private provision of care. Key achievements include increased life expectancy and reductions in communicable disease rates. However, challenges remain such as the dual burden of disease, natural disasters, weak health information systems, and high out-of-pocket expenditures. Future prospects include expanding the use of telemedicine, incentivizing an even workforce distribution, and passing more legislation to clarify the health system framework.
The health system of Bangladesh has undergone a number of reforms and has established an extensive health service infrastructure in both the public and private sectors during the past four decades. Bangladesh has achieved impressive gains in population health, achieving the Millennium Development Goal 4 target of reducing under-five child mortality by two thirds between 1990 and 2015, and improving other key indicators such as maternal mortality, immunization coverage, and survival rates from malaria, tuberculosis, and diarrhoea diseases.
With this webinar, we invite you to join in the discussion on the post-Ebola strategy in West Africa. During the webinar four experts from different backgrounds will outline their view of the Ebola Crisis and most importantly share their vision on what needs to be done now, and post-Ebola, to ensure aversion of further food insecurity and social marginalization.
The spread of the Ebola virus disease has major consequences on the African countries it has hit the hardest: Guinea, Liberia, and Sierra Leone. The death toll from the disease and associated losses pose great economic consequences.
More than 2,600 people have died in West Africa. Transportation companies suspended their operations to the countries for fear of contamination even though the World Health Organisation advised against it. So far, the economies are experiencing adverse effects with escalating food insecurities.
Sierra Leone and Liberia, two of the most hit countries, recently came out of more than a decade of gruesome civil wars. Their institutions are still fragile and the deprivation from the Ebola crisis could trigger ever bigger problems.
The youth played a major role in both the Sierra Leone and Liberia conflicts as a result of economic and social marginalization. Without an effective strategy to assure young people a brighter future of economic and social stability, impact of the 2014 Ebola crisis on food insecurity and social livelihoods could trigger an even greater post-Ebola crises.
Agenda points:
Short term strategy: containment strategy & humanitarian aid
Long term strategy: improvement of (social) health care & international assistance
The importance of microprogrammes: Engagement, voicing the right people, AYM’s call for action**
The Republic of Korea HiT notes that economic development and universal health coverage through national health insurance has led to a rapid improvement in health outcomes. Overall, the health status of the Korean population is better than that of many other Asian countries. Reducing inequality in health coverage outcomes, strengthening primary health care and improving coordination between hospitals and long-term care facilities to meet the needs of the aged population are the challenges facing the Government.
"Looking Ahead" Post-Ebola Strategy in West Africa is the first in a series of planned webinars, where we invite knowledgeable individuals and participants to join the post-Ebola strategy in West Africa discussion.
During the webinars, experts from different backgrounds, will outline their view on the Ebola Crisis and most importantly, share their vision on what needs to be done now, and post-Ebola, to ensure aversion of further political and economic disturbances.
The fast spread of the Ebola virus has major consequences on the African countries it has hit the hardest: Guinea, Liberia, and Sierra Leone.
Besides the death tolls and associate losses, the countries are also facing great danger because of the economic consequences the virus carries.
Sierra Leone and Liberia, two of the most hit countries, have both recently come out of more than a decade of gruesome civil wars and the set back of the disease does not help with the stabilization of the economies. Their democracies are fragile and the deprivation from the Ebola crisis could be a trigger for political disruption.
The youth played a major role in those conflicts as a result of economic and social marginalization. Without a post-Ebola strategy to ensure the youth a future of economic and social stability, there may be unforeseeable instabilities.
ABOUT THE ORGANIZER:
Twenty-First Century African Youth Movement, (AYM) empowers and mobilizes Africa’s youth through employment. The AYM is dedicated to developing new and exciting enterprise opportunities for young people in Sierra Leone, to help provide young people with the confidence, power and skills they need to get themselves into employment and out of poverty.
Mobilizing Africa’s unemployed and underemployed youth is the key to the continent’s economic growth and stability. AYM works to mobilize marginalized youth through education, training, and employment, creating entrepreneurial opportunities to help move communities away from poverty, disease, and hunger. AYM aims to establish personal empowerment and community resilience by energizing the continent’s youth population, its most critical resource in the reversal of social and economic stagnation.
For more information, visit:
http://www.aym-inc.org/ebola-looking-ahead/.
AYM’s call for action:
Dr David J Baumler’s AYM Pepper Challenge: http://youtu.be/iU1Ot60mT7I
This document proposes a plan to universalize access to quality primary healthcare in India. It discusses some of the key problems in healthcare access such as poor rural facilities, malnutrition, and high infant mortality. It then outlines a proposed biennial door-to-door health inspection program led by teams consisting of doctors, nurses, and municipal representatives. The program would check sanitation, nutrition, and provide basic medical aid and awareness. Implementing such inspections through a dedicated body in each block could help ensure even underprivileged communities receive quality primary care. Challenges to the plan include funding, staffing, and ensuring standards are uniformly applied.
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Global partnerships in health innovation (1)Ted Herbosa
The document discusses plans for achieving Universal Health Coverage in the Philippines by 2016. Key points include:
- Expanding PhilHealth coverage to insure an additional 5.6 million poor and near-poor families and improving benefit packages.
- Scaling up preventive health programs, deploying more health workers, and upgrading health facilities to ensure all Filipinos have access to quality care.
- The total additional funding needed from 2013-2016 is estimated to be PHP 137.2 billion to fully implement Universal Health Coverage.
Providing Health in Difficult Contexts: Pre-Pilot Performance-Based Financing...RBFHealth
The Adamawa Primary Health Care System in Nigeria has implemented performance-based financing (PBF) to address underlying issues plaguing the health system. After two years of pre-pilot implementation, results have been encouraging with improvements in key indicators like institutional deliveries and vaccination rates. Success stories like Mayo-Ine health center demonstrate how community engagement and strengthened management can boost coverage. However, some indicators still show room for growth, and deeper analysis finds issues like staffing shortages and infrastructure problems influencing performance. Moving forward, continued scale-up and addressing broader health system challenges will be important to sustain gains under PBF in Adamawa State.
Dr Magure investigates the role of health delivery systems and looks at how health can be delivered in the future.
Presented at 'Moving Forward with Pro-poor Reconstruction in Zimbabwe' International Conference, Harare, Zimbabwe, (25 and 26 August 2009)
Department of Health Program Directions and Priorities Towards MDGs 4 and 5Michelle Avelino
The document outlines the Department of Health's (DOH) current efforts, status, and directions regarding achieving Millennium Development Goals 4 and 5 in the Philippines. It discusses programs established to improve maternal and child health, including emergency obstetric care facilities, integrated service packages, training programs, and monitoring systems. It notes accomplishments, ongoing challenges, and a proposed approach to scaling up family planning and maternal, newborn and child health programs through collaboration with partners.
Affordable care act and community health centeresfjlanasa
Community health centers have provided comprehensive primary care to millions of Americans for over 45 years, particularly vulnerable populations. With over 8,500 sites serving 20.2 million patients annually, health centers play a key role in increasing access to care. The Affordable Care Act provides $11 billion over 5 years to support health center operations, expansion, and construction to further increase access and play an essential role in implementation of the ACA. This funding has already led to increased patients served and new access points and facilities.
Greece: Primary Care in a time of crisis. 2nd VdGM Forum, Dublin 2015Evangelos Fragkoulis
2nd Vasco Da Gama Movement Forum, Dublin 2015
The Effect of the Economic Crisis on the Health Systems of the peripheral countries: Greece, Ireland, Spain, Portugal and Italy.
Similar to Solomon Islands health system review (20)
Sri Lanka has achieved strong health outcomes over and above what is commensurate with its income level. The country has made significant gains in essential health indicators, witnessed a steady increase in life expectancy among its people, and eliminated malaria, filariasis, polio and neonatal tetanus. The Sri Lanka HiT review presents a comprehensive overview of the different aspects of the country’s health system, and the background and context within which the health system is situated. The review also presents information on reforms to address emerging health needs such as the growing challenge of noncommunicable diseases (NCDs) and serving a rapidly ageing population
This document summarizes Thailand's response to the COVID-19 pandemic between September 2020 and November 2020. It covers preventing local transmission through measures like health communication, physical distancing, and testing. It also discusses ensuring infrastructure and workforce capacity, providing health services, financing coverage, governance, and multi-sectoral measures. The November 2020 update focuses on gradually lifting restrictions while maintaining preparedness for a potential second wave through ongoing surveillance, prevention, and rapid response systems.
Japan was one of the first countries to be hit by COVID-19 and declared a state of emergency by April 2020. Japan’s response to COVID-19 included the imposition of context-specific measures and restrictions based on local need to contain the spread of the disease. Containment measures were enacted under the Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response. Citizens were requested to abide by containment measures that focused on avoiding the 3C’s: Closed spaces with poor ventilation; Crowded places; Close‐contact settings. Health infrastructure, workforce, and supply chain were strengthened, alongside social security interventions including financial support for citizens. Primary health centers were strengthened and were at the forefront of Japan’s COVID-19 response at the local level.
This publication presents the various measures that were put in place from the beginning of the outbreak until December 2020 to control COVID-19 transmission in the country. We aim to update this document as new policies and interventions are operationalized to respond to the outbreak.
The document provides an overview of South Korea's health system response to COVID-19. Key measures included transparent communication, social distancing guidelines, extensive testing and contact tracing, increasing hospital capacity, and maintaining access to healthcare. The country's universal health coverage system supported its efficient mobilization of resources to test, treat, and manage COVID-19 cases.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
This review outlines the main organizational, financing, human resources and service delivery features of the health-care system. Although there has been implement in overall health outcomes since the 1990’s the current levels are still below average for the country’s Pacific neighbors. The remoteness of the many rural communities has hampered improvements in health services. This is one of the major challenges that the country faces in order to achieve SDG heath targets by 2030. This Hits highlights steps taken to overcome challenges especially in the face of epidemiological change in disease burden that is slowly taking place in the country.
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
This is primarily based on a chapter from our most recent publication.
I want to acknowledge the authors of the chapter:
Melisa Tan, Victoria Haldane, Sue-Anne Toh & Helena Legido-Quigley from NUS
Martin McKee from LSHTM
Summary of the current 4 main NCDs situation in Asia including risk factors
Examples of health system response
Challenges
More from Asia Pacific Observatory on Health Systems and Policies (APO) (9)
CHAPTER THREE: MUDRA AND BANDHA
Chapter 3 Verse 1 Kundalini is the support of yoga practices
As the serpent (Sheshnaga) upholds the earth and its mountains and woods, so kundalini is the support of all the yoga practices.
Chapter 3 Verse 2 Guru’s grace and opening of the chakras
Indeed, by guru's grace this sleeping kundalini is awakened, then all the lotuses (chakras) and knots (granthis) are opened.
Chapter 3 Verse 3 Sushumna becomes the path of prana and deceives death
Then indeed, sushumna becomes the pathway of prana, mind is free of all connections and death is averted.
Chapter 3 Verse 4 Names of sushumna
Sushumna, shoonya padavi, brahmarandhra, maha patha, shmashan, shambhavi, madhya marga, are all said to be one and the same.
Chapter 3 Verse 5 Sleeping goddess is awakened by mudra
Therefore, the goddess sleeping at the entrance of Brahma’s door should be constantly aroused with all effort by performing mudra thoroughly.
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Attitude and Readiness towards Artificial Intelligence and its Utilisation: A...ShravBanerjee
AI is a hot topic in recent days... We students of IPGME&R, Kolkata, India have done a study on Attitude, Readiness and Utilization of AI by medical students.
Artificial Intelligence (AI): The theory and development of computer systems able to perform tasks normally requiring human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages.
Our study showed that:
1. Nearly half of the study participants showed a favorable attitude towards role of AI in healthcare
2. Around three-fifth of the participants could define basic concepts of data sciences and AI and were ready to choose AI based applications for healthcare; they were willing to accept AI usage despite feeling a lack of cognitive skills
3. Most of them used AI-based applications for studying (ChatGPT), however, some of them faced difficulties in using them
Thank you!
50 Hr – Restorative Yoga Teacher Training Certificate Course
50 Hr – Restorative Yoga Teacher Training Course
Course Fee: INR 15,000 for Indian citizens only, for foreigners USD 350.
Yoga Manual (01)
Certificate
Excluded with accommodation and food
Upcoming Batches 50 Hr Non-Residential (Week-Days/Week-End)
Professional Yoga Teacher Training
Our 50 hours Restorative Yoga Teachers Training Course is beautifully programmed for those enthusiasts who desire to have a professional certificate in the future but can’t afford the time of two months in one slot.
If you have less time or you want to learn slowly, so 50-hour yoga teacher training course in Bangalore can be the perfect yoga course for you, karuna yoga offers a self-paced yoga teacher training course in Bangalore India, and you can join the other half in 1 year of time to complete 200/300 hours Teacher Training Course.
In order to obtain a professional certificate of 200/300 Hour, Teachers Training Course affiliated with the Yoga alliance one has to complete 200 Hours which is usually completed in one or two months of time, we designed this course in such a way that if any participant wants to first get introduced with the way and process of professional yoga teacher training course and have only short time then students can enroll for this yoga course.
Our 50 hours Yoga Teacher Training Course program runs along with our regular student of 200/300-hour Teacher Training Course students in the first phase, upon completion of the course if a student wants to finish remaining their balance of 150/250 hours of Teacher Training Course in the future, then students can continue the course of the second stage of Teacher Training Course to obtain 200/300-hour Teacher Training Course certificate affiliated with Yoga Alliance in order to have a professional certificate.
Our 50 hours can be accepted as continuing education from Yoga Alliance if in the future you want to continue the training from our center. Please make a note while completing 50 hour TTC you will be only provided with a certificate issued by our organization and the certificate will not be affiliated with Yoga Alliance, and only after completion of the second stage of balance 150/250 hours of TTC, which technically becomes 200/300 hours in total of training, we will issue the certificate of 200/300-hour Teacher Training Course.
Karuna Yoga Vidya Peetham is a Registered Yoga teacher training school in Bangalore, India with an affiliation of Yoga Alliance, USA which offers 50 Hour Yoga Teacher Training in Bangalore, India. If you look forward to the course then this is the best choice.
International Certification
Upon successful completion of the course, you will receive a certificate of completion of the 20 hour Hatha Yoga course, that you can count towards your continuing education. Our yoga teacher training courses are accredited by Yoga Alliance USA.
Pre-requisites:
This course is open to all students who wish to deepen their
50 Hr – Hatha-Vinyasa Yoga Teacher Training Course
50 hours – Hatha-Vinyasa Yoga Teacher Training Course
Course Fee: INR 32,000 for Indian citizens only, for foreigners USD 350.
Yoga Manual (01)
Certificate
Excluded with accommodation and food
Upcoming Batches 50 Hr Non-Residential (Week-Days/Week-End)
Professional Yoga Teacher Training
Our 50 hours Yoga Teachers Training Course Hatha-Vinyasa Yoga Teacher Training Course is beautifully programmed for those enthusiasts who desire to have a professional certificate in the future but can’t afford the time of two months in one slot.
If you have less time or you want to learn slowly, so 50-hour yoga teacher training course in Bangalore can be the perfect yoga course for you, karuna yoga offers a self-paced yoga teacher training course in Bangalore India, and you can join the other half in 1 year of time to complete 200/300 hours Teacher Training Course.
In order to obtain a professional certificate of 200/300 Hour, Teachers Training Course affiliated with Yoga alliance one has to complete the 200 Hours which is usually completed in one or two months of time, we designed this course in such a way that if any participant wants to first get introduced with the way and process of professional yoga teacher training course and have only short time then students can enroll for this yoga course.
Our 50 hours Yoga Teacher Training Course program runs along with our regular student of 200/300-hour Teacher Training Course students in the first phase, upon completion of the course if a student wants to finish remaining their balance of 150/250 hours of Teacher Training Course in the future, then students can continue the course of the second stage of Teacher Training Course to obtain 200/300-hour Teacher Training Course certificate affiliated with Yoga Alliance in order to have a professional certificate.
Our 50 hours can be accepted as continuing education from Yoga Alliance if in the future you want to continue the training from our center. Please make a note while completing 50 hour TTC you will be only provided with a certificate issued by our organization and the certificate will not be affiliated with Yoga Alliance, and only after completion of the second stage of balance 150/250 hours of TTC, which technically becomes 200/300 hours in total of training, we will issue the certificate of 200/300-hour Teacher Training Course.
Karuna Yoga Vidya Peetham is a Registered Yoga teacher training school in Bangalore, India with an affiliation of Yoga Alliance, USA which offers 50 Hour Yoga Teacher Training in Bangalore, India. If you look forward to the course then this is the best choice.
International Certification
Upon successful completion of the course, you will receive a certificate of completion of the 20 hour Hatha Yoga course, that you can count towards your continuing education. Our yoga teacher training courses are accredited by Yoga Alliance USA.
Pre-requisites:
This course is open to all student
Online Live Personal Yoga Training at Home
Home Yoga
Change is Possible!
I am ready to help you, to improve your health, reduce stress and moving towards perfect peace, happiness and joy!
Show you the difference between intentional self-care and unintentional numbing out, so that you can be fully awake for all of your life
Restore your natural physical alignment, because it is critical to your health and well-being
Help you develop a practice of intentional surrender because it brings relief from stress and will improve every aspect of your life
Show you how to take care of yourself because that is the first step toward the connection you are craving with others
Restore your mind-body connection, because decision-making is so much easier when you can hear your own intuition
Home yoga course contents
The private yoga lesson consists of Power Yoga, Dynamic Yoga, Yoga Therapy for different ailments, Yoga for stress management, yoga posture (asana), yogic breathing (pranayama), guided meditation and relaxation. Sometimes the cleansing practices like Vamana Dhouti (vomiting), Jala & Sutra Neti (nasal cleaning), Laghu Sankhaprakshalana (intestine cleansing), vyutkarma & sheetkarma kapalabhati (nasal cleansing), Trataka (eye cleansing) and MSRT (immune system enhancement) are also included depending on the requirement of the participant
If you are looking for a secluded, silent, one-on-one yoga practice with personal care and attention and without any outside disturbances, private yoga lessons are perfect for you. In private yoga lessons, you save your time and energy from traveling to a distance yoga studio and practice yoga from the comfort of your home in a personal ambiance. In private yoga lessons, you learn properly with one-on-one attention from the yoga trainer. The yoga trainer also gets enough time to understand your requirements and customizes the yoga practices accordingly for your maximum health benefit.
If you are suffering from any specific health problems, private yoga lessons are ideal for you. Yoga therapy practices cannot be done in a group, it has to be done always one-on-one basis. Because your problem is different from others. In a group yoga class, the yoga practices are not addressed according to your body conditions & requirements, some of the practices in the group might be harmful to you. Moreover, if the group yoga trainer is not a qualified yoga therapist but only a yoga instructor, he may not know the yoga practices that are useful and harmful to you. Therefore, if you are suffering from any specific health conditions, you require private yoga lessons with one-on-one attention from an experienced yoga therapist for your recovery.
How many people can join in private yoga lessons?
We allow one or, maximum of two people at a time in a private yoga lesson.
Private yoga course contents
The private yoga lesson consists of Power Yoga, Dynamic Yoga, Yoga Therapy for different ailments, Yoga for stress management, yoga post
This presentation tells about health education for hand wash to children. Every child should know that how to keep hand clean. And maintain the good hand washing practices. Nowadays disease are easily spread through uncleaned hands.germs are habitat in their hands and then it causes different types of diseases.so, we must give the health education for hand washing to every children. And make them practice.
30 – Hours Yogic Sukshma Vyayama Teacher Training Course
What is Sukshma Yoga?
Dhirendra Brahmachari formulated this system and wrote books to clearly formulate the ancient yogic science. This practice simple yet powerful series of specific exercises that improve health and enhance the strength of different organs and systems in the body, from top of head to toes.
Suksma means subtle prana, mind, and intellect: Vyayama means exercise. Suksma Vyayama is meant for the Subtle Body (Suksma Sarira), it is not meant for the Sthula Sarira (Gross Physical Body).
Need of Suksma Vyayama
In yoga, it is said that most pranic blockages start in our joints. Ayurveda says that ‘ama’ or the toxic and undigested waste material tends to settle in the empty spaces of our body, the joints. To remove these impurities we practice Suksma Vyayama, to release any such impurities in our subtle pranic body.
Three dimension of suksma Vyayama:
1.Breathing (slow or fast: Bhastrika/Bellows)
2.Point of concentration (mental concentration on Chakras)
3.Exercise (using Bandhas and Mudras)
Sukshma yoga purifies and recharges the body, mind, energy, and emotion. It prepares the well foundation for further means of Yoga practice. It includes Sukshma Vyayama (Subtle Exercise), and Vishram (Rest & Relaxation). It is itself complete package that fulfills the basic need of human being.
Sukshma Vyayama is one of the major parts for physical activity and the regulation of entire physiologies. Sukshma Vyayama is also known as a kind of warm up exercise or basic exercise or clinically anti-rheumatic group of exercise and also called body scan. The system of the physical and breathing exercise which help to sequentially work out all joints of a body, to warm it up. This system has a strong purifying effect on energy body of a human.
1.1. History of Sukshma Vyayama
We will observe visible Parampara of Sukshma Vyayama. Literal meaning of Parampara is the continuous chain of succession by Master to followers. In Parampara system, the knowledge is passed on without changes from generation to generation). Unfortunately because of the absence of enough information we are not able to find sources of this tradition.
System of Sukshma Vyayama knowledge which was unknown in the west before that was extended by one of outstanding yoga masters, Dhirendra Brahmachari (1925-1994). He received Initiation into Sukshma Vyayama techniques from Maharshi Kartikeya, the prophet and sacred great yogi who was his Master. In the preface to the book “Yogic Sukshma Vyayama” Dhirendra Brahmachari wrote about his precious Guru. Deep knowledge made him the unique expert of human characters, of their abilities and possibilities. From Maharshi Kartikeya, Dhirendra Brahmachari received a precept to spread knowledge about Sukshma Vyayama. The invaluable merit of Dhirendra Brahmachari is that he managed to accumulate knowledge in the convenient form, to make it open and understandable for the audience everywhere. The b
Yoga for Hypertension and Heart Diseases
Yoga Hypertension and Heart Diseases Certificate Course
Prevention and healing have been always the main purpose of yoga therapy practice. Yoga therapy is the process of empowering every individual to progress toward better health and optimal well-being through the application of the teachings and practices of Yoga therapy class. With the support of the Yoga trainer, implements a personalized and evolving Yoga therapy techniques that not only addresses the illness in a multi-dimensional manner, Pancha Kosa (Five Sheaths): Annamaya Kosha (Physical Body), Pranamaya Kosha (Energy Field), Manomaya Kosha (Mental Dimension), Vignanamaya Kosha (Psychic level of experience), Anandamaya Kosha (Bliss and Beatitude). It helps to reduce patient suffering in a progressive, non-invasive and complementary manner.
Why to study yoga Hypertension and Heart Diseases course?
Consequently, the demand for yoga therapist with specialized knowledge in yoga as a therapeutic tool, in different fields such as: health management organizations, hospitals and alcohol rehabilitation centers have grown rapidly. Studying yoga therapy as a tool to overcome and ease the symptoms of common illnesses has become extremely popular recently, due to the great therapeutic effects yoga practitioners experience in their body, mind and soul.
What you will learn from this course?
You may offer special seminars for people with similar diseases/conditions.
You will learn how to use yoga to assist in healing ailments and managing conditions?
You aim to be part of a positive change regarding health and lifestyle habits.
You want to teach people how to prevent diseases.
In group classes, you can teach your students how to become healthy.
You will feel more self-confident when approached by students that come to yoga seeking for support in their healing process.
Therapeutic applications of posture, movement and breathing.
Pre-Requisites:
This course is open to all students who wish to deepen their knowledge and application of some of the highest teachings of
Participants do not need to be yoga
Mastery of any yoga practice is not
Only yours sincere desire for knowledge and your commitment to personal
Love for Yoga is the most important eligibility factor for learning this course.
Students who want to know Yoga in totality and move beyond Asana and Pranayama, Mudra & Bandha.
Assessment and Certification
The students are continuously assessed throughout the course at all levels. There will be a written exam at the end of the course to evaluate the understanding of the philosophy of Yoga and skills of the students. Participants should pass all different aspects of the course to be eligible for the course diploma.
What do I need for the online course?
Yoga mat
Computer / Smartphone with camera
Internet connection
Yoga Blocks
Pillow or Bolster or Cushion
Strap
Notebook and Pen
Zoom
Recommended Texts
Asana Pranayama Mudra Bandha by Swami
21. Alignment for Advanced Yoga Asana
The advance asanas that are taught during various asana classes throughout the duration of the teacher training are brought up for analytical discussions and practical sessions of methods to adjust advance postures with both verbal cues and hands-on adjustments. Learning revolves around demonstrations, observation and practicums by assisting the lead instructors during some advanced yoga classes. Students will demonstrate observe and assist lead instructors in adjusting in a basic yoga class.
Learning Objective
Be able to identify misalignments of advance postures. Be able to observe student’s capacity during adjustments. Be able to safely and gently adjust advance postures with verbal cues and with hands-on adjustments. To provide adjusting and assisting techniques of yoga asana class.
5 Must-Have’s in ePCR Software for a More PROFITABLE and EFFICIENT EMS, NEM...Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS & NEMT organization, not just certain groups of people or certain departments.
It should benefit EMS crews – making it convenient to enter data and have the tools to increase document accuracy.
It should benefit the back-office by streamlining documentation and billing processes internally and with health facilities.
It should benefit the entire organization by improving workflow efficiency, comply with regulations, reduce costs, and contribute to generating data-driven reports.
To achieve those benefits, ePCR software must have these 5 functions.
The Importance of Gratitude in Daily Life.pptxMartaLoveguard
Prezentacja - The Importance of Gratitude in Daily Life
Slide 1: Introduction
Welcome to the presentation on the importance of gratitude in daily life. Today, we'll explore how cultivating gratitude can significantly impact our mental, emotional, and physical well-being.
Slide 2: What is Gratitude?
Gratitude is the practice of acknowledging and appreciating the good things in our lives, big and small. It involves recognizing the positive aspects of our experiences, relationships, and circumstances rather than focusing solely on what's lacking or negative. Cultivating gratitude involves a mindset shift towards abundance and appreciation.
Slide 3: Psychological Benefits
Gratitude plays a crucial role in enhancing mental health by reducing negative emotions such as envy, resentment, and frustration. Research indicates that practicing gratitude promotes more positive emotions like happiness and satisfaction with life. Studies have shown that gratitude can lead to improved overall well-being and a greater sense of fulfillment.
Slide 4: Emotional Resilience
Gratitude fosters emotional resilience by helping individuals cope with stress and adversity more effectively. It encourages a mindset that focuses on solutions and growth rather than dwelling on problems. By finding reasons to be grateful even in challenging times, individuals can develop resilience and maintain a positive outlook.
Slide 5: Social Benefits
Expressing gratitude strengthens relationships by fostering feelings of connection and appreciation. When we show gratitude towards others, it deepens our bonds and encourages reciprocity in kindness and support. Gratitude also enhances empathy and compassion, leading to more meaningful social interactions.
Slide 6: Physical Health Benefits
Gratitude isn't just beneficial for mental and emotional well-being; it also impacts physical health. Research suggests that grateful individuals may experience better sleep, reduced inflammation, and improved immune function. Adopting a grateful mindset can contribute to overall holistic health and well-being.
Slide 7: Cultivating Gratitude
There are practical ways to cultivate gratitude in daily life. Keeping a gratitude journal, where you write down things you're thankful for each day, can help reinforce positive emotions. Additionally, expressing gratitude to others through thank-you notes or verbal appreciation can strengthen relationships and increase overall happiness.
Slide 8: Conclusion
In conclusion, integrating gratitude into our daily routines can lead to profound positive changes in our lives. By focusing on what we are thankful for, we shift our perspective towards abundance and possibilities. Embracing gratitude empowers us to live more fully and joyfully, enhancing both our personal well-being and the quality of our relationships.
2. 2
Authors:
Nicola Hodge
Beth Slatyer
Linda Skiller
Editors:
Maxine Whittaker
Health Systems in Transition: Solomon Islands
Health System Review
Suggested citation: Hodge N, Slatyer B, Skiller L. Solomon Islands Health System Review. Vol.5 No.1. Manila: World Health
Organization, Regional Office for the Western Pacific, 2015.
3. Solomon Islands: Socio-demographic profile
Overview of health system
Service delivery network
Governance and administration
Financing
Major reforms
Infrastructure
Human Resources
Main findings
Progress made
Remaining challenges
Future prospects
3
Presentation outline:
This map is an approximation of actual country borders
Source: https://www.who.int/countries/slb/en/
4. 4
Socio-demographic profile
Area 28370 sq. km
More than 900 islands
and atolls
Population • 515870 (2011)
• 80% Rural population
• 4.1 TFR (2013)
Life expectancy at
birth m/f
66/69 (2012)
GDP per capita: USD 3455 (PPP, current)
HDI 152
Expenditure on
health % GDP
8% (2012)
Source: Secretariat of the Pacific Community, 2014
Solomon Islands population pyramid 2013
5. 5
Unified, blended system
1.1. Government as steward and manager
2.2. On track for UHC
3.3. Government and donor financed
4.4. Prevention and primary care focused
Overview: Health system
1. Minimal private sector and NGO involvement
2. Minimal OOP payments
3. Service provision reflecting population distribution
4. Efficient workforce structure/nurse-led
7. 7
• Funder, regulator and provider of nearly all services
• Ministry of Health and Medical Services – leading central organisation
National
• Delivery of primary health care and outreach programmes
Provincial Health Offices
• NGO and faith based organizations: Funding and service delivery,
largely in collaboration with MHMS
• Private sector has a minimal role in health system. No formal consumer
or consumer advocacy groups exist
Other
Overview: Governance and Administration
8. 8
Overview: Health Financing
Moderate levels
of expenditure
relative to
national income
Government
and donor
funding majority
financing
Minimal OOP
and catastrophic
spending
Strained fiscal
space with high
barriers to
increased health
spending
• THE as proportion of GDP doubled
from 4.1% in 1991 to 9% in 2012
• Overall health expenditure tripled
from 1995-2011
• 95% government and donor financing
• OOP payments and catastrophic
spending are the lowest compared to
East Asia and Pacific region, possibly
resulting in high utilization
• Slowing economic growth and logging
revenues limiting growth in fiscal
spending
9. 9
Overview: Major reforms
• 2008 – Sector-Wide Approach (SWAp)
• Building MHMS leadership and technical effectiveness with donor
support
• 2010 – National Health Strategic Plan 2011-2015
Key goals:
• Universal Health Coverage
• Decentralization of national programmes
• Efficiency at NRH
• Human resources for health
• Supporting service delivery through improved administration
systems
• Improvements to public financial management and procurement
outcomes
• Performance culture and indicators: from a ‘budget’ focus to a
‘performance’ focus
10. 10
Source: MHMS, 2011c, 2014c; WHO, 2010b
Overview: Infrastructure
Health network by province
• Majority of health care infrastructure in poor conditions including hospitals, area and
rural health centres
• Investment on infrastructure is donor dependent
• Rate of hospital beds per 1000 population decreasing: 2 beds/1000 population (2006)
• NHSP: No comprehensive data on utilization, operating statistics to contribute to NHSP
goals of better administrative systems
11. 11
Overview: Human resources
Source: Asante et al., 2011
Proportion of health care workers by cadre, 2010
• Critical shortage of health workers in the Solomons
• Nurse-led primary health system
• Doctors largely based in provincial hospitals or NRH
• Physicians sent overseas as it is not cost-effective to have training schools in country
12. 12
Overview: Human resources
Distribution of health personnel by province, 2010
Source: Asante et al., 2011
• Even distribution of health workers (except Guadalcanal and Malaita)
• MHMS: drafting first HRH plan for health sector
13. 13
Achievements and progress made
UHC
•On track to achieve UHC
•Achieved despite: low per capita expenditure, high delivery costs. Limitations on fiscal spending largely
overcome
MDG
•MDG 1: Improved child nutritional status – achieved. Yet, one-third children remain stunted
•MDG 4: Decline in infant mortality and under-5 mortality. Variation in immunisation coverage among
provinces remain
•MDG5 : Improved maternal health. Corresponding increase in births with assistance of skilled health
personnel
Outcomes
•Steady improvement in health outcomes
•High contact rates, low expenditure, improving satisfaction levels
14. Achievements and progress made: Financial equity
14
Source: World Bank, 2010
Public hospital inpatient care use by poorest
and richest wealth quintiles
Source: World Bank, 2010
Public hospital inpatient care use by poorest
and richest wealth quintiles
• Overall high level of equity and access across income levels
• Low OOP payments and catastrophic health spending
• All medications are free of charge to citizens
• NHSP and SWaP implementation: Strong affordable system, efficient use of government
and non-government resources alike and delivers sustainable services
15. 15
Achievements & progress: Public Health Programmes
Safe
Motherhood
EPI
IMCI
Malaria and
TB control
Healthy
Settings
• Efficiency improvements: In line with NHSP, national programmes
integrating aspects of external agencies, e.g. malaria, water and sanitation
16. 16
Achievements & progress: Nurses and nurse aides
• Over 50% of the workforce are nurses or nurse aides
• 96.5% of all facilities are staffed by nurses and/or nurse aides
• Nurses fill a variety of crucial roles in the health system: infection control, public health
programmes and filling in gaps in services such as mental health
Workforce
backbone
Disease
Surveillance
Public
health
programmes
Filling in
service gaps
17. 17
Achievements & progress: Pharmaceuticals
WHO
quality
assessment
on suppliers
Free to
citizens
Low drug
stock-outs
Higher
availability
in rural
areas
Parallel
reforms in
place
• Free medicines for citizens accessing
the public health sector
• Pre-qualified suppliers are used with
WHO based quality assessment
• Electronic inventory system allows
stock management, future forecasting
resulting in low level stock-outs
• Parallel health reforms and investments
strengthened overall success of
operations
18. 18
Remaining challenges: Population health concerns
Proportion (%) of primary health care clinic attendance by condition
Source: Maike, 2010; MHMS, 2012
• Increase in patients presenting with ARI,
skin diseases, lower malaria
• Lack of appropriate data to assess
mortality rates and impact of
interventions
• Mortality: Malaria: 3/100,000 people;
non-HIV TB: 18/100,000
• Early stage of epidemiological transition.
41% of deaths expected from NCDs
• “Other” conditions could be hiding rise
of NCD prevalence
20. 20
Remaining challenges: Infrastructure
Source for both tables: Nomura S et al., 2017
Hospitals Communicatio
n
Running water Electricity Oxygen source Anaesthesia
machine
Operating
theatres
12 in total All but Kilu’ufi
hospital has
phone,
internet, Short
Wave Radio
(SWR).
Yes, 5 have had
extended
disruption of
water supply
Yes, 3 have had
interrupted
electricity
supply
Generally yes,
Kilu’ufi has
interrupted
supply
4 have working
machines, 5 do
not
NRH has four, 3
have no
operating
theatres at all
Source: Adapted from Auto et al., 2006; Natuzzi et al., 2011; Oberli, 2010
Hospital infrastructure, 2014
• Funding gaps for most health facilities lead to poor infrastructure at hospital, AHC and RHC
levels. These include disruption of water and electricity supply, and lack of or inoperable
machines
• 70% of health clinics require significant upgrade, repair or renovation
• Donor funding heavily relied upon for investment funding
• Consequences: Existing resources and human resources become strained under growing
pressures to provide adequate health care
21. 21
Remaining challenges: Barriers to planned reforms
UHC target: access and financial constraints
Shift to performance culture under NHSP:
Slow progress, no explicit strategy
Human resources: Lack of planning,
implications for nurse-led health care
22. 22
Remaining challenges: Information reporting
• Gender:
• National reports not disaggregated by gender
• Limited data on which to base firm conclusions, little attention received at
national level on health needs
• Mortality and morbidity:
• Lack of data to assess epidemiological change, or effect of response
• Health Information System:
• Reliance on manual reports
• Duplication of functions by multiple national programmes
• Facility reporting:
• Baseline data and targets not reported for several indicators makes tracking
progress difficult
23. 23
Remaining challenges: Quality of care
•5% of rural population has access to improved
sanitation
•Prone to sudden outbreaks of infectious disease
NHSP health
determinants
•Baseline data and targets missing from outpatient
services
•Assessment tools for health facilities & equipment
exist but utilization and follow-up are unclear
Information
reporting
•Health worker to population ratio low
•Quality of vaccines due to breaks in the cold chain
•Challenges in quality of diagnosis and treatment
Health services
•Regulations not always implemented
•Misuse of already scarce resources
Regulation and
administration
24. 24
Remaining challenges: Finances
Strain on health
system
Low fiscal
capacity
Limited increase
in patient/donor
contribution
Government
outlay on health
already high
Limited
economic growth
prospects
Administration
accountability
Poor accounting
Inefficient fund
use
Administrative accountability:
• Poor accounting training, petty
theft and fraud
• Zero tolerance agreement and
parallel budget reforms in place
Highly inefficient use of funds:
• Excessive allocation for capacity
building
• Not needs based
Other
• Expected rise in costs & costs
of NCDs – challenge in
maintaining existing financial
protection
25. 25
Future prospects: Solomon Islands
Prevention
& primary
care
Nurse-led
health care
MHMS
Challenges: Human
resource and financial
constraints
Development:
SWAp, Healthy Settings,
better admin and public
financial management
Foundation of the future health system
26. Based on the Health Systems in Transition
Solomon Islands Health Systems Review, 2015
26
The Solomon Islands, also referred to as “the Solomons”, are a small Pacific state. It is a double-chain volcanic archipelago comprised of more than 900 islands and atolls covering an area of 28370 square kilometres (WHO, 2010b). It shares ocean borders with Papua New Guinea to the west and Vanuatu to the east.
The Solomons are prone to earthquakes and tsunamis due its position in the Pacific ‘ring of fire’ (WHO, 2010b; Sade, 2005b). Rising rides and sea levels are also a threat.
The population sat at 515870 in 2011 (SISO, 2011a). 80% reside in rural areas though urban growth is occurring at a rapid pace. The country has a young age structure. The median age in 2009 was 20 years old (WHO, 2010b).
The total fertility rate (TFR) is high and stands at 4.1 births per woman.
Life expectancy has risen steadily for men and women. In 1980, male life expectancy was 58 while female life expectancy was 60. This has risen to 66 and 69 respectively in 2012 (WHO, 2012; World Bank, 2012a).
Overall GDP in USD has risen from $168 million in 1980 to $1.096 billion in 2013 highlighting a six-fold growth over this period. It is classified as a low-middle income country but is still heavily dependent on aid (World Bank, 2012b). The GDP per capita (PPP, current) is $3455 USD. Major civil unrest during 1998-2003 caused social and economic declines with thousands displaced and the disruption or destruction of much public infrastructure (Auto et al., 2006b).
Health Expenditure as a percentage of GDP is 8% as of 2012.
According to the Human Development Index, the Solomons ranked 152 out of 189 countries in 2017 (UNDP, 2018)
UNDP link: http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/SLB.pdf
The Ministry of Health and Medical Services (MHMS) acts as steward and manager which is appropriate given the population size, fiscal space and geographic context. It is the central actor in the health system.
Universal health coverage of an affordable basic package of care is on track despite limited resources.
95% of health financing is supplied by the Government and development partners with 3-4% from out-of-pocket (OOP) payments.
The current National Health Strategic Plan (NHSP) 2011-2015 prioritizes prevention and primary care with the aim of building on resilient rural health services and providing better care with little no expected growth.
NGOs, faith-based services and the private sector play a small role in the health sector. NGOs and faith-based services work directly with MHMS.
Most provinces have at least one level of health facility based on the size and distribution of their population.
More than 50% of the workforce is made up of nurses and nurse aides who form the backbone of the health system, and dominate postings in rural areas. This creates an efficient workforce structure with referrals to doctors in larger provincial hospitals.
A formal referral system exists within the health system. Referrals are made to doctors based in larger provincial hospitals or the National Referral Hospital (NRH). However, many patients often bypass provincial hospitals to go directly to the NRH to receive the highest standards of care available.
The utilization rates of inpatient and outpatient care are equally distributed between the richest and poorest quintiles.
In outpatient care, health service contact rates are high by regional comparison. 87% of those ill sought care with 85% seeking public sector health services (Maike, 2010).
Public health activities, which improve health, quality of life and prolong life and prevent diseases are integrated into the primary care system.
Serious shortages of clinical equipment and medical supplies exist at most health facilities. The NRH does not have trained staff or equipment to conduct diagnostic tests other than for malaria.
Inpatient care begins in Area health centres (which sit below provincial hospitals in the health system hierarchy) but is limited due to bed and service constraints. Rural health centres have holding beds not designed to be inpatient beds.
Specialist hospital care provided at the NRH is from specialist national clinicians or invited specialists. Patients may be referred overseas if appropriate services are unavailable in the Solomons.
Ministry of Health and Medical Services (MHMS) is the central actor in the health system for the Solomons. It acts as funder, regulator and provider of nearly all services.
It is divided into four major divisions: health improvement, health care, health policy and planning and administration and finance.
The provincial health offices are responsible for the delivery of primary health care services and outreach programmes in their sector.
NGOs, faith-based organizations play significant roles in funding and service delivery but largely collaborate with MHMS. The private sector plays a minimal role in the health sector.
There are currently no formal consumer or consumer advocacy groups in the Solomons.
Little formal consultation occurs with the public.
The health system is characterized by moderate levels of health expenditure relative to national income. Health outcomes have been resilient to political and economic crises in recent years.
Total health expenditure (THE) was estimated to be $313 million SB in 2009. THE as a percentage of GDP has historically doubled from 1995 at 4.1% to 9% in 2012 (World Bank, 2012b; WHO, 2011a) with overall health expenditure per capita (PPP, current) tripling between 1995 and 2011.
The main sources of funding are general government revenue and external donor resources which accounted for 95% of health financing in 2011. In the 2005/2006 Household Income and Expenditure Survey, 1% of total household income was spent on health care each year pointing to minimal out-of-pocket (OOP) payments. This could be the reason for high utilization.
There is a good level of financial risk protection and minimal levels of catastrophic health spending. Compared to the East Asia and Pacific region, OOP burden on the poor was lowest in the Solomon islands (<0.05% of monthly household budget) (World Bank, 2010).
Government expenditure on health is high and unlikely to grow, with little expected growth in donor financing. The government is experiencing an economic slowdown tied to a decline in logging revenues. A limited fiscal scope combined with high cost of delivery (electricity and transport) are an additional barrier for health system funding growth.
Voluntary health insurance accounts for a negligible source of health revenue.
After a stabilization period following civil unrest, the Government began a new phase of reform under the National Health Strategic Plan (NHSP) 2011-2015.
In 2008, the MHMS and key development partners agreed to develop a Sector-Wide Approach to allow aid financing flow through Solomon Islands systems. The objective was to help the Government meet recurrent costs of service delivery, align donor support and conduct evidence-based dialogue about resource allocation and sector performance. MHMS and development partner collaboration has improved (Tyson, 2011; Tyson & Dodd, 2012; Kelly & Tuckwell, 2014) with a rolling programme of policy analysis, surveys and reform as well as a Technical Cooperation Inventory being two areas supporting MHMS leadership and technical assistance.
Under the NHSP 2011-2015, prevention became the primary focus of service delivery. The need to plan, cost and implement a basic package of primary care within a low growth scenario at provincial levels was the main priority.
The key goals for the NHSP outlined include:
Universal Health Coverage – to expand maternal, neonatal and child health, communicable disease and NCD services with a prevention focus.
Decentralization of national programmes – For all national public health programmes to integrate service delivery models and prioritize prevention.
Better efficiency at NRH and use of human resources– Funding has been capped with a view to improve service quality and efficiency. Staffing has been labelled a top issue but decisions on training and roles have not been addressed.
Improved administration systems, public financial management and procurement outcomes– Audits and assessments applied resulting in roadmaps for improvement on a system wide basis, including developing transparency and zero tolerance to fraud.
Performance culture and indicators – Shifting from a ‘budget’ focus to a ‘performance’ focus.
In order of levels of care (from lowest to highest), there are 187 nurse aide posts, 102 rural health centres, 38 area health centres, 7 provincial hospitals, 1 National Referral Hospital (NRH). The provinces have access to a health network based on the size and distribution of the population (Auto et al., 2006a; Natuzzi et al., 2011).
The NRH is the largest hospital in the Solomons with 300-400 beds and specialized departments in dentistry, general surgery, gynaecology and obstetrics (Oberli, 2010).
The majority of hospitals are in poor condition with a substantial investment in infrastructure for building maintenance and equipment required (Auto et al., 2006a).
A 2005 review of area health centres found 70% required significant upgrade, repair or renovation. This was 10% better than a review conducted in 1989 (Waqarakirewa, N.D). A review on rural health centres showed the same trends.
30-40% of THE is allocated to investment funding. Three-quarters of this allocated to infrastructure (MHMS, 2011b; Foster et al., 2009b). This creates a dependency on foreign donors to continue recurrent financing.
No comprehensive data exists on utilization and operating statistics but this will change with the Health Facility Costing Study which will contribute to NHSP goals of better administrative systems.
Compared to Fiji, Kiribati and Tonga, the number of hospital beds in the Solomons per 1000 population was similar and like them, has been decreasing since 2000. The average number of beds was just under 2.0/1000 population in 2006.
Nurses form the backbone of the health workforce in the Solomons. There are 2728 health workers in the public health sector. There are 936 nurses and 153 doctors and dentists (Asante et al., 2011). 53% of the workforce is made up of nurses or nurse aids with doctors and dentists only make up 6%.
There is a critical shortage of health workers in the Solomons (Georganas, 2010). However, the distribution of personnel is evenly spread across provinces except for Guadalcanal and Malaita (1:425 and 1:432 respectively).
Health care workers, mainly physicians, move overseas for better work or training opportunities (Same et al., 2011). Physicians are often sent to Fiji, Papua New Guinea or Cuba as it is not cost-effective for the Solomons to maintain medical and specialist training schools.
There is a critical shortage of health workers in the Solomons (Georganas, 2010). However, the distribution of personnel is evenly spread across provinces except for Guadalcanal and Malaita (1:425 and 1:432 respectively).
The return of 94 doctors trained in Cuba has implications on how the health care services will be provided. The MHMS is completing the first human resource plan to address this.
Universal health coverage is largely on track in the Solomons. Low per capita expenditure, high delivery costs and limited space to increase fiscal spending has not stopped near universal coverage of the basic care package. Overall, there has been a steady improvement in health outcomes.
The health system achieves high coverage with three quarters of the population using public health facilities and around 90% of mothers giving birth in a facility (MHMS, 2014a).
The Solomons has also made progress towards meeting their Millennium Development Goals. The goal for improved child nutritional status has already been achieved. The goal for infant and under-five mortality rates is on track with substantial declines in mortality. The maternal health target is also on track with a significant decline in maternal deaths since the 1990s and more mothers giving birth with skilled health personnel assistance (Mishra et al., 2010).
The People’s Survey by the Regional Assistance Mission to Solomon Islands (RAMSI) in 2013 found 21% of respondents thought health services had improved a lot in the past five years and 56% thought there had been some improvement (ANU, 2013). Access and utilization compares favourable with other low-income countries. There appear to be no significant differences in immunization coverage by income groups. Neither are rural populations less likely to seek treatment from a health facility.
Data from the Household Income Expenditure Survey (HIES) has found no evidence of lower utilization by the poor (next slide).
The Solomon Islands health system has provided a relatively resilient financial risk protection scheme, even in the face of political unrest.
The system has delivered a very low rate of OOP payments which is believed to have to led to high contact rates with health facilities, negligible rates of catastrophic health spending and above-average health outcomes relative to income per capita.
The Solomons is one of the few countries in the region where inpatient and outpatient care use is not adversely affected by income level. OOP payments do not represent a significant burden on citizens. Households in the poorest income quintile allocate less than 0.05% of their household budget to health care expenses (World Bank, 2010). This creates a relatively equitable system.
The 2006 House Income Expenditure Service found that nearly 87% of people sought care when ill and overall satisfaction is high.
All medications are free of charge to citizens accessing the public health system. All of them are imported as no local manufacturing exists.
The NHSP and SWaP system have enabled the Solomons to move towards a strong, affordable system. This means that it makes the best use of all resources, uses government and non-government resources efficiently and does not try to deliver unsustainable services.
The MHMS conducts a series of public health programmes through facilities, tours and community-level Healthy Settings activities. These include the Safe Motherhood programme, Expanded Programme on Immunization (EPI), Integrated Management of Childhood Illnesses (IMCI), nutrition, malaria and tuberculosis control.
The Safe motherhood programme covers family planning including antenatal care, obstetric care, postnatal care, STIs/reproductive tract infections and HIV control (MHMS, 2006). The programme is aligned with the WHO Global Reproductive Health Strategy Activities which includes training of nurses, surveys, intervention and protocols for obstetric/gynaecological complications (MHMS, 2006).
The EPI provides weekly immunization clinics, measles campaigns and a once a year ‘catch up’ campaign (Jack, 2011b).
The IMCI focuses on early child health including vaccines, feeding recommendations and management of malaria, diarrhoea and pneumonia (Jack, 2011b). By 2007, 18 facilitators and 197 first-level health workers had been trained across seven provinces (MHMS, 2007c; Jack, 2011b). 81% of 12-23 month old children were fully vaccinated by 2007.
The MHMS works with partners to address vector-borne disease control including malaria and tuberculosis. The Solomons has already reached the WHO Western Pacific Region goal to reduce by half the morbidity and mortality from all forms of TB by 2015, relative to 2000 levels. Malaria levels have also been reducing steadily since 2009 (WHO, 2013b; Mishra et al., 2010).
The Healthy Settings programme aim is to adopt healthy behaviours in villages, schools, towns, health facilities and workplaces. By encouraging people to care for their own health and having the right range of services in place, sustained improvements in outcomes can occur in the medium-long term.
Efficiency improvements: In line with NHSP, national programmes integrating aspects of external agencies, e.g. malaria programme into provincial services, water and sanitation services are contracted out to NGOs.
Nurses form the backbone of the health system in the Solomons. Nurses and nurse aides provide the majority of care.
Nurse aide posts, RHCs and AHCs are all staffed by nurses and/or nurse aides. Together, Nurse aide posts, RHCs and AHCs add up to 96.5% of all facilities in the Solomons (MHMS, 2011c, 2014c; WHO, 2010b) highlighting their importance within the system.
This workforce structure, which includes referral to doctors in larger hospitals, meets WHO guidance and is cost-effective.
More than 50% of the health workforce are nurses or nurse aides (Asante et al., 2011). This can be seen in other Pacific Island Countries and Territories with a similar population size such as Fiji and Vanuatu (WHO, 2009).
Infection control nurses also play a crucial role in disease notification and surveillance including identifying potential disease threats by monitoring trends and identifying and investigating outbreaks.
They also form a crucial part of the public health programme activities initiated by the MHMS. These include the Safe motherhood programme as family planning nurses and as ICMI health workers.
Nurses also fill in gaps of other services including mental health care which provincial hospitals do not reserve beds for. Instead, trained mental health nurses deliver public education, clinical care and referral in six provinces. Delivery of specialist outreach programmes is dependent on the nurse and medical staff skills at that particular location (Waqatakirewa, N.D.).
Pharmaceutical provision is managed by the MHMS National Pharmacy Services Division (NPSD). The overall goal is to ensure complete, equal and safe access to essential medicines (MHMS, 2011f).
All medications are free of charge to Solomon Islanders accessing the public health system. There are only a few private pharmacies in the country.
Quality assurance is performed through the use of pre-qualified suppliers based on a WHO model of assessment.
The National Medical Stores (NMS) which has the responsibility of overseeing operations (MHMS, 2008a) uses an electronic inventory system to track stock called mSupply. This tool is used for stock management, to forecast future consumption, track usage and expiries and ensure distribution to facilities. It also allows for dispensing and patient history record keeping at hospitals. This has contribute to low drug stock-outs at facilities.
At Second Level Medical Stores (SLMS), mSupply Mobile is used to manage inventories, place and manage orders for clinics. SLMS are staffed by pharmacy officers who provide medicine-related information to the public and health professionals.
The NPSD has launched National Pharmacy standards, infrastructure projects, training in stock management and building and refurbishing eight SLMS (MHMS, 2011f). This has increased storage space, security for storing and distributing large volumes of pharmaceuticals while ensuring uniform standards are applied across health facilities (MHMS, 2011f).
NMS infrastructure is now inadequate and excess stock is placed aboard shipping containers.
The availability of medicines in rural areas is improving.
A lack of comprehensive and reliable mortality data means it is difficult to assess changes in causes of death or to attribute improved health outcomes to specific policy interventions. No data exists on variations in mortality rates by socioeconomic or ethnic status (Thomas & Duituturaga, 2014).
Mortality rates from malaria was 3/100000 in 2012 and from non-HIV-positive tuberculosis it was 18/100000 population in 2009 (WHO, 2012; MHMS, 2013).
The Solomons are at an early stage of epidemiological transition. An estimated 51% of mortality rates occur due to communicable diseases, 41% from noncommunicable diseases(NCDs) and the remainder from injuries (8%) (WHO, 2012).
31% of the population report daily smoking and 25% of the male population reported consuming five or more alcoholic beverages per day within the previous week.
Burden of disease is largely made up of acute respiratory infection (ARI), clinical malaria and skin diseases. While malaria rates have decreased from 18% to 10% of those presented at primary health care clinics between 2001 and 2011, ARI has increased from 21% to 31% and skin diseases from 5% to 12% in the same period.
The classification of “Other” diseases could be hiding the true burden of disease such as NCDs.
The Solomons has a young, rapidly growing population. Its young population, including its increasing numbers of young women reaching reproductive age increases the need for maternal and child health services.
The country has a high rate of maternal mortality for out-of-facility births though utilization rates of maternal and child health service indicators are high.
Maternal mortality rates have dropped significantly from 1990 at 550/100000 but still remains high 99.7/100000 live births in 2013. Infant mortality has dropped from 96/1000 live births to 10.6 over the same period (See table above).
A growing adolescent fertility rate from 57.1 births per 1000 women aged 15-19 years in 2000 to 66.0 in 2011 is also cause for concern. Combined with a low level of contraceptive prevalence rate (27% of married women aged 15-49), this can create greater risk of STI spread.
The majority of hospitals, AHCs and RHCs are in very poor condition.
Most hospitals require a high level of investment for maintenance of buildings and equipment (Auto et al., 2006a). Many hospitals rely on generators for power and often can only rely on them during the day due to cost, power outages.
Access to running water is also limited throughout the country and in hospitals. 80% of hospitals have rainwater-collecting tanks (Auto et al., 2006a). Gizo Hospital and NRH’s plumbing needs to be repaired as some parts of the hospital wards have no tap water access.
A 2005 review of AHCs found up to 70% of health clinics required significant upgrade, repair or renovation. This is 10% better than a review conducted in 1989 (Waqatakirewa, N.D.)
While some health facilities have been damaged by cyclones and other natural disasters, most are not properly or regularly maintained due to lack of funding (Waqatakirewa, N.D.; JTAI, 2006).
A RHC review showed the same trends as in the AHC review including poor infection control, hygiene and waste disposal as well as unfit or inappropriate birthing facilities.
Development partner contributions are heavily relied upon for investment funding and this dependency can only up funding gaps for buildings and equipment alike.
There are serious shortages of medical equipment and medicine supplies at most health facilities. Most hospitals rely on old and poorly maintained medical, diagnostic and surgical equipment. 5 of 12 hospitals do not have working anaesthesia machines while 3 have no operating theatres at all.
Reform in the health system is aimed at prioritizing prevention and primary care. This entails shifting resources and changing what health workers do. However, there are several challenges in implementation.
To achieve universal health coverage, a higher level of financing will be required. The average distance a patient must travel to get treatment at the NRH is more than 240km (Natuzzi et al., 2011). A shortage of roads and transport between islands adds to time and financial constraints for patients. Furthermore, high delivery costs including electricity and transport also limit the fiscal scope of the health system.
The NHSP has shifted to a performance culture from a ‘budget’ culture. This aims to inculcate a better quality of care agenda as opposed to services constrained by a budget. However, no documented strategy for developing performance orientation across the sector or to clarify intentions exist. Better dialogue is occurring due to improvements in the health information system and financial reporting about resource allocation and performance both within the health system and across government. However, progress is slow.
The MHMS is completing its first human resource plan for the sector linking it with planning, development and management (MHMS, 2011e). However, there is no provision in the national budget or health services for returning Solomon Islanders sent to Cuba for medical training. This carries greater implications for how the nurse-led provincial health system will continue to work in the future.
Gender inequality information and reporting is low. There is little survey data or information from other sources to help understand issues women face, especially in rural areas. They continue to face difficulties in accessing family planning services and have received little attention by the national health sector policy alongside poverty and ethnic inequality.
Health-related gender inequalities also mean high fertility rates and limited information on preventative care (Maike, 2010). Data presented in national plans and reports is not disaggregated by gender.
There is a lack of comprehensive and reliable mortality data meaning it is hard to assess changes in the causes of death or attribute better health outcomes to specific policy interventions. No data exists on mortality rates by socioeconomic status or ethnicity (Thomas & Duituturaga, 2014).
The Health Information System (HIS) still relies on health facilities sending manual reports to provincial hospitals where data input occurs. Software has started to be rolled out so data can be entered on site via the internet. Several public health programmes capture and analyze their own data creating duplication of costs (JTAI 2006; MHMS, 2011e).
Baseline data and targets are unavailable for outpatient department service utilization, the number of centres offering basic emergency obstetric care. This creates issues for tracking of progress of health outcomes.
The NHSP 2011-2015 has a number of hurdles to overcome to ensure high quality of care across the health system:
Determinants of health – only 5% of the rural population has access to improved sanitation (MHMS, 2011e). Overall, urban areas have 77% sanitation coverage compared to 5% in rural areas (Jack, 2011b).
Baseline data and targets are missing from outpatient services. Until programmes have regular support, supervision and performance monitoring, quality of care will be an issue
Health status – Tuberculosis and other infectious diseases continue to be a serious problem and are prone to sudden outbreaks.
Health worker to population ratio is very low
While health service utilization is high, there are problems with invalid vaccines due to broken cold chain and questionable validity of diagnosis and treatment (Foster, Chamberlain et al., 2009).
Tools exist to assess quality of equipment and status of health facilities but implementation and follow-up are unclear. A recent review of RHCs (2012) found no incinerators and significant numbers of facilities without sterilizers.
Improvements in systems and transparency have been effective in identifying and demonstrating the impact of corruption. Misuse of scarce resources directly affects care quality but while it is recognized, real behaviour change is yet to be seen.
Regulations are in place to ensure health concerns are addressed including the Mental Health Treatment Act and the Environmental Health Act. However, these have not always been translated into practice. For example, there are no specialized mental health inpatient departments at provincial departments.
The fiscal space for health is unlikely to grow due to a number of factors:
Government outlays on health are already high by international standards at 8% in 2012 (World Bank, 2012b; WHO 2011a)
Limited economic growth prospects following the global downturn in 2007-08
Limited expected increase in patient and donor financing
A recent audit found a number of issues identified in a 2005 audit of the MHMS remained. These include poor accounting due to limited or no formal training, widespread low-level petty theft adding up to a small percentage of total spending (DFAT, 2013). In 2011, AusAID reported 19 cases of fraudulent use of donor funds between 2004/05 and 2010 (Anonymous, 2011). A substantial fraud case amounting to $10 million SB was discovered in 2013 but a zero tolerance agreement appears to be having an impact.
Reforms to public financial management in cash management, budget integration, accounting and audit functions are in progress.
A relatively high allocation of funding to in-service training and workshops involves the UN and Secretariat of the Pacific Community (SPC) contributing workshop coordinators and training providers. This is highly inequitable, inefficient and the same may apply to pre-service training. There is considerable scope for savings by creating an integrated in-service training programme. Here, the UN and SPC could provide curriculum development and teaching support to identify and build sustained skills and expertise.
Geographic distribution of funds is also inefficient. Honiara receives the highest amount of health spending but a recent survey and health information system data highlights Malaita has greater health outcome and service delivery needs while accounting for 30% of the population. Yet it receives a significantly lower share than expected (World Bank, 2010b). This forces patients to bypass facilities and to go to the NRH directly.
External advisers and partners can also drive up costs by pressuring the government to include new expensive vaccines with little overall benefit in health outcomes.
Other issues include inefficient utilization of staff in some facilities and a weakly developed service model for Healthy Setting activities while some activities such as family planning appears to be underfunded.
Expectation of rising costs of health, including future costs of NCDs creates a risk that current levels of financial protection will not be able to be maintained.
While the current unified, blended health system with the MHMS as steward and manager has been deemed appropriate for its population size, fiscal space and geographic context, there are a number of developments that need to occur to provide sustainable health care in the future.
The focus on prioritizing prevention and primary care should remain as under the NHSP. Greater clarity in administrative systems, roles and responsibilities can underpin effective management and deliver better health outcomes.
The basic characteristics of the primary care system should be kept with a high level of emphasis on nurse and nurse aide roles but also the referral system and provincial health offices. Planning and implementation of efficiencies should not undermine equity.
The main challenges faced by the government are financial and human resource constraints. The volatile financial situation along with increasing disability, hardship and vulnerability, urbanization and a rise in NCDs with slowing growth are all expected.
Public financial management, including reporting and auditing should be improved to ensure financial sustainability of the system.
Greater planning and budgeting is required for returning overseas medical staff. There are concerns that doctors trained in Cuba could replace existing nurses creating an imbalance in health workforce distribution and utilization. The first human resource plan for the sector is underway.
While reviews on SWAp have recommended improvements, it is agreed that the basic framework should remain. It will also lead to better attaining better baseline data to inform policy choices and build towards a performance culture for development partners and citizens.
The Healthy Setting interventions should be strengthened through funding and partnerships which will save the most money in the long run. By budgeting and planning with the private (including UN) sector, it can contribute to prevention and primary care successes.