conceptual frameworks: health systems and the community
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Conceptual Frameworks: Health Systems and the CommunityHenry Perry, Johns Hopkins UniversityCORE Group Spring Meeting, April 30, 2010TRANSCRIPT
Conceptual Frameworks: Health Systems and the Community
Henry PerryJohns Hopkins University
CORE Group, 30 April 2010
Frameworks are mental models
Tools for Transformational Change to Promote the Production of Health
The Leadership Disciplines*
• Personal Mastery• Mental Models• Systems Thinking• Shared Vision• Team Learning
*Peter Senge, The Fifth Discipline, 1990
Do we actually see reality or just our “mental models”?
“ ‘Mental models’ are deeply ingrained assumptions, generalizations, or even pictures or images that influence how we understand the world and how we take action.”
Peter Senge, The Fifth Discipline, p.8.
Mental Models• Mental models are the lenses through
which we observe reality.
• Our perception of reality is totally dependent upon the amount of distortion in these lenses. But do we accept that we all have these lenses?
Mental Models• Mental models are the structures
that we impose on reality.
• We produce in our minds concepts of reality (paradigms), and these predetermine what we will actually be able to see when we observe reality.
Mental Models by Other Names• Perceptions• World View• Assumptions• Paradigm, Conceptual Framework• Beliefs• Prejudice
How we think determines what we see and how we act.
It’s not “Seeing is believing”, but “Believing is seeing”!
Mental Models Define Our “Reality” and Pre-determine the Choices We Make and the Actions We Take
• Who “produces crops” in your mental model of the agricultural system?– How does your answer determine the roles
and functions of the Ministry of Agriculture?
• Who “produces health” in your mental model of the health system?– How does your answer determine the roles
and functions of the Ministry of Health?
What is a system?
Systems Thinking Looks at:• The whole and the parts
and • The interactions among
the partsStudies the whole in order
to understand the parts
Systems
A system is something that:
•maintains its existence and
•functions as a whole
Through the interaction of its parts.
Households
Government Communities
The Health Production System
The Health System has an inherent stability
Households
Government Communities
ValuesValues
PracticesPractices ResourcesResources
ValuesValues
PracticesPractices ResourcesResources
ValuesValues
PracticesPractices ResourcesResources
Mosley and Chen, 1984
Mosley and Chen 1984
Census-base, Impact-Oriented (CBIO) Conceptual Framework
• Basic assumptions: improving the health of a defined population is the overarching goal
• Strong community-partnerships are required for this, and this trust between the health system and the community, and this requires, among other things, responding to community priorities
CBIO (cont.)
Steps:– Define the community– Make a community diagnosis of epidemiological
priorities and the community’s priorities– Epidemiological priorities: most serious, preventable,
readily preventable or treatable conditions in the community
– Community priorities: no clear framework for defining this
– Clarify program priorities by merging epidemiologial priorities and community priorities
CBIO (cont.)
Steps (cont)- Define resources available (social capital, human resources, money, etc.)- Plan program- Implement program- In 3-5-10 years, carry out community
diagnosis again
Routine systematic home visitation a key action- For defining epidemiological priorities- For defining community priorities- For delivering key services- For monitoring progress and measuring
health improvement
Strengthening Health Systems to Improve Health Outcomes. WHO, 2007
Framework of the Health of the Public
• Disease-oriented public health – Control specific diseases or conditions
• Services-oriented public health– Ensure that those who need services get them
• Community-oriented public health– Work with communities to help them improve their health
• All three are equally important and are like the legs of a three-legged stool
– John Wyon
Primary Health Care: An Ambiguous Mental Model?
• Medical care system delivery concept• Alma Ata concept• Health system model vs. production of health
model (World Health Organization vs World “Disease” Organization)
• Community-based primary health care
IMCI
• Facility-based IMCI
• Community-based IMCI
What Is Health?
Final Challenge
What is the most appropriate mental model
conceptual framework for thinking about how
to achieve a world in which no one dies of a
preventable disease or health-related
condition?