ministry of public health and social welfare family health implementation of the national health...

MINISTRY OF PUBLIC HEALTHAND SOCIAL WELFAREwww.mspas.gob.sv

FAMILY HEALTH FAMILY HEALTH

IMPLEMENTATION OF THE NATIONAL HEALTH SYSTEM

OUR GREAT CHALLENGE


Strategic Objective:

““Implement a concerted CHANGE in the health Implement a concerted CHANGE in the health sector that promotes an efficient integrated sector that promotes an efficient integrated decentralized NATIONAL HEALTH SYSTEM TO decentralized NATIONAL HEALTH SYSTEM TO ACHIEVE universal coverage, care for all people, ACHIEVE universal coverage, care for all people, in the entire country.”in the entire country.”

5-year Strategic Plan5-year Strategic Plan 2004-2009. MSPAS2004-2009. MSPAS


1. Eradicate extreme poverty and hunger1. Eradicate extreme poverty and hunger2. Achieve universal primary education2. Achieve universal primary education3. Promote gender equality and empower women3. Promote gender equality and empower women4. 4. Reduce child mortalityReduce child mortality5.5. Improve maternal healthImprove maternal health6.6. Combat HIV/AIDS, malaria, and otherCombat HIV/AIDS, malaria, and other diseases diseases 7. 7. Ensure environmental sustainabilityEnsure environmental sustainability8. Develop a global partnership for8. Develop a global partnership for developmentdevelopment

Millennium Development GoalsMillennium Development Goals MDGMDG


Health care put within reach of all Health care put within reach of all individuals and families in the individuals and families in the community, through means that are community, through means that are acceptable to them, with their full acceptable to them, with their full participation and at a cost that the participation and at a cost that the community and the country can support.community and the country can support.

Primary Health Care


SSNNSS

UNIVERSAL COVERAGE

QUALITY OF CARE AND SERVICES

EQUAL ACCESS

SATISFACTIONOF CONSUMERSAND PROVIDERS

BETTER HEALTHSTATUS IN

THE POPULATION

FINANCING MODELFINANCING MODEL

MANAGEMENT MODEL

SOCIALPARTICIPATION

IN HEALTH

DEVELOPMENT OF HUMAN

RESOURCES IN HEALTH

MODEL OF DELIVERY

ADJUSTMENT OF THELEGAL FRAMEWORK

MODEL OF CARE

MECHANISM

NATIONAL NATIONAL HEALTH HEALTH POLICY POLICY

ImpactImpactObjectivesObjectives

StrategicStrategicObjectivesObjectives

MSPASSTEERING

ROLE

FOCUS ONFAMILYHEALTH

COMPLEMENTARYCONNECTEDNETWORKS

1. Increase State budget allocation for public spending in health.

2. Improve the efficiency of public institutions. 3. New financing sources.


PROCESS OF CHANGE IN HEALTHTHE INITIATIVE aimed at creating a National Health THE INITIATIVE aimed at creating a National Health System, in response to the following strategic objectives:System, in response to the following strategic objectives:

Expand health services coverage for the population within a framework that gives special importance to family health.

Improve quality AND compassion of health-care services

holding as key the model of individual, family and community health care.


Fam

ilyF

amily

Hea

lth

Mo

del

Hea

lth

Mo

del

IMPLEMENTING THE IMPLEMENTING THE CONCEPTUAL FRAMEWORKCONCEPTUAL FRAMEWORK


PHC-based model, with emphasis on health PHC-based model, with emphasis on health

promotion and community work that views as promotion and community work that views as

the unit of analysis the care and intervention ofthe unit of analysis the care and intervention of

“the family”,the family”, provides intra- and extramural provides intra- and extramural

services, which promote healthy lifestyles, services, which promote healthy lifestyles,

control of environmental risks and preventive control of environmental risks and preventive

care with focus on family life and life cycle in care with focus on family life and life cycle in

order to promote and preserve health of the order to promote and preserve health of the

family members and their environment.family members and their environment.

FAMILY HEALTHFAMILY HEALTH


• Guarantee access to and equity in the supply of Guarantee access to and equity in the supply of

health services, based on the strategy of primary health services, based on the strategy of primary

care, with emphasis on health promotion, to family care, with emphasis on health promotion, to family

members and their environment in order to achieve members and their environment in order to achieve

satisfaction and improve the level of health; satisfaction and improve the level of health;

promoting co-responsibility.promoting co-responsibility.

General objectiveGeneral objective


• Determine geographical and population areas of responsibility, assigning families to family health teams and health facilities.

• Organize the network of services connecting the levels of care and strengthening the process of referrals and follow-up visits.

Objective specificObjective specific


• Strengthen the promotion and prevention of health risk and impairments.

• Establish integral management of service networks.

Specific objectivesSpecific objectives


• Family and community Family and community focus, respecting their culture focus, respecting their culture and rights. and rights.

• Define andDefine and guarantee continuous health servicesguarantee continuous health services, , applying standards, protocols, instruments, as well as applying standards, protocols, instruments, as well as evaluation mechanisms that ensure effectiveness. evaluation mechanisms that ensure effectiveness.

• Made up ofMade up of processes andprocesses and procedures procedures developeddeveloped by by

interdisciplinary and integrated teams.interdisciplinary and integrated teams.

CharacteristicsCharacteristics


• A flexible, dynamic, and interactive model capable of predicting and responding on a timely basis to the current and future health characteristics and needs of the family.

• Based on social participation and intersectoral approach.

• Essential: address and resolve the population’s most common health problems and risks through family and community participation.

CharacteristicsCharacteristics


Training

Familyinterventions

MultidisciplinaryTeams

Health Promotion

Comprehensivecare

Strengthenfirst level

FAMILYHEALTHMODEL

Essen

tial

Com

pon

en

ts


Family File

Family Registry, reduces time spent on data collection and Family Registry, reduces time spent on data collection and allows longer time devoted to relation with the patientsallows longer time devoted to relation with the patients.

Familiograma (“Family Diagram”)

Structural diagram of family composition and of the system Structural diagram of family composition and of the system of relationships of several generations in the family, of relationships of several generations in the family, identifies risk factors and dysfunctions, and its important identifies risk factors and dysfunctions, and its important role in causing illness, recuperation and rehabilitation. role in causing illness, recuperation and rehabilitation.

InstrumentsInstruments


• NAME

• ADDRESS

• LIFE-CYCLE FILES

• CLINICAL HISTORIES

• HEALTH FILE

• INTERVENTION PLAN

• FAMILIOGRAMA

What does the Family File contain?What does the Family File contain?


Community workService-oriented cultureAvailability of promotersCulture of volunteer service

Population targeting (poverty)Prompt careGreater problem-solving capacity (physician)

Traditional Model

Expansion of rural coverage, Fosalud, Hospital without walls

Value-added to the modelValue-added to the model


Nov-Dec 06

Selection

of Units

Preparation

Inputs

Training

January-December 07 January-December 08

Gradual implementation

in the public network of

Regional establishments

Implementation of other

SIBASI Units in the

5 Regions

All Units

of all

SIBASIS

January 09

Preparation Pilot Extension Expansion

interface

Phases of ImplementationPhases of Implementation


FAMILIES

EDUCATIONAL CENTERS

WORK ENVIRONMENTS

HEALTH FACILITIES

Key Elements of InterventionKey Elements of Intervention


ORGANIZATION FOR ORGANIZATION FOR IMPLEMENTING THEIMPLEMENTING THE FAMILY FAMILY

HEALTH MODEL HEALTH MODEL


The The FHTFHT includes preferably: includes preferably: 1 health promoter1 health promoter1 nurse and1 nurse and1 physician. 1 physician.

A Health Facility can have more than one family health A Health Facility can have more than one family health team, according to its installed capacity and defined team, according to its installed capacity and defined population. population.

These teams are supported by other professionals These teams are supported by other professionals (dentists, specialists, psychologists, nutritionists, etc.) as (dentists, specialists, psychologists, nutritionists, etc.) as well as technical personnel (laboratory, RX, Pharmacy)well as technical personnel (laboratory, RX, Pharmacy)

Family Health Teams (FHT) Composition


The basic geographical unit is the program area of The basic geographical unit is the program area of

the Family Health Promoters and includes homes, the Family Health Promoters and includes homes,

dwellings, blocks, communities, country houses, dwellings, blocks, communities, country houses,

grouping of cantons, or parts of these. grouping of cantons, or parts of these.

Such geographical units include a maximum Such geographical units include a maximum

group of 250 families, approximately equal to group of 250 families, approximately equal to

1,000 - 1,200 people.1,000 - 1,200 people.

Family Health Team Area of Intervention


Interventions


Geographical AreaGeographical AreaProgrammedProgrammed

familiesfamilies

Families Families

AssignedAssigned

ProgressProgress

Western RegionWestern Region 8,5908,590 3,1613,161 37%37%

Central RegionCentral Region 2,1872,187 1,1971,197 54%54%

Metropolitan RegionMetropolitan Region 1,9471,947 862862 44%44%

Paracentral RegionParacentral Region 3,6333,633 1,2401,240 34%34%

Eastern RegionEastern Region 8,1628,162 4,9164,916 53%53%

Families Assigned to the Family Health Families Assigned to the Family Health ModelModel