Global Health

Part II: Cross-Cutting Global Health Themes (continued)
 

Chapter 5 - Introduction to Health Systems

A health system is defined by the WHO as "all actors, institutions, and resources that undertake health actions" and is generally regarded as the combination of resources, organization, and management that deliver health services to a population. Health services are organized into three levels: primary, secondary, and tertiary. Primary care involves a physician who is the first point of contact with a patient. Secondary care involves general hospitals that provide care that a primary care physician cannot do. Tertiary care focuses on high-level diagnostics and treatments provided by highly specialized hospitals. Public, private, and nongovernmental sectors participate in different parts of the health system. The roles that these sectors play in different countries have a significant impact on how these systems should be designed. The general consensus is to place the highest importance on delivering primary health care (public sector), especially in low-income countries. 

While health systems are categorized similarly to countries' income, there are differences within each income level. At times, middle-income countries have a more successful health service program than high-income countries. Many high-income countries, such as Germany and the UK, have established universal healthcare coverage regulated by the government, without regard to patients' ability to pay for health services. The United States is the only high-income country that has a healthcare system not founded on that principle; with about fifty percent contributed by the private sector. However, the recent implementation of the Affordable Care Act will create significant changes in the U.S. healthcare system since the passage of Medicare and Medicaid. This is discussed more thoroughly in the "Weekly Journal" tab. 

Countries face a number of issues with health systems, including effects of demographic and epidemiological changes, stewardship, governance, human resources, financing, quality of care, and access and equity. Greater attention needs to be paid in countries' infrastructure, organization, and allocation of funds. By stimulating the coverage of underprivileged groups, the burden of disease is lessened. Countries should focus on providing low-cost services that have the highest impact on preventing illnesses. 

Chapter 4 (from Introducing Global Health) - Aid

Types of Aid: International (usually governmental), Humanitarian (private or nonprofit), Bilateral*, Multilateral*
*types of official direct assistance*
Most aid given is allocated to maximize public health in affected areas.

Throughout the years, the transfer of aid has been highly controversial.  Critics of aid are a minority group. They argue that aid fosters dependency in foriegn sources, which are not stable or constant. Countries that receive aid are reported to be complacent and corrupted. Critics believe that overall, low-income countries that receive aid should be left alone to build up their own economies and infrastructure. The majority of the world's population is in favor of aid. People point to the statistics that have shown that overall, public health has improved over time, as seen through life expectancy rates, improved economies, higher education, and decreased poverty rates. Both sides agree that in many cases, the aid given is not working fast enough. 

The following are three approaches in providing aid for public health:
Ex-Ante Approach - aid flows to infrastructure (hospitals, buildings, pipelines)
Sachs Approach - aid flows to non-medical determinants of health (sanitation, jobs, vaccination education)
Institutional Approach - aid focuses on building up local knowledge of health, providing incentives to improve lifestyle choices, reform (this is difficult to implement in all contexts)
 

Link to developing countries
Arguments against direct assistance to developing countries have been made. Critics say aid is harmful; it is poorly managed and misused and further consolidates power for political leaders. 

 

Questions & Ethics
Is aid really independent of government and/or business? 
Are developing countries better off without any assistance?