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The dramatic changes during the Last four decades of the 20th century have greatly affected and led to a repositioning of the Government’s role in health as well as other social sectors. As market forces fail to address Properly the health needs of populations, governments have an obligation to intervene in order To improve both equity and efficiency, to carry out public health functions and to produce vital Public goods which have bearing on health development. The regional committee is invited to Discuss ways in which to strengthen health systems functions with particular focus on Governance, financing and service delivery, in order to protect the social role of government in Health development. Introduction : Introduction Governments, through ministries of health and other related ministries and agencies, play an important role in health development, through strengthening health systems and generation of human, financial and other resources. This allows health systems to achieve their goals of improving health, reducing health inequalities, securing equity in health care financing and responding to population needs . Improved health outcomes are not attributable to health systems alone, as evidence has shown, but to social, economic, cultural and environmental determinants also, as reflected in the WHO conceptual framework of Health For All Evolution of the role of governments in health development : Evolution of the role of governments in health development Human beings and communities throughout history have always strived to cater for their health needs by using indigenous medicines and the knowledge available from other source. Religious leaders have also played an important role in the provision of health care, the art of healing often being intertwined with religious belief. The growth of the private sector in service delivery and in health personnel education was made possible through the direct and indirect involvement of governments. Incentives were given to private investors by governments in several countries in the form of tax credits and other facilities. Legislative support, norms and standards were developed by ministries of health and higher education with a view to improved regulation of the development of the private sector. Domains of government role in health development : Domains of government role in health development Ministries of health are responsible for leading health development through the implementation and improvement of main health system functions , including leadership and governance, health care financing, provision of health services, and generation of inputs for health development, including human resources for health and biomedical technology. Efforts are coordinated with other related ministries and departments. Leadership and governance : Leadership and governance Governments are the guardians of social commitments and values such as solidarity, social justice and equity, which are stated in their constitutions, signed treaties and conventions. In many constitutions worldwide, and in the Eastern Mediterranean Region, the rights to health care and education are clearly indicated and governments are responsible for providing access to these services without financial barriers and for ensuring that the value of health as a basic human right of all is protected Health service delivery : Health service delivery In most countries, while health care financing is socialized, delivery of health care services is secured by both public and private providers and nongovernmental organizations. The role of government is often to steer the overall health development by designing health policies and programmes, securing essential public health functions and regulating the delivery of health services. In most countries, governments provide health care services, including public goods such as promotive and preventive services and hospital care. While the role of private hospitals in service delivery is growing in these countries, public hospitals remain the reference for quality standards,prices of services, training of quality health professionals and health and medical research in various aspects. AIIMS' students educating slum dwellers in Delhi about water-borne diseases.Run By Delhi Government : AIIMS' students educating slum dwellers in Delhi about water-borne diseases.Run By Delhi Government Government’s works Health care financing : Health care financing Governments play a major role in health care financing by mobilizing the necessary resources through public budgets and other contributive mechanisms, pooling resources allocated to health development, guiding the process of resource allocation and purchasing health services from various providers. Ministries of health are entrusted to protect equity in access by improving financial risk protection, by reducing financial barriers to access particularly to the poor and to vulnerable populations, and by ensuring that health care financing by all income groups is fair. Health care financing is becoming an important function in health systems as inequities inside and between countries with respect to access increase because of financial barriers and lack of appropriate social protection. Government Aided Schemes/Programs/Projects : Government Aided Schemes/Programs/Projects Government aided schemes and programmes are run by the Government for the health and welfare of the citizens. According to the Indian Constitution), the subject of ‘Health’ comes under the purview of State Government. This means that the State Governments are responsible for maintaining and bettering the health of the people who live under its jurisdiction. The main policy, framework and support is enumerated by the Centre while the States devise their own models of accomplishing the Central Government's health related goals. Human resource development : Human resource development As human resources constitute the main inputs and assets in health systems, governments are responsible for designing appropriate policies for human resource development aimed at meeting the real needs of populations, securing appropriate skills mix, improving equity in distribution of human resources, managing them properly, and monitoring and evaluation of the national health workforce. Governments set national standards for health personnel education and develop systems for accreditation of training institutions. Appropriate policies and strategies for human resources development depend on the degree of intersectoral collaboration between ministries of health and ministries of education and other related departments. Often the lack of coordination among various stakeholders leads to duplication and inefficient production of the health workforce. Promotion of the centrality of health in socioeconomic development : Promotion of the centrality of health in socioeconomic development Governments play a crucial advocacy role in promoting the central role of health in overall social and economic development. Several initiatives were taken by ministries of health and other related ministries of the Region to improve health outcomes through promoting the social and economic determinants of health, such as a sustainable environment, literacy, female education and empowerment, and poverty reduction. Key challenges facing governments in health development : Key challenges facing governments in health development The main challenge since the early 1980s is represented by the move towards market economies and the reduction in interest in central planning in social and economic development. In many developing economies, macroeconomic reforms including structural adjustment and stabilization programmes, were implemented under pressure from the International Monetary Fund and the World Bank and were often accompanied by cuts in public spending on social sectors including health and education. Cost sharing policies were implemented in order to compensate for diminishing government budgets allocated to health. Economy : Economy In the social field, the main challenges are represented by growing poverty, widening disparities within and between countries and increasing social exclusion. Almost 3 billion people are living on less than US$ 2 per day, despite rising per capita income in many developing countries. The average income ratio at global level of the richest 20% of the population to the poorest 20% is 82 to 1, compared to 30 to 1 in 1960 . The increase in social, economic and environmental vulnerability is associated with a deterioration of health status among deprived communities and calls for a more proactive role from governments. The way forward : The way forward The report of the Commission on Macroeconomics and Health provided additional evidence of the importance of investing in health and also of the importance of the role of governments and international institutions to generate the necessary financial resources for health using national resources, supporting poverty reduction strategies aimed at improving economic growth and seeking regional and international solidarity. Some ministries of health from the Region, using the evidence of the high economic return on investment in health and of the synergy between health and development, have been instrumental in convincing ministers of finance to allocate reasonable public sources to health development. Conclusions : Conclusions Governments have an important role in health development in both developed and developing economies in view of their social mandate and the peculiar nature of the health care market. The efforts initiated by governments to build modern health systems must be continued and adapted to the new changes and challenges in the political, economic, social and cultural fields. Recommendations : Recommendations 1. Governments should promote investment in health development as having important economic return and should advocate the centrality of health in all development initiatives. 2. Governments should continue to play their leadership role in health development in order to protect societal values of equity, solidarity and fairness in Health Care. 3. Governments should strengthen their governance capabilities, particularly in policy development, regulation and public/private mix management. Reforming the health care structure : Reforming the health care structure Physicians and Hospital Leaders Must Come Together in a Genuine Partnership We are now seeing the beginning of the end of what might be called the "industrial age of medicine." Health care in the 20th century was delivered almost exclusively in hospitals and long-term care (LTC) facilities. But the new century has brought with it a focus on new technologies, innovative treatments, and a new sensitivity to patient preferences, and these have changed how and where health care is delivered. Today care is often provided in a much less intensive setting than the hospital or LTC center; sometimes the venue is the patient's own home STRUCTURES OF THE PAST : STRUCTURES OF THE PAST Almost everyone agrees that today's health care infrastructure is rapidly becoming obsolete. Here are three examples. The Changing Role of Nurses About 80 percent of the work done by nurses is based on the 20th-century belief that health care is best delivered in hospitals during admissions that require the patient to stay at least several days.4 Yet the average length of patient stays has fallen dramatically in recent years; for some treatments and procedures, hospital stays have been eliminated altogether. As a result, much of the work that nurses once performed in hospitals is now done elsewhere by other people. Although nurses often say they don't have time to do their work, they fail to realize that much of it could be done in other settings, often by the patients themselves. Health care system : Health care system Health care systems are designed to meet the health care needs of target populations. There are a wide variety of health care systems around the world. In some countries, health care system planning is distributed among market participants, whereas in others planning is made more centrally among governments, trade unions, charities, religious, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has often been evolutionary rather than revolutionary Goals : Goals The goals for health systems, according to the World Health Report 2000 - Health systems: improving performance (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another Providers : Providers Health care provider Health care providers are trained professional people working self-employed or as an employee in an organization, whether a for-profit company, a not-for profit company, a government entity, or a charity. Organizations employing people providing health care are also known as health care providers. Examples are doctors and nurses, paramedics, dentists, medical laboratory staff, specialist therapists, psychologists, pharmacists, chiropractors, and optometrists. Financing : Financing There are generally Four primary methods of funding health care systems: 1.Direct or out-of-pocket payments, 2.Deneral taxation to the state, county or municipality, 3.Social health insurance, 4.Voluntary or private health insurance, and donations or community health insurance. Photo gallery of health care : Photo gallery of health care Slide 25: Health care worker giving support to resident in nursing home Slide 26: Health care professional measuring blood pressure of male patient in sitting position Slide 27: Mother caring for her sick child Slide 28: Resuscitation boxes at ICU, surgery area of hospital Slide 29: Man in ambulance with paramedics Slide 30: Doctor Placing Acupuncture Needle Slide 31: Hands Holding Tiny Baby In Hospital Slide 32: Medical devices in a Hospital Slide 33: Woman with plastic surgery lines drawn on face Slide 34: Dr Fayaz A Shawl, interventional cardiologist, holds Rotablator catheter (with diamond-studded burr on tip), which is used for PTCRA (Percutaneous Transluminal Coronary Rotational Atherectomy) Slide 35: Hemodialysis at hospital Slide 36: Exploring our role as health care We are entering an era of medical awareness and understanding in which all health care need to shoulder the responsibility for a patient’s medical health. Thank you : Thank you Presented By RAJNI ANAND You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.