The underlying dynamics of health care systems in developing countries.

Table of Contents

Acknowledgement

Dedication

Index of Tables

Index of Figures

Abstract

Introduction

Theory
2.1 Conceptual Approach in the Analysis of the Health Care Systems Dynamics
2.1.0 Definitions: Health care Systems, Health Planning, Policy setting and SES
2.1.1 Health Care Systems
2.1.2 Health Planning
2.1.3 Policy
2.1.4 Interplay of Policy Implications and Program Evaluation on Health Care Systems Efficiency
2.1.4 The Socio-Economic Status (SES)
2.1.5 The Social Determinants of Health
2.1.6 Health Care Systems and Financing
2.1.7 Conceptual Relationships between Policy and Planning In Health Care Systems Dynamics
2.1.8 The Hypothesis

The Research Process
3.1 Study Avenues
3.2 The Models
3.2.1. Panel Methods
3.3 Time Lapses
3.4 Data
3.4.1 Indicators
3.5. Variable Analysis
3.5.1 The Dependant Variables
3.5.2 The Independent Variables
3.5.3 Control Variables
3.6.0 Connectance of Indicators to the Dynamic Drivers of Health Care Systems
3.6.1 Incremental Calculus Approach (Elion, 1984)
3.5.7 Research Summary

Results
4.1 Scope in the Health Care Systems
4.2 Outcomes and Performance of Health Care Systems
4.3 Adjustments in Health Care Financing
4.4 The Interplay of Social Factors and Health Prevalence
4.5 Results on the Tested Determinants of Health

Discussion
5.1 Hypothesis Assessment
5.2 Limitations of the Results
5.2.1 Indicators
5.2.2 Data and Measurements
5.3 Generalizations
5.4 Fields of Future Research
5.5 Caveats

6. Conclusion

Reference

Index of Tables

Table 1: The Micro (Individual) And the National-Level (Macro) Health Inputs

Table 2: Population Percentages of Patients With Respect to Class of Employment from SAS Medical Center Kampala Uganda (2009)

Table 3: Data collected on the levels of education for the patients in SAS Medical center Kampala 2010

Index of Figures

Figure 1: TEH vs. Health Inequalities in OECD Countries

Figure 2: Standard of living Vs. Salary (Ug.x) for Urban Residents (2007-2012) Uganda

Figure 3: Propositions of the Macro and Micro-Level Health Inputs

Figure 4: Life Expectancy At Birth For OECD Countries (1990-2005)

Figure 5: PYLL per 100,000 all Causes of Mortality for OECD Countries. (1990-2005)

Figure 6: Generated financing contributions towards health care in the OECD states (2005)

Figure 7: Percentage Health Risks In Relation To the Occupational Classes As Registered In Main Referral Hospitals of Uganda (2008-2010)

Abstract

The main purpose for this thesis accomplishment is to expose chronologically the key findings and core results that emerged from the research study that aimed at analyzing the significant and cardinal role played by both the policy setting and the planning undertaking in the elevation of the health care systems for the developing countries.

The WHO has at so many times defined health care systems as individuals, groups and state entities involved or has an astounding stake in the restoration, upholding and elevating the health prevalence of the community. Under this perspective, paradventually the analysis considered the trend of correlation between these different stakeholders and the extent to which they impact the planning and policy development given the access to effect fundamental changes.

However, with further elaborations as key findings from the interviews and rigorous research undertakings the different health disparities as they are distributed along the global demographic gridlines have been analysed and comparisons drawn out in order to correlate and relate the impact of the different determinants of health with socio-economic status as a frontier.

Introduction

The driving forces that determine the impact of the health care systems originate from the contributions of the policy setting and the planning process as involved subsequently in public health programs. Nevertheless, the influence and the strength of the health care systems can easily be described at any particular time in health interventions and programs on parameters of efficiency, efficacy and availability.

Since policy and planning are core foundations that support the strength of the health care systems, the extent at which they meet the determinants of efficiency, values of efficacy and the implications of availability can alternatively provide ideal means by which such systems are to be assessed (MacRae, 1985).

Under this study; planning undertakings together with the policy settings are idealized as co-partners sharing the same position of effecting the strategic measures for promoting health in the developing world. Henceforth, this study places these two domains in the fluent control position of the astounding strategies which perhaps as normally conceptualized will enhance the achievement of advantages in the health care systems such as those outlined below;

i. Provision of health care services to the population
ii. Generating the instrumental resources as the need may demand
iii. Promotion of reliable financing criteria
iv. Ensure stewardship in all the stake holders

The dynamic trends of health care service delivery in the developing countries is certainly non-uniform and this sort of abnormal distribution correlates with adjustments that are associated with the socio-economic status of the populations (GTZ-ILO-WHO). What happens is that while arranging the demographic associations with health prevalence for the various global regions, healthy advantaged clusters of settlements are localized within proximal vicinities and this sort of rendering on the other hand of impoverished health statuses the reverse is true thereby unraveling the effects of the normally blinded factor. Emphasis has barely been directed towards socio-economic status as one of the principle determinant of health not only in the poor states but much more in the states with giant economies.

Much of the policy speculation unfortunately has been focused on the promotion of health through establishment of health care service providing facilities to the remote regions of the poor states which ideally can be considered to yield the same fruits as the process of elevating the social and economic bases of the populations (BARROS, 1998). However, this conceptualization is merely ideal and theoretical with little practical reliability and for this reason; the anticipated results may materialize more from the adjustments of the socio-economic status of the population than it would from the direct health interventions.

Poor infrastructures in developing and poor states are responsible for the detrimental socio-economic class distribution as they allow in the influx of increased accidents due to automobiles, problems associated with suburb congestion in urban regions, low standard employment that increases the risks of occupation hazards and the other shortcomings.

Therefore, the distribution of health wellness is hardly uniform and yet worst still, the inflow of the negative externalities of socio-economic status causes implicative disparities which at so many times affect the largest population (LIGHT, 2001).

Nevertheless, from the statistics as provided from the OECD states relating to their health care expenditures and budgetary spending in comparison with the quality of health care service delivery in states, a reasonable pattern of this relationship is shown from the extract below (figure 1).

Figure 1: TEH VS Health Inequalities in OECD Countries

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Source: WHO Data Health systems: www.who.int/health systems (2011)

Health inequalities are determined by assessing the distribution of various factors that contribute to health wellness and risk such as Nutrition and diet, occupation and environmental health risks. However, direct measurements of health inequalities are determined through statistical research results showing the trends and patterns for the distribution of morbidity rates and the also for the mortality rates as caused by disease infections rather than accidental.

Despite of these sharp depictions in the above figure that are so evident and requiring less articulation, this study venture into the health care systems outweighs the burden presented by the dynamic trends caused by both policy and planning. Further still, with comparatively a more elaborative exposition it shows how this pair of factors are less effective when the impact of social economic status is neglected.

More effectively under the scope of this thesis is the political and effects of foreign capitalistic policies as they correlate with policy and planning though this relationship is of great importance in the developing and the poor states little is based on its impacts. Political systems in most of the poor states are unpredictable and have been so much victimized by foreign influence and interruption in which case any institutional analysis oriented towards them is vulnerable to bias.

Prospectively, the thesis has been arranged systematically with various chapters that transcend with background literature, conceptualization and research outcomes.in brief these aspects of this thesis follow the trend as thus; the theoretical dimension of the topic is discussed after the introduction, which then is followed by the conceptual framework where eventually the resulting hypothesis is descriptively enacted. The fourth section of this thesis mainly expose the outcomes of the research undertaking involved in this study context and these results obtained will be used to analyse and propose a precise operational and dynamic framework that can cause fundamental changes in the health care systems for the poor states.

The fifth chapter also commences with the further analysis into the patterns and trends generated from the research as regards to the health dynamics determinants and the social economic status dimensions both towards health and the economic development. Implications and prospects will further be diagnosed in the proceeding chapters before the summarizing and concluding section of the whole thesis.

Theory

2.1 Conceptual Approach in the Analysis of the Health Care Systems Dynamics

2.1.0 Definitions: Health care Systems, Health Planning, Policy setting and SES

2.1.1 Health Care Systems

The general perspective from the analytical point of view will align health care systems among social sectors that seek to elevate social wellbeing through health wellness and strategic planning and undertakings to strengthen efficient health care support for the communities. Being regarded as formal social settings in the community, the health care systems are therefore open-ended in objectives at least for the current situation and at the same time equivocal to both public health wellness and policy settings.

The current global advocacy for health promotion has sown the seed of interest in a number of entities and individuals with a passion for reducing the health inequalities and minimizing the side effects of the disparities caused. Such influx of numerous stake holders with the majority being non-government organizations and world bodies have enacted a new branding on the outlook of health care systems from being merely evolutional to revolutionary extents.

From the ambitions of such multiple entities and numerous stakeholders the health care systems can therefore be described or defined as institutions, individuals, organizations, governments and government agencies that peruse the prevalence of health wellness. Such entities and individuals or societies uphold the strategies through modifying policy settings and planning undertakings while streamlining these arenas towards core measures of achieving health wellness goals for the global community.

From an international point of view, health care systems are the core underlying facilities in the public health arena that strengthen the various dimensions of;

-Health care cost
-Health care coverage
-Consistency of the health care services to the target group in the community
-Complexity
-Chronic illness

In other words, it is either through the health care systems and their operational strategy that the costs of health care services are enacted and modified for the good of the current health status or for purposes of achieving the policy demarcations as initially intended (NEWHOUSE, 1992a).

The rest of the great five “C”s follows the same channel of systematic objectivity though these emphatically are controllable only through the gridlines already set through policy setting and planning.

The operational framework of the health care systems have a great deal in determing the structural outlook and dynamic functionality and this has always been attributed to the administrative rendering yet in so many cases it has its great dependency on the political environment. A majority of regional governments such as those in Africa has a complete grip and autonomous control on the health care sectors and exercises their significance by setting and enacting health care policies, carryout progressive planning for health care facilities and programs, enforce regulation of the other private entities.

In this case, therefore, the frameworks are ideal to the favoring outlines of the government system at the time and public or universal inclusion in the objectivity of health care services is a primary concern.

2.1.2 Health Planning

Planning in its essence collectively embeds the systematic and chronological stepwise arrangement of objectives and goals for pursuit within an entity mainly for purposes of achieving them using the already streamlined channels (BARROS, 1998). Planning performs the role of a compass but with an accomplishing objectivity and not merely exploratory as this may be a passive undertaking and less instrumental for organization that seeks to achieve specified goals.

Health planning touches the health faculty of strategizing and lay out of measures and undertakings through which the prevalence and health promotion are to be achieved in a community. Health care systems are multiple individual entities and here the faculty of planning is not only entitled to a specified quorum of personnel though this in most cases is the real approach followed which at one point has associated short comings. Further still, such a blinded approach also affects a conceptual interpretation as it renders a misinforming picture of the clear extent on how true planning should be handled in an organization where there are various stake holders and most especially in a scenario where they originate from different dimensions of professions and social exclusion aspects.

The best conceptual description can only originate from the point of view in which this event is handled possibly whether it is a mere desk work requiring analyzing data, interview objectives from the stake holders, and finalizing the process by writing down the approved or set objectives and committing them to the channels through which they are to be executed. And if this is the perspective of the analysis and observation then it will swiftly be decided that planning is only the drawing frameworks requiring to be executed for the entity to achieve its prospects.

However, from another point of view if the process is scrutinized beyond the intellectual drawing boards to a more pragmatic approach where it involves research and extended analysis of trends and comparing those of the past with those in the current and execute the outcomes. Then in this case, these will certainly be a composite of analysis, comparison, objectivity, policy deterministic, and fundamental changes of all possible aspects that pertains health prevalence.

From this rendering health planning is an act of practical undertaking involving a series of processes such as scrutinizing the situation to discover the need and designing the strategies for checking the weakness and finding all possible means through which execution of the strategies can materialize or to be transferred from the drawing board into practice.

Hence, concisely, health planning will aim at achieving health prevalence through the stepwise approaches chronologically attended in the likely hood as;

1. Setting up or adapting the primary or principal objective for the program
2. Analyzing the environment or the current situation of the area under target
3. Collecting and checking data of the past, current, related entities for comparisons
4. Evaluating the resources available, those needed and their appropriate allocation
5. Organization structuring and involvement of the stakeholders
6. Designing the measures, and structural impressions to depict the objective
7. Selecting the channels and parameters for execution of strategies
8. The execution stage

Nevertheless, strategic planning must be directed by indicators of need in an organization or system and these prompts or arouse the fundamental innovations and renovations accordingly which further generates the targets so that the strategies are not blinded but astounding in eliminating all discrepancy (Jee, 1999). The targets generated are of various implications and require non-uniform measures because their makeup can be dependant of unique factors such as;

- Demographic distribution of factor
- Information and data dimensions
- Resource availability
- Policy settings, etc

2.1.3 Policy

Policy is a set or compositional arrangement of rules, guidelines, operational demarcations for an entity and they act to regulate and streamline the smooth and proper running of activities as they should be. For within policy is included the institutional statutes, that can act as the operational manual guides so that the activities of the entity protected from irregularities that normally cause distortion of the set objectives.

The faculty of policy is a wide section within an organization most especially like in the health sector where health is a public service that embeds a lot of stake holding entities and individuals. Policy is very instrumental streamlining the key issues and activities of the public health sector and without it more difficulties and negative externalities will be unraveled.

Policy setting involves a series of processes all of which are core and equally important for the whole objectives to be achieved. The basic step by step stages in policy setting include;

Agenda selection which mainly involves outlining the core problems in relation to the objectives of the health care entity. At first, multiple factors and predicaments are taken into consideration, their impact and implications on health wellness of the target population checked with an intention of proving their efficacy as underlying factors for the prevalence of poor health care services in the communities.

Formulation is another stage in the policy setting criteria which involves a number of professionals and technocrats from the associated entities and the society all with the stake in the health care promotion process. The main activity under this stage is for the technical team to compare the challenges discovered, assess the current situation of the population and then decide schemes and criteria through which the sector can advance over these challenges through the set approaches while observe certain regulations.

Implementation follows certain considerations and phenomenon by which the set and formulated policy demarcations are executed as decided on. The stage is an important one calls for enforcement and observation as induced by the authorities either institutional, individual or state dictated.

Policy evaluation and assessment then is enacted as an axillary process that checks the loopholes, strengths and weaknesses in the set policy. This process can be carried out through various ways such as overviewing the achievements of the entity and their correlation with the set objectives or selected agenda. Evaluation of the policy helps to iron out the whole poor policies or in some cases helps to interject or enact amendments within the already existing policy for excellent accomplishments of its purpose.

The policy setting process is an important one during directing public health interventions as it formally mobilize public patent and helps to meet with statutory requirements of both the state and for the sector or health care entity.

2.1.4 Interplay of Policy Implications and Program Evaluation on Health Care Systems Efficiency

Policy settings in public health care systems plays an effective function in the objective operations and act as core forces that enable the implementation of strategies to promote the health welfare of communities. However, as important as it may look to be that policy has an impact of objective streamlining and then a regulatory role that seeks to guide and control the activities of the health care entities be it private based or under government management.

The main difference of the policy implications when compared to the impacts caused on either the government and the private health care entities is that objectivity and regulation demarcations are limited to different extents in these two orientations (LIGHT, 2001). Private health care entities have objective set according to the dictated policies of the state that are even more or less advantageous related to the goals of the entity in which case they are of restrictive nature than being remedies.

Despite of the limitations that policy could impose onto private entities at some extent even though such are not the primary intentions of these undertakings, the policy work plan and the analysis part of it act as remedies for resetting operational and activity work processes which in so many cases are good for innovation.

However, policy outlines on their own are sidelined and are therefore, imbalanced advantages or undertakings, which require for counterbalancing factors or items that will effectively boost their significant role in promoting health care service delivery. In program design and interventional development for purposes of redeeming health care outcries policy settings will plot the demarcations of the operations and activities whereas the role of the evaluation process will certainly be to check the areas of weakness and enlist the impacts of the policy settings onto the target population.

At so many cases a blunder has been committed by the health care technocrats who barely study the post and pre-policy implementation effects from the different regions the same types of policies have been enacted and so the process becomes blinded with a lot of bias. Sensitive policies such as the decisions on who is to carry the expense of the health care insurance, how are the re-imbursements to be generated, channels through which the financing resources are to be directed and other driving forces in health care financing are not satisfactory. Therefore, with time they will generate loopholes in process which if neglected could cause a manifold breakdown in the service delivery for the health services towards the community (Glied, 2008).

2.1.4 The Socio-Economic Status (SES)

If the economic status of the general national population is to be analysed the scope shows without fault that the economic status of individuals are non-uniform but though this is not so shocking as it is further elaborated that those with better economic status also have better of life styles.

The socio-economic status event also corresponds to the distribution of better conditions of living to individuals in regard to their economic status. In other words those that are more advantaged economically are also entitled to the better condition privileges.

The statistical board of Uganda (UNBS) for instance revealed that the largest number of individuals in poor conditions of accommodation, inadequate access to health care services, poor education status and conditions, and other statuses is more prevalent with the individuals of poor economic bases.

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Source:(UNBS 2010)”The National Statistical Review on Standards of Living.”

The rankings of the individuals only catered for those employed and this means that their financial flow can easily be evaluated and compared with their spending on the different common services. Nevertheless, the figures generally indicate that there is a decreasing standard of the type of services that individuals can access as controlled by their economic bases and the pattern flows with decrease in salary levels.

Typical distribution of individuals in the different regions of the state also depends a lot on their economic status in which case it is evident that also those individuals with better economic bases are clustered in better off neighborhoods while the poor population is most distributed in the slums (RICE, et al. 1985).

2.1.5 The Social Determinants of Health

The advent of health care dynamics is controlled by a composition of factors where the majority are the social determinants of the health status for various individuals. Further still, the dynamics are dependant on the impact induced by the input of each factor and these vary in type hence a systematic criteria required for their assessment.

Conceptually, the various researchers have always remarked after their key findings that health is no better different from other commodities though its affecting factors vary from the inputs available and to what extent they can be controlled or adjusted.

In this case large population clusters for the individuals with more health risks are more distributed in regard to the more prevalent health determinant whereas these factors have the same relationship to economic bases of individuals their extent at which they impact health does not regularly fall under the same pattern. Take for instance life style and occupation conditions and both of these have an interrelationship with economic status and they are considered as social determinants for the health status of individuals though on assessing the their impact it is depicted that the population clusters falling under the life style are not equivalent to that of its counterpart.

The health determinant partially determines the health inputs, which are denoted as HC and among these, are the medical related factors and the non-medical determinants (NM).

Therefore,

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The most common non-medical factors that can influence the health status for the individuals include;

- Education
- Age
- The life style of individuals
- Genetics
- Environmental factors
- Economic basis

However, such factors mainly affect health outcomes on an individual basis or micro status and this poses a challenge to use such indicators for national wide statistics. From research contributions, an alternative approach can be used that tries to reset and translate these factors to more excellent parametric calibration that will generate an association with macro dependency and this can then be used to assess their effect at the national level variables (Table 1).

Table 1: The Micro (Individual) And the National-Level (Macro) Health Inputs

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Adapted from: The influence of health care financing systems on health outcomes (Marian Schmidt, 2010)

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