Epidemiology and Health Systems

Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 1 |

2nd National Scientific Conference on Epidemiology

17 -19 October, Bandung

Epidemiology and Health Systems

Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA

Public Health Specialist


Outline

Setting up the scenario – Epidemiology

Skills of Epidemiology Trainings

Uses of Epidemiology

Health Systems and Framework

System thinking

Epidemiological Model for Health Systems

Tree Model of Health System Framework


Epidemiology – What is this…

let me ask people around


What do you mean by Epidemiology

is the study of skin disease



Worst taught course in

Medical School



the science of making

obvious obscure



the science of long division and

provide a summary equation


BUT

The emphasis is not on statistics,

formulas, or computation, but on

epidemiologic principles and

concepts”.

Make statistics as simple as

possible…so that everybody can

absorb


Epidemiology

Epi (upon) + demos (people) + logy (study of)

WHO Define as:

Is the study of the distribution and

determinants of health-related states or

events in specified population and the

application of this study to the control of

diseases and other health problems.


Lets Analyze the Definition

Study – it is the basic science of public health

Distribution – Time, Place and Persons

Determinants – search for the causes (all WH questions)

Health Related states/events – whole spectrum of health – related

events

Populations – Deals with Population rather than individual

Control – Steers public health decisions on developing and evaluating

interventions


Let’s come out from the box

Have a broader vision


The evolving conception of epidemiology as a liberal art

Epidemiology is often considered to be a biomedical science that relies on

a specific methodology and high-level technical skills.

Its not only about diseases and outbreak investigation

Its not only talk about statistical significance and regression analysis…

Infact, epidemiology in many respects also is “low-tech” science

that can be appreciated by those who don not specialize in this

field.

The biggest CONFOUNDER is that


Skills Acquired Through

Epidemiological Training

Use of Interdisciplinary Approach

– Mathematics and biostatistics (for quantitative methods)

– History (for historical accounts of states/events and early epidemiological

methods

– Sociology (social determinants of states/events)

– Demography and geography (population structures and location of

states/events)

– Behavioral sciences (models of states/events, design of health promotion

programs)

– Economics (economic determinants of Health)

– Law (examining evidence to establish causality; legal based for health policy)


Skills Acquired Through

Epidemiological Training

Use of the Scientific Method

Enhancement of Critical Thinking Ability

Use of quantitative and Computer Methods

Communications skills


Briefly

Current Uses of Epidemiology

– Historical: study the history of the health of populations (epidemiological

transitions)

– Community health use: diagnose the health of the community ( to measure the

true dimensions and distribution of ill-health in terms of incidence, prevalence,

disability and mortality; to set health problems in perspective and define their

relative importance to identify groups needing special attentions.

– Health services use: study the working of health services (Operational

research and disease management)

– Risk assessment use: estimate individuals’ risks of disease, accident, or

defect)

– Disease causality use: search for the causes of health and diseases


Application of Epidemiology on

Health Systems Development

Health system strengthening has become a recognized priority for

achieving major public health goals such as those identified by disease-

specific global health initiatives, disease eradication, MDGs, universal

coverage etc.

The most important single contribution that public health makes to

strengthening health systems is provision of relevant and

scientifically valid epidemiologic data upon which to base decisions

and policies affecting all aspects of the larger health system

Providing the right kind of care to the right people in the right way at the

right time.


Health Systems

A health system is the sum total of all the organizations,

institutions and resources whose primary purpose is to improve

health.

A health system needs staff, funds, information, supplies,

transport, communications and overall guidance and direction.

And it needs to provide services that are responsive and

financially fair, while treating people decently.


Health System Framework


System Thinking in Health Systems

Systems thinking is an approach to problem solving that view

‘problem’ as part of a wider dynamic system.

Systems thinking involves much more than a reaction to

present outcomes or events.

It demands a deeper understanding of the linkages,

relationships, interactions and behaviors among the elements

that characterize the entire system.


System Thinking in Health Systems

Hence, system thinking includes:

– the nature of relationships among the building blocks

– the spaces between the blocks (and understanding what

happens there)

– the synergies emerging from interactions among the

blocks.


Epidemiological Model for

Health Systems


Population

• The physical environment

• Economic environment

• Social Environment

• Life style/behaviour

• Distribution

• Type

• Risk Population

• Marginalized

Population Needs - Health

• Mortality

• Morbidity

• DALYS

Who, Where,

When, How,

Why, What

Health Workforce

• Distribution & Need

• Training & Capacity

• Quantity and Quality

• Other workforce

Finance

• Health Insurance

• User Fee

• Costing and budgeting

Information

• Types of Info

• Info Generation

• Application

• Dissemination

Health Services

• Types of Services

• Distribution

• Other workforce

• Logistics

Medical Products,

vaccine, technologies

• Logistics

• Technology &

Utilization

• Management

Governance/leadership

• Leaders and Managers

• System &

Epidemiological

thinking

• Strategic

Implementation

Development of Health Policy, Planning,

Strategies, Standards


Monitoring of the health system,

organizational and programs

performance

with epidemiological techniques


Epidemiology Defines Health System Needs by..

• Monitoring the population (demography)

• Distribution

• Type

• Risk Population

• Marginalized



• Helping to determine

• The physical environment

• Economic environment

• Social Environment

• Life style/behaviour



• Population needs based on the burden of

diseases/events

• Mortality

• Morbidity

• DALYS

Who, where,

when, how, why,

what


Based on those needs Building Blocks function on

Health Workforce

• Distribution of different type of health

workforce (based on WH questions)

• Trainings and distribution

• How many, what types of health care

workers etc (Quantity and Quality)

• Other group of cadres not specialized in

health



Finance

• How to pay for the service

• Health insurance (Social,

Community, Private)

• User fee mechanism

• Cost of the services (for local and

national planning) etc



Information

• Types of information needed

• Mechanism of information generation

• Utilization at various levels

• Dissemination


• Health Services (service delivery)

• Types of services implementation

(Immunization, mass campaign, clinical

facilities, prevention and health education and

list goes on)

• Where and how to distribute the services

• Who are going to deliver, rational distribution

of health workforce and other logistics

• Supporting services



Medical Products, Vaccine and Technologies

• What are the essential list of medicine,

vaccines and equipment

• Need for new technology, innovation

and utilization

• Distribution and management of supply

chain etc



Governance and Leadership

• System thinking or epidemiological thinking

capacity for managers and leaders

• Development of contextual policy as per the

need

• Centralization or decentralization

Based on those needs Building Blocks

function on


Based on above we have to develop

• Health Policy

• Health Planning

• Health Strategies

• Health Standards



The 3 Dimensions of Health Systems

(1) Health system building blocks

(2) Program/disease areas

(3) Performance drivers

• Inputs

• Policies & regulations

• Organizational Structures

• Behaviors of HS actors


A “Cube” View of the Health System

© Abt Associates, 2001


Inputs vs. Other Key HSS Performance

Drivers






Acknowledgement and References

1. All the available pictures downloaded from Google Image

2. Everybody’s Business – WHO Framework for Action (Accessed

from http://www.who.int/healthsystems/strategy/en/ )

3. World Health Organization – www.who.int

4. Dr Kenneth J. Rothman (his text books on epidmiology)

5. Ann Lion. Strengthening Health Systems - Moving Beyond

Supporting the Health System, Health Systems 20/20

Disclaimer: These references and contents are only used for teaching

purpose.

http://www.who.int/healthsystems/strategy/en/

http://www.who.int/


Thank You

Email

[email protected]

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Date post:	16-Jul-2015
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Epidemiology and Health Systems

Health & Medicine