Health Caare Delivery in Abroad

8/3/2019 Health Caare Delivery in Abroad

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INTRODUCTION

A health care system is the organization of people, institutions, andresources to deliver health care services to meet the health needs of targetpopulations.

There is a wide variety of health care systems around the world, with asmany histories and organizational structures as there are nations. In somecountries, health care system planning is distributed among marketparticipants. In others, there is a concerted effort among governments, tradeunions, charities, religious, or other co-ordinated bodies to deliver plannedhealth care services targeted to the populations they serve. However, healthcare planning has been described as often evolutionary rather thanrevolutionary.

GOALS

The goals for health systems, according to the World HealthOrganization, are good health, responsiveness to the expectations of thepopulation, and fair financial contribution. Progress towards them depends onhow systems carry out four vital functions: provision of health care services,resource generation, financing, and stewardship. Other dimensions for theevaluation of health care systems include quality, efficiency, acceptability, andequity. They have also been described in the United States as "the five C's": Cost,Coverage, Consistency, Complexity, and Chronic Illness Also, continuity ofhealth care is a major goal

PROVIDERS

Health care providers are institutions or individuals providing healthcare services. Individuals including health professionals and allied healthprofessions can be self-employed or working as an employee in a hospital,clinic, or other health care institution, whether government operated, privatefor-profit, or private not-for-profit (e.g. non-governmental organization). Theymay also work outside of direct patient care such as in a government healthdepartment or other agency, medical laboratory, or health training institution.Examples of health workers are doctors, nurses, midwives, paramedics,

dentists, medical laboratory technologists, therapists, psychologists,pharmacists, chiropractors, optometrists, community health workers,traditional medicine practitioners, and others.
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FINANCING

There are generally five primary methods of funding health care systems

1. general taxation to the state, county or municipality2. social health insurance3. voluntary or private health insurance4. out-of-pocket payments5. donations to charitiesMost countries' systems feature a mix of all five models. One study based on

data from the OECD concluded that all types of health care finance "arecompatible with" an efficient health care system. The study also found norelationship between financing and cost control.

The term health insurance is generally used to describe a form of insurance

that pays for medical expenses. It is sometimes used more broadly to includeinsurance covering disability or long-term nursing or custodial care needs. Itmay be provided through a social insurance program, or from privateinsurance companies. It may be obtained on a group basis (e.g., by a firm tocover its employees) or purchased by individual consumers. In each casepremiums or taxes protect the insured from high or unexpected health careexpenses.

By estimating the overall cost of health care expenses, a routine financestructure (such as a monthly premium or annual tax) can be developed,ensuring that money is available to pay for the health care benefits specified in

the insurance agreement. The benefit is typically administered by a governmentagency, a non-profit health fund or a corporation operating seeking to make aprofit.

Many forms of commercial health insurance control their costs byrestricting the benefits that are paid by through deductibles, co-payments,coinsurance, policy exclusions, and total coverage limits and will severelyrestrict or refuse coverage of pre-existing conditions. Many governmentschemes also have co-payment schemes but exclusions are rare because ofpolitical pressure. The larger insurance schemes may also negotiate fees withproviders.

Many forms of social insurance schemes control their costs by using thebargaining power of their community they represent to control costs in thehealth care delivery system. For example by negotiating drug prices directlywith pharmaceutical companies, or negotiating standard fees with the medicalprofession. Social schemes sometimes feature contributions related to earningsas part of a scheme to deliver universal health care, which may or may not also
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involve the use of commercial and non-commercial insurers. Essentially themore wealthy pay proportionately more into the scheme to cover the needs ofthe relatively poor who therefore contribute proportionately less. There areusually caps on the contributions of the wealthy and minimum payments thatmust be made by the insured (often in the form of a minimum contribution,

similar to a deductible in commercial insurance models).

In addition to these traditional health care financing methods, some lowerincome countries and development partners are also implementing non-traditional or innovative financing mechanisms for scaling up delivery andsustainability of health care, such as micro-contributions, public-privatepartnerships, and market-based financial transaction taxes. For example, as ofJune 2011, UNITAID had collected more than one billion dollars from 29member countries, including several from Africa, through an air ticketsolidarity levy to expand access to care and treatment for HIV/AIDS,tuberculosis and malaria in 94 countries.

Payment models

In most countries, wage costs for health care practitioners are estimated torepresent between 65% and 80% of renewable health system expenditures.There are three ways to pay medical practitioners. There has been growinginterest in blending elements of these systems.

OVERVIEW AND HISTORICAL PERSPECTIVE OF GLOBALHEALTH

The term Global Health stands for a new context, a new awareness and anew strategic approach in matters of international health. Its focus is theimpact of global interdependence on the determinants of health, the transfer ofhealth risks and the policy response of countries, international organizationsand the many other actors in the global health arena. Its goal is the equitableaccess to health in all regions of the globe.

The term International Health has mainly been used to encompassapproaches to health problems in developing countries and the flow of

resources and knowledge from the developed to the developing world. GlobalHealth in contrast focuses on relationships of interdependence that transcendthis division as well as national frontiers and policy sectors, in particular

- The global distribution of health and disease and their determinants,- The impact of globalization on health- The changing nature of global health governance.

Global Health incorporates a historical perspective: global epidemicshave ravaged societies in the past, there have been other periods of
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globalization in the worlds history and for centuries countries have craftedinternational agreements and institutions to protect the health of theirpopulations and (by proxy) their economies. With this in mind Global Healthexplores how at the beginning of the 21st century changing economic, politicaland social realities lead to a new quality of impact and necessitate

new types of responses along two dimensions:- First, Global Health contributes to the understanding of the extent towhich the transfer of health risks changes in nature, direction and impact dueto the increased speed, reduced distance and cultural transfer brought aboutby modern means of transport and communication as well as new forms ofeconomic dependence and interdependence. Not only can infectious diseasetravel more rapidly than ever before, but so can harmful lifestyles, pollution,toxic substances and unsafe goods and products.

- Second, Global Health contributes to the development of strategies thatcounteract epidemiological polarization and aim to achieve a balance betweensupportive global mechanisms and decentralized approaches. As a priority this

includes building the capacity of the developing world to govern health in thenew global context as well as strengthening the local response to the newsocial, behavioral, environmental or biological risks to health such as theglobal HIV/AIDS epidemic, urban violence orbit-terrorist threats. Whiletechnical solutions exist for many of the most pressing global health problems,closing the global health gap will require massive political and financialcommitment in both developed and developing countries as well as areorientation in policy and strategy. Indeed the very fact that solutions existbut are not accessible to the poorest is one of the key driving forces of theglobal health agenda. This entails resolving the participatory gap in settingglobal health priorities, the operational gap in building efficient and

sustainable public health responses and the accountability gap in addressingthe health needs of the poorest at the local and the global level.

Strategic responses give priority to increasing the capacity of all actors towork together as partners to produce better health outcomes and need toinclude:

- breaking down barriers between policy sectors such as foreign anddomestic policy and including health in the security, foreign relations andeconomic development agenda, and

- developing inclusive systems of health governance that take intoaccount the changing role of nation states and international organizations aswell as the dense network of private sector and non-governmental sectors in

the health arena, as well as the dynamics between local and global responses.Finally Global Health explores the emerging value base and the new

agendas and relationships that emerge when health becomes an essentialcomponent and expression of global citizenship. In doing so it can build on agrowing awareness that health is a valuable resource, a basic human right anda global public good that needs to be protected and promoted by the globalcommunity.


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In 1977 attendees at the annual meeting of the world healthassembly maintained that a major goal for member agencies should be theattainment by all citizens of the world by the year 2000 a level of health thatwill permit them to lead a socially and economically productive life. The goal ofhealth for all by the year 2000 was extended in to the next century with the

document health for all in the 21st

century. These goals have continued to bepromoted by numerous health related conferences held around the world,including international council for nurses.

In 1978 concern for health of the worlds people was voiced at the

international conference on primary health care that was held in Alma Ata inwhat was then Soviet central Asia. They adopted a resolution that proclaimed

that the major key to attaining HFA2000 was the world wide implementation ofprimary health care and many terms they used to describe nation that have

achieved a high level of industrial and technological advancement in theirhealth care system. The term developed country refers to those countries with

a stable economy and a wide range of industrial and technologicaldevelopment. e.g. US, Canada, Japan, UK, France, and Australia. A country isnot yet stable with respect to its economy and technological development is

referred to as a lesser developed country. E.g. Bangladesh, Africa, Indonesia.

As countries promote the objectives of HFA21, they realize that they need

to improve their economics and infrastructure. They often seek funds and

technological expertise from the wealthier and more developed countries.

MAJOR GLOBAL HEALTH ORGANIZATION

A large number of international organization have an ongoing interest in

global health. Recent reports indicate that the majority of funds raised byinternational organizations are used for food relief, worker training anddisaster relief .international organizations are classified as multilateral

organization or nongovernmental organization(NGOs) or private voluntary

organizations(PVOs) .

MULTILATERAL ORGANIZATION

Multilateral organization is those that receive funding from multiple

government and nongovernment resources. The major organizations are part ofthe united nation and they include the world health organization ( WHO ), the

united nations childrens fund (UNICEF), the pan American health organization

(PAHO), and the world bank.


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World health organization

It is a separate autonomous organization that, by special agreement,

works with United Nations through its economic and social council. The ideafor a worldwide health organization developed from the first international

sanitary conference in 1902, which is viewed as precursor to the world healthorganization. Continued efforts by this and other worldwide agencies resultedin the formation of the WHO in 1946 as an outgrowth of the league of nations

and the UN charter.

The WHO headed by a Director general and five assistant generals, have

three major divisions.

The world health assembly approves the budget and makes decision

about health policies.

The executive board serves as the liaison between the assembly and

secretariat.

The secretariat carries out the day to day activities of the WHO. Apartfrom coordinating international efforts to control outbreaks of infectiousdisease, such as SARS, malaria, tuberculosis, influenza, and HIV/AIDS, theWHO also sponsors programs to prevent and treat such diseases. The WHOsupports the development and distribution of safe and effective vaccines,pharmaceutical diagnostics, and drugs, such as through the ExpandedProgram on Immunization. After over two decades of fighting smallpox, the

WHO declared in 1980 that the disease had been eradicated the first diseasein history to be eliminated by human effort. The WHO aims to eradicate poliowithin the next few years.

The organization develops and promotes the use of evidence-based tools,norms and standards to support Member States to inform health policyoptions. It oversees the implementation of the International Health Regulations,and publishes a series of medical classifications including the InternationalStatistical Classification of Diseases (ICD), the International Classification ofFunctioning, Disability and Health (ICF), and the International Classification ofHealth Interventions (ICHI). The WHO regularly publishes a World HealthReport including an expert assessment of a specific global health topic. Theorganization has published tools for monitoring the capacity of national healthsystems and health workforces[12] to meet primary health care goals. Theorganization has endorsed the world's first official HIV/AIDS Toolkit forZimbabwe (from 3 October 2006), making it an international standard.
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In addition, the WHO carries out various health-related campaigns forexample, to boost the consumption of fruits and vegetables worldwide and todiscourage tobacco use. Each year, the organization marks World Health Dayfocusing on a specific health promotion topic.

WHO conducts or supports health research in areas of communicablediseases, reproductive health, non-communicable conditions and injuries,neglected tropical diseases,[16]health policy and systems, and other areas, aswell as improving access to health research and literature in developingcountries such as through the HINARI network. The organization relies on theexpertise and experience of many world-renowned scientists and professionalsto inform its work, such as the WHO Expert Committee on BiologicalStandardization, the WHO Expert Committee on Leprosy, and the WHO StudyGroup on Interprofessional Education & Collaborative Practice.

The WHO also promotes the development of capacities in Member States

to use and produce research that addresses national needs, by bolsteringnational health research systems and promoting knowledge translationplatforms such as the Evidence-Informed Policy Network (EVIPNet). WHO andits regional offices are working to develop regional policies on research forhealth - the first one being the Pan American Health Organization/RegionalOffice for the Americas (PAHO/AMRO) that had its Policy on Research forHealth approved in September 2009 by its 49th Directing Council DocumentCD 49.10.

The World Health Organization's suite of health studies is working toprovide the needed health and well-being evidence through a variety of data

collection platforms, including the World Health Survey covering 308,000respondents aged 18+ years and 81,000 aged 50+ years from 70 countries, andthe Study on Global Ageing and Adult Health (SAGE) covering over 50,000persons aged 50+ across almost 23 countries. The WHO Assessment Instrumentfor Mental Health Systems (WHO-AIMS), the WHO Quality of Life Instrument(WHOQOL), and the Service Availability Mapping (SAM) tool provide guidancefor data collection in other health and health-related areas. Collaborativeefforts between WHO and other agencies, such as through the Health MetricsNetwork, serve the normative functions of setting high research standards.

WHO has also worked on global initiatives in surgery such as the GlobalInitiative for Emergency and Essential Surgical Care and the Guidelines forEssential Trauma Care[25] focused on access and quality. Safe Surgery SavesLivesaddresses the patient safety in surgical care. The WHO Surgical SafetyChecklist is in current use worldwide in the effort to improve safety in surgicalpatients.
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Main publications

Bulletin of the World Health Organization Eastern Mediterranean Health Journal Human Resources for Health, journal published in collaboration with

BioMed Central Pan American Journal of Public Health World Health Report, series of global health policy reportUnited nations international childrens emergency fund

United Nations Children's Fund (or UNICEF; pronounced /junsf/YEW-ni-sef[1]) was created by the United Nations General Assembly on December 11,1946, to provide emergency food and healthcare to children in countries thathad been devastated by World War II. In 1953, UNICEF became a permanentpart of the United Nations System and its name was shortened from theoriginal United Nations International Children's Emergency Fund but it hascontinued to be known by the popular acronym based on this old name.Headquartered in New York City, UNICEF provides long-term humanitarianand developmental assistance to children and mothers in developing countries.It is one of the members of the United Nations Development Group and itsExecutive Committee.

Head Anthony Lake

Status Active

Established December 1946

Headquarters New York, USA

Website UNICEF official site

Parent org ECOSOC

Website UNICEF official site

Parent org ECOSOC
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UNICEF relies on contributions from governments and private donorsand UNICEF's total income for 2006 was $2,781,000,000. Governmentscontribute two thirds of the organization's resources; private groups and some6 million individuals contribute the rest through the National Committees.UNICEF's programs emphasize developing community-level services to promote

the health and well-being of children. UNICEF was awarded the Nobel PeacePrize in 1965 and the Prince of Asturias Award of Concord in 2006.

Most of UNICEF's work is in the field, with staff in over 190 countriesand territories. More than 200 country offices carry out UNICEF's missionthrough a program developed with host governments. Seven regional officesprovide technical assistance to country offices as needed.

Overall management and administration of the organization takes placeat its headquarters in New York. UNICEF's Supply Division is based inCopenhagen and serves as the primary point of distribution for such essential

items as vaccines, antiretroviral medicines for children and mothers with HIV,nutritional supplements, emergency shelters, educational supplies, amongothers. A 36-member Executive Board establishes policies, approves programsand oversees administrative and financial plans. The Executive Board is madeup of government representatives who are elected by the United NationsEconomic and Social Council, usually for three-year terms.

Following the reaching of term limits by Executive Director of UNICEFCarol Bellamy, former United States Secretary of Agriculture Ann Venemanbecame executive director of the organization in May 2005, with an agenda toincrease the organization's focus on the Millennium Development Goals. She

was succeeded in May 2010, by Anthony Lake.

UNICEF is an inter-governmental organization and thus is accountableto governments. UNICEFs salary and benefits package is based on the UnitedNations Common System.

UNICEF National Committees

There are National Committees in 36 industrialized countries worldwide,each established as an independent local non-governmental organization. TheNational Committees raise funds from the private sector.

UNICEF is funded exclusively by voluntary contributions, and theNational Committee collectively raise around one-third of UNICEF's annualincome. This comes through contributions from corporations, civil society
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organizations and more than 6 million individual donors worldwide. They alsorally many different partners including the media, national and localgovernment officials, NGOs, specialists such as doctors and lawyers,corporations, schools, young people and the general public on issues relatedtochildrens rights.

Promotion and fundraising

In the United States, Canada and some other countries, UNICEF isknown for its "Trick-Or-Treat for UNICEF" program in which children collectmoney for UNICEF from the houses they trick-or-treat on Halloween night,sometimes instead of candy. UNICEF is present in 190 countries and territoriesaround the world. UNICEF designated 1979 as the "Year of the Child", andmany celebrities including David Gordon, David Essex, Alun Davies and CatStevens gave a performance at a benefit concert celebrating the Year of theChild Concertin December 1979. Many people in developed countries first hear

about UNICEF's work through the activities of 36 National Committees forUNICEF. These non-governmental organizations (NGO) are primarilyresponsible for fundraising, selling UNICEF greeting cards and products,creating private and public partnerships, advocating for childrens rights, andproviding other invaluable support. The U.S. Fund for UNICEF is the oldest ofthe National Committees, founded in 1947. New Zealand appointed, in 2005,18-year-old Hayley Westenra, a talented, world famous opera / pop singer astheir Ambassador to UNICEF, in an effort to enlist the youth of the world insupporting UNICEF. Westenra has made several trips to visit underprivilegedchildren in third world countries on behalf of UNICEF, in an effort to publicizetheir plight, and has engaged in fund-raising activities in support of the

UNICEF mission, as well

Pan American health organization

The Pan American Health Organization (PAHO) is an international publichealth agency with over 100 years of experience working to improve health andliving standards of the people of the Americas. It enjoys internationalrecognition as part of the United Nations system, serving as the Regional Officefor the Americas of the World Health Organization, and as the healthorganization of the Inter-American System.

Description

PAHO is based in Washington, D.C., and has scientific and technicalexperts at its headquarters, in its 27 country offices, and its nine scientificcenters, all working with the countries ofLatin America and the Caribbean indealing with priority health issues. The health authorities of PAHO's MemberStates set PAHO's technical and administrative policies through its Governing
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Bodies. PAHO Member States include all 35 countries in the Americas; PuertoRico is an Associate Member. France, the Kingdom of the Netherlands, and theUnited Kingdom of Great Britain and Northern Ireland are Participating States,and Portugal and Spain are Observer States.

The Organization's essential mission is to strengthen national and localhealth systems and improve the health of the peoples of the Americas, incollaboration with Ministries of Health, other government and internationalagencies, nongovernmental organizations, universities, social security agencies,community groups, and many others.

Activities

PAHO promotes primary health care strategies, which reach people intheir communities, to extend health services to all and to increase efficiency inthe use of scarce resources. It assists countries in fighting old diseases that

have re-emerged, such as cholera,dengue and tuberculosis, and new diseasessuch as the spreading AIDS epidemic, providing technical cooperationincluding education and social communications support, promoting work withnon-governmental organizations, and support for programs to preventtransmission of communicable diseases. The Organization is also involved inprevention of chronic diseases such as diabetes and cancer, which areincreasingly affecting the populations of developing countries in the Americasand in promoting the use of research evidence to inform health care decisionsthrough the implementation of knowledge translation strategies such as theEvidence Informed Policy Network - EVIPNet Evipnet. In September 2009 the49th Directing Council approved PAHO's Policy on Research for Health

CD49.10 becoming the first regional office of the World Health Organizationwith a policy to provide a strategic approach aimed at using research toimprove equity, health and development, and to strengthen national healthresearch systems.

In its efforts to improve health, PAHO targets the most vulnerable groupsincluding mothers and children, workers, the poor, the elderly, and refugeesand displaced persons. It focuses on issues related to equity for those who lackaccess to health, and on a Panamerican approach encouraging countries towork together on common issues and build lasting capacities.

PAHO and its Member Countries are committed to improving the safetyof blood in the Americas, launching a blood safety initiative designed to ensurethat all blood for transfusion is free of disease and to increase the number ofvolunteer blood donors.

Improvement of drinking water supplies, adequate sanitation, and increasedaccess to health care for the poor are still top priorities for PAHO, with a focuson equity. The Organization is intensifying its efforts to have countries know
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the true state of health of their populations and where the inequalities lie.Program efforts focus on correcting inequality, taking into accountdecentralization and change of state functions, on showing that health has arole to play in the success of other sectors, and on how attention to healthaffects positively other aspects of human development. Advocacy in this area is

also directed to reducing pernicious gender inequity, which reflects in somehealth problems of women.

Values, vision, mission

The Pan American Sanitary Bureau (PASB), the oldest internationalhealth agency in the world, is the Secretariat of the Pan American HealthOrganization (PAHO). The Bureau is committed to providing technical supportand leadership to PAHO Member States as they pursue their goal of Health forAll and the values therein. Toward that end, the following values, vision, andmission guide the Bureau's work.

Values

Equity: Striving for fairness and justice by eliminating differences that areunnecessary and avoidable.

Excellence: Achieving the highest quality in what we do.

Solidarity: Promoting shared interests and responsibilities and enablingcollective efforts to achieve common goals.

Respect: Embracing the dignity and diversity of individuals, groups andcountries.

Integrity: Assuring transparent, ethical, and accountable performance.

Vision

The Pan American Sanitary Bureau will be the major catalyst forensuring that all the peoples of the Americas enjoy optimal health andcontribute to the well being of their families and communities.

Mission

To lead strategic collaborative efforts among Member States and otherpartners to promote equity in health, to combat disease, and to improve thequality of, and lengthen, the lives of the peoples of the Americas.


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Directors of the Panamerican Sanitary Bureau

Dr. Walter Wyman (US) 1902-1911 Dr. Rupert Blue (US) 1912-1920 Dr. Hugh Cumming (US) 1920-1947 Dr. Fred Soper (US) 1947-1959 Dr. Abraham Horwitz (Chile) 1959-1975 Dr. Hector Acua (Mexico) 1975-1983 Dr. Carlyle Guerra de Macedo (Brazil) 1983-1995 Dr. George Alleyne (Barbados) 1995-2003 Dr. Mirta Roses Periago (Argentina) 2003-2013

World bank

The World Bank is an international financial institution that providesloans[2]to developing countries for capital programmes.

The World Bank's official goal is the reduction ofpoverty. By law all of itsdecisions must be guided by a commitment to promote foreign investment,international trade and facilitate capital investment.[3]

The World Bank differs from the World Bank Group, in that the WorldBank comprises only two institutions: the International Bank forReconstruction and Development (IBRD) and the International DevelopmentAssociation (IDA), whereas the latter incorporates these two in addition to threemore:[4] International Finance Corporation (IFC), Multilateral Investment

Guarantee Agency (MIGA), and International Centre for Settlement ofInvestment Disputes (ICSID).

History

The World Bank is one of five institutions created at the Bretton WoodsConference in 1944. The International Monetary Fund, a related institution, isthe second. Delegates from many countries attended the Bretton WoodsConference. The most powerful countries in attendance were the United Statesand United Kingdom, which dominated negotiations. Although both are basedin Washington, D.C., the World Bank is, by custom, headed by an American,

while the IMF is led by a European.

The President of the Bank, currently Robert B. Zoellick, is responsible forchairing the meetings of the Boards of Directors and for overall management ofthe Bank. Traditionally, the Bank President has always been a US citizennominated by the United States, the largest shareholder in the bank. Thenominee is subject to confirmation by the Board of Governors, to serve for afive-year, renewable term.
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The Executive Directors, representing the Bank's member countries,make up the Board of Directors, usually meeting twice a week to overseeactivities such as the approval of loans and guarantees, new policies, theadministrative budget, country assistance strategies and borrowing andfinancing decisions.

The Vice Presidents of the Bank are its principal managers, in charge ofregions, sectors, networks and functions. There are 24 Vice-Presidents, threeSenior Vice Presidents and two Executive Vice Presidents.

Activities

Poverty reduction strategies

For the poorest developing countries in the world, the bank's assistanceplans are based on poverty reduction strategies; by combining a cross-section

of local groups with an extensive analysis of the country's financial andeconomic situation the World Bank develops a strategy pertaining uniquely tothe country in question. The government then identifies the country's prioritiesand targets for the reduction of poverty, and the World Bank aligns its aidefforts correspondingly.

Forty-five countries pledged US$25.1 billion in "aid for the world'spoorest countries", aid that goes to the World Bank International DevelopmentAssociation (IDA) which distributes the loans to eighty poorer countries. Whilewealthier nations sometimes fund their own aid projects, including those fordiseases, and although IDA is the recipient of criticism, Robert B. Zoellick, the

president of the World Bank, said when the loans were announced onDecember 15, 2007, that IDA money "is the core funding that the poorestdeveloping countries rely on".

Clean Technology Fund management

The World Bank has been assigned temporary managementresponsibility of the Clean Technology Fund (CTF), focused on makingrenewable energy cost-competitive with coal-fired power as quickly as possible,but this may not continue after UN's Copenhagen climate change conference inDecember, 2009, because of the Bank's continued investment in coal-firedpower plants.

Clean Air Initiative

Clean Air Initiative (CAI) is a World Bank initiative to advance innovativeways to improve air quality in cities through partnerships in selected regions ofthe world by sharing knowledge and experiences. It includes electric vehicles.
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United Nations Development Business

Based on an agreement between the United Nations and the World Bankin 1981, Development Business became the official source for World BankProcurement Notices, Contract Awards, and Project Approvals. In 1998, the

agreement was re-negotiated, and included in this agreement was a jointventure to create an electronic version of the publication via the World WideWeb. Today, Development Business is the primary publication for all majormultilateral development banks, United Nations agencies, and several nationalgovernments, many of whom have made the publication of their tenders andcontracts in Development Business a mandatory requirement. Currently, thesubscription to "online version only" is not free, but costs US$ 550.

The World Bank or the World Bank Group is also a sitting observer in theUnited Nations Development Group.

BILATERAL ORGANIZATIONS

A bilateral organization is a single government agency that provides aid

to lesser developed countries which operates with in a single country . The USagency for international development (USAID) is the largest of these and

operates totally out of the united states. Japan, France, Canada, Germany,Sweden and Great Britan have similar organization. All bilateral organizationsare influenced by political and historical agendas that determine which

countries receive aid. Incentives for engaging in formal agreements may include

economic enhancements for the benefits of both countries, national defense ofone or both countries or the enhancement and protection of private

investments made by individuals in these nations.

NONGOVERMENTAL OR PRIVATE VOLUNTARY ORGANIZATIONS

Non governmental organization or private voluntary organization provide

almost 20% of all external aid to lesser developed countries. NGOs and PVOsare represented by many different kinds of religious and secular groups.

Religious organization which reflects several denominations and religious

interest, support many health care programmers including hospitals in ruraland urban areas, orphanages and leprosy treatment centers. For examplemaryknoll missionaries, sponsored by the Christian catholic church, catholic

relief services.
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Types of NGOs

NGO type can be understood by orientation and level of co-operation.

NGO type by orientation

Charitable orientation; Service orientation; Participatory Empowering orientation;

NGO type by level of co-operation

Community- Based Organization; City Wide Organization; National NGOs; International NGO

NURSING AND GLOBAL HEALTH

Nurse have an important leadership role in healthcare throughout theworld. In particular, nurses with community and public health experienceprovide much needed knowledge and skill in countries where nursing is not anorganized profession and they give guidance not only to nurses but also to theauxiliary personnel who are part of the primary health care team. In manysettings through out the world, nurses provide direct client care and facilitatethe educational and health promotional needs of the community. Nursing isoften viewed as one of the strongest advocates for primary health care throughits social commitment to equality of health care and support of the conceptsthat are contained in the Alma Ata Declaration.

In the past nursing was viewed as a trade and the acquisition of skillsand knowledge took place in the equivalent of a middle school or junior high. Insome countries physician to population ratio is higher than the nurses topopulation ratio. In these cases physician influence nursing practice and placeeconomic and political pressure on local, regional and national governments tocontrol services that nurses offer. Nurses have set up successful and costeffective clinics to deliver quality primary care and cost effective clinics todeliver quality primary care services, but they are constantly being threatenedby physicians who want to outset the nurses and replace them with physicianwho will increase the cost of services.


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GLOBAL HEALTH AND ECONOMICAL DEVELOPMENT

Global health is related to economic, industrial and technologicaldevelopment. Access to services and the removal of financial barriers alone donot account for use of health services. In fact, the introduction of health care

technology from developed countries to lesser developed countries has led toless than satisfactory results. Improvement in the overall health status of apopulation contributes to the economic growth of a country in several ways.

By a reduction in production loss that was caused by workers who areabsent from work because of illness.

By an increase in the use of natural resources that because of thepresence of diseases entities might have been in accessible.

By an increase in the number of childrens who can attend school andeventually participate in their countries economic growth.

However adequate health care coverage for individuals who live in lesserdeveloped countries is often lacking because of their governments mayreallocate their financial resources from internal health needs and education toinvest instead in the countries market economy or to develop technology or topay off the interest on their national debt.

When governments experience an economic crisis, house hold expenditureare adversely affected. Most often the provision of health services in lesserdeveloped countries depends on the importation of drugs, vaccines and otherhealth care products, which in turn depends on a network of foreign exchangethat is influenced by economical and political factors.

It is important that the nurses who work in international communities arenot only acknowledge the importance of technology and development but alsorecognize the political, economic and cultural implications.

FUNDAMENTAL ELEMENTS OF HEALTH CARE DELIVERYSYSTEM

The countries of the world present many different kinds of health caresystem but most consist of five fundamental elements

Usership or who can use the system Benefits or what kind of coverage a citizen might expect Providers who deliver health care Facilities or where the provision of health care takes place Power or who controls access and usability of the system


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HEALTH CARE DELIVERY SYSTEM N ABROAD COUNTRIES

HEALTH CARE DELIVERY SYSTEM IN UNITED STATES

Historical background

The US health care system has been experiencing constant changes since themid 1980s. Before that time the cost of health care was a function of whateverresources were needed by physicians and other other health care professionalsto diagnose and treat a client health care problem.

In the united states , total health expenditure grew from 41.9 billion to 25billion in 1985. This occurred in an environment where there were noincentives to control use of inappropriate diagnostic test or treatments. Whatever physician choose to order for a clients care and treatment, insures paid forit. This was the case even if treatments were not medically sound. Rising cost

were also due to an aging population. As a result both regulatory andcompetitive approaches have been used in an attempt to control health carespending and developed certificate of need(CON) aim to control the structure ofhealth care by limiting the development of hospital capacity.

Professional standards review organizations(PSROs) were created to review thequality, quantity and cost of hospital care provided through medicare. Theprospective payment system (PPS) established by congress in 1983, eliminatedthe cost based reimbursement. Hospital serving medicare clients were nolonger paid cost for services

Levels of health care

The health care industry is moving towards health care practices thatemphasis managing health rather than managing illness. The progress is slowbecause the delivery system has been illness oriented. With this newperspective health care system moving towards integrated deliverynetworks(IDNs).

The health care dlivery system provides six levels of care.it describes the scopeof services and settings where health care is offered to clients in all stages ofhealth and illness.

Preventive care and primary care services: primary care has been definedby the institute of medicine in 1994 as the provision of integrated accessiblehealth care services by clinician who are accountable for addressing largemajority of health services, developing a sustained partnership with clients,and practicing in the context of family and community. Health promotion is themajor theme for primary health care. It includes


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School health services Occupational health services Physicians office Clinics Nursing centers Block and parish nursing Volunteer agencies Primary health care in community

Secondary and tertiary care: diagnostic and treatment services are generallythe most commonly used services of the health care delivery system. With thearrival of managed care these services are being delivered in primary caresettings. It includes

Hospitals Intensive care Subacute cre Psychiatric facilities Rural hospitals

Restorative care: client recovering from acute or chronic illnesses or who havedisabilities usually require a continuing level of care that is needed until theyreturn to the previous level of function or reach a new level of function limitedby their disability.the goal is to assist the individual in regaining maximalfunctioning, enhancing the individuals quality of life while promoting clientindependence and self care. It includes

Home care settings

Wound care Respiratory care Vital signs Elimination Nutrition Rehabilitation Medications Intravenous therapy Laboratory studies

Rehabilitation centers

Physical therapy Occupational therapy Speech therapy


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Levels of care Description

Preventive care Education

Prevention

Primary care Early detection

Routine care

Secondary care Emergency treatment

Critical care

Tertiary care Special care (highly technical services

Restorative care Intermediate follow up care

(surgical postoperative , medical

Routine care)

Rehabilitation

Home care

Long term care/hospice care

Continuing care Chronic care

personal care

SPECTRUM OF HEALTH CARE SERVICE DELIVERY


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HEALTH CARE SYSTEM IN SINGAPORE

Historical back ground

The Singapore government spent only 1.3 percent of GDP on healthcare

in 2002, whereas the combined public and private expenditure on healthcareamounted to a low 4.3 percent of GDP. By contrast, the United States spent14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970...Yet, indicators such as infant mortality rates or years of average healthy life

expectancy are slightly more favorable in Singapore than in the United States...It is true that such indicators are also related to the overall living environment

and not only to healthcare spending. Nonetheless, international experts rankSingapore's healthcare system among the most successful in the world in

terms of cost-effectiveness and community health results.

Our healthcare system comprises public and private healthcare,complemented by rising standards of living, housing, education, medicalservices, safe water supply and sanitation, and preventive medicine.

Over the years, MOH has followed the principle of ensuring that good andaffordable basic medical services are available to all Singaporeans. We havebeen continuously fine-tuning our system to ensure we are always aligned withthis principle and developed our healthcare system into one that has receivedpraise and recognition both locally and internationally.

MOH would like to share some of the accolades received for our healthcaresystem.

PhilosophySingapore healthcare begins with building a healthy population through

preventive healthcare programmers and promoting a healthy lifestyle.

Good, affordable basic healthcare is available to Singaporeans throughsubsidized medical services at public hospitals and clinics. Our hospitals andhealthcare system will never withhold help to a Singaporean because offinancial limitations.
http://www.moh.gov.sg/mohcorp/hcsystem.aspx?id=22966http://www.moh.gov.sg/mohcorp/hcsystem.aspx?id=22966http://www.moh.gov.sg/mohcorp/hcsystem.aspx?id=22966http://www.moh.gov.sg/mohcorp/hcsystem.aspx?id=22966


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Health care services

Primary HealthcarePrimary health care includes preventive healthcare and health education.Private practitioners provide 80% of primary healthcare services while

government polyclinics provide the remaining 20%. However, public hospitalsprovide 80% of the more costly hospital care with the remaining 20% by privatehospital care.

Our island network of 18 outpatient polyclinics and some 2,000 privatemedical practitioner's clinics provides our primary health care services. Eachpolyclinic is an affordable subsidised one-stop health centre, providingoutpatient medical care, follow-up of patients discharged from hospitals,immunization, health screening and education, investigative facilities andpharmacy services. The needy elderly receive further help through the PrimaryCare Partnership Scheme (PCPS). PCPS is most helpful for those who cannot

travel to polyclinics. More..

Hospital CareOur 7 public hospitals comprise 5 general hospitals, a women's and children'shospital and a psychiatry hospital. The general hospitals provide inpatient andspecialist outpatient services, and a 24-hour emergency department. 75% ofpublic hospital beds are heavily subsidized. There are also 6 national specialtycenters for cancer, cardiac, eye, skin, neuroscience and dental care. More..

Intermediate and Long Term CareThere is a comprehensive range ofresidential and community-based healthcareservices that caters to the long-term care needs of Singaporeans. The servicesavailable include community hospitals, chronic sick hospitals, nursing homes,sheltered homes for the ex-mentally ill, inpatient hospice institutions, homemedical, home nursing and home hospice care services, day rehabilitationcenters, dementia day care centers, psychiatric day care centers andpsychiatric rehabilitation homes.

Through the Chronic Disease Management Programme (CDMP), patients workwith their doctors to manage their diseases. They regularly monitor their

conditions, seek early medical treatment and make the necessary lifestylechanges. Medisave may be used for the outpatient treatments of four chronicdiseases (diabetes, high blood pressure, lipid disorder and stroke), whichaffects about 1 million Singaporeans. MediShield provides a low costcatastrophic illness insurance scheme, designed to help members meet medicalexpenses from major or prolonged illnesses.
http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=314http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=314http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=392http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=394http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=396http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=408http://www.moh.gov.sg/mohcorp/programmes.aspx?id=204#CDMPhttp://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=304http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=306http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=306http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=304http://www.moh.gov.sg/mohcorp/programmes.aspx?id=204#CDMPhttp://www.moh.gov.sg/mohcorp/hcservices.aspx?id=408http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=396http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=394http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=392http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=314http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=314


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Integratedcare

With our partners and stakeholders, we seek to provide patients with holisticand integrated care. The Agency for Integrated Care (AIC) was set up to

smooth the transition of patients from one care setting to another. Eachregional healthcare cluster is anchored by a regional Hospital working with avariety of Primary, Intermediate and Long-Term care sector and supportservices to deliver patient-centric care. Our healthcare clusters - AlexandraHealth (managing Khoo Teck Puat Hospital in the north), National HealthcareGroup (managing Tan Tock Seng Hospital in the centralregion), National University Health System (managing National UniversityHospital), Jurong Health Services (managing the upcoming Jurong GeneralHospital in the west) and SingHealth (managing Changi General Hospital in theEast) - have also been set up to drive the movement towards integrated care.More

Dental

Dental care begins with preventive dentistry promoted through the HealthPromotion Board. The Board targets students through a network of 200 staticclinics located in the schools as well as 30 mobile dental clinics. This plusfluoridation of potable water and availability of fluoridated toothpaste hasgreatly diminished dental decay and tooth loss. Public dental services areavailable in some polyclinics and hospitals, and the National Dental Centre.

Health care financing

BudgetIn 2008, Singapore spent about S$ 10.2 billion or 3.9% of GDP on healthcare.Out of this the Government expended S$2.7 billion or 1.0% of GDP on healthservices. Singapore offers universal healthcare coverage to our citizens, with afinancing system anchored on the twin philosophies of individual responsibilityand affordable healthcare for all. Through a mixed financing system, use ofmarket-based mechanisms to promote competition and transparency and theadoption of technology to improve the delivery of healthcare services, we havesecured good healthcare outcomes for our population. We have done so with anational healthcare expenditure of below 4% of our GDP, which is low amongdeveloped countries (although this is expected to grow with an ageing

population).

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http://www.alexhosp.com.sg/index.phphttp://www.alexhosp.com.sg/index.phphttp://www.nhg.com.sg/http://www.nhg.com.sg/http://www.nuhs.edu.sg/http://www.juronghealth.com.sg/http://www.singhealth.com.sg/Pages/Home.aspxhttp://www.moh.gov.sg/mohcorp/hcfacilities.aspx?id=106http://www.hpb.gov.sg/http://www.hpb.gov.sg/http://www.hpb.gov.sg/http://www.hpb.gov.sg/http://www.moh.gov.sg/mohcorp/hcfacilities.aspx?id=106http://www.singhealth.com.sg/Pages/Home.aspxhttp://www.juronghealth.com.sg/http://www.nuhs.edu.sg/http://www.nhg.com.sg/http://www.nhg.com.sg/http://www.alexhosp.com.sg/index.phphttp://www.alexhosp.com.sg/index.php


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HEALTH CARE DELIVERY SYSTEM IN UNITED KINGDOM

Historical background

The discussion in this section traces some of the main developments in

the UKNational Health Service (NHS) over the last fifty years with particularemphasis on those features that remain relevant for understanding the natureof the service today. The National Health Service (NHS) came into operation in1948 following the provisions of the NHS Actof 1946. This Act was of crucialimportance in establishing the post-Second World War pattern of health servicefinance and provision in the United Kingdom. It introduced the principle ofcollective responsibility by the state for a comprehensive health service, whichwas to be available to the entire population free at the point of use. Freedomfrom user charges was a key feature of this approach which placed heavyemphasis on equality of access.

The political consensus for establishing the NHS was built during the war

and was in tune with other welfare state initiatives in areas such as socialsecurity, education and housing, which were being developed at this time.However not every group subscribed fully to this consensus. Most notably, themedical profession was initially opposed to some of the proposed features ofthe newly established NHS. The Royal Collegesthe professional bodies thatrepresent different medical specialties led by consultants (senior specialists)and general practitioners (GPs) were strongly opposed to any loss ofprofessional autonomy.

They wanted independence from bureaucratic interference and wereespecially concerned about proposals that would have placed the health serviceunder local government control. In the event, skilful negotiation by the

Minister of Health, Aneurin Bevan, obtained the support of the medicalprofession for the establishment of a central government-run NHS with anumber of concessions to demands for professional autonomy. Thus GPs wereallowed to operate as independent contractors within the NHS while hospitalspecialists, although salaried employees of the NHS, were allowed to retain alarge degree of control over their conditions of employment. They were alsopermitted to retain the right to private practice alongside their NHS work.These conditions of service remain largely unchanged today.

One of the assumptions behind the establishment of the NHS was that therewas a backlog or stock of ill health that would be made good by the newservice, after such time demand would level off or fall. In the event, of course,

this did not happen and demand in the 1950s outstripped the funding that wasmade available. One consequence of limited funding was extreme pressure onan under-resourced hospital service. Recognition of this problem led to the1962 Hospital Plan which proposed major new capital funding over the nextten years and introduced the concept of the district general hospital (DGH).The DGH represented a planned approach to hospital provision whereby a unitof between 600 and 800 beds would cater for all the general medical needs of


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a population of between 100 000 and 150 000. This pattern of hospitalprovision has persisted until the present day and is one reason why a numberof commentators said that the NHS internal market introduced by thereforms of 1991would be characterized by a series of local monopolies.

Health care servicesThe Department of Health sets the overall policies on all health issueswith the aim to improve the health and well-being of the people of England. Inrespect of the provision of health care services, the Department of Health isresponsible for formulating policies, setting national standards and allocatingresources for the NHS, through which the public can access various healthcare services.513.2.2 The NHS delivery system consists of several types ofstatutory organizations, in particular strategic health authorities and primarycare trusts. The whole of England is split into the territories of 10 strategichealth authorities, each serving 2.5 million to 7.4 million people. Eachauthority is governed by a board which consists of eight to 13 appointed

members.52 Strategic health authorities do not deliver health care services.Their main responsibility is to monitor the public health care services withintheir respective regions. In fulfilling the monitoring role, strategic healthauthorities ensure that primary care trusts follow policy directions set by thegovernment and monitor the performance of primary care trusts. In addition,strategic health authorities are responsible for developing strategic directionsto improve the public health care services in their respective regions.533.2.3 Atpresent, there are altogether 152 primary care trusts distributed among theterritories of the 10 strategic health authorities, serving populations of between90 000 and 1.2 million. Each primary care trust is governed by a board whichconsists of eight to 15 appointed members. Controlling around 80% of the NHS

budget, primary care trusts are responsible for planning and managing healthcare services in their localities, either by commissioning services from otherhealth care providers, e.g. hospital care from an NHS trust, or by providingthem directly.

Private healthcare

The private healthcare sector is much smaller than the NHS and doesnot have the same structures of accountability. It mirrors the NHS by providingGPs (many doctors in the NHS also have private practices), nursing homes,ambulances, hospitals and medical specialists, but it does not have to follow

national treatment guidelines and health plans and it does not haveresponsibility for the health of the wider local community.

Private health insurance: Membership of health insurance schemes,such as BUPA, accounts for a large proportion of private health treatment.Many employers offer membership of such schemes or people pay for itthemselves.


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Secondary care in the private sector: Secondary care, which refers tomore specialised health treatment such as hospitals, mental health provisionand care for the elderly, is well served by the private sector. While people maybe registered with an NHS GP, the private sector is often used for secondarycare such as:

Diagnostic tests for certain conditions, one-off specialist treatmentsuch as visiting a dermatologist, specific operations in a private hospital, non-essential treatment such as cosmetic surgery and treatment for addiction orrehabilitation

Private hospitals: There are over 300 private hospitals in the UK. Privatehospitals are provided by private hospital groups and the NHS also provides anumber of private patient units within its hospitals. Private hospitals arelicensed by the local healthcare authority, which conducts two inspections ayear. They are not regulated by the national inspection bodies that monitor

NHS organisations.

The regulation and inspection of healthcare

A number of bodies check that people are getting good healthcareservices. These special healthcare authorities mainly regulate and inspectimportant aspects of healthcare, such as clinical guidelines on medicalconditions and patient safety.

Providing guidance on medical treatment

The National Institute for Clinical Excellence (NICE) publishes guidelinesand advice for the public and for healthcare professionals in England andWales. These cover specific diseases, drugs, medical devices and technologiesand the management or treatment of certain conditions. The NHS is expectedto take these guidelines into account. Private hospitals do not have to followthem, although they take them into account as best practice guides.

Monitoring healthcare standards

The Healthcare Commission is responsible for monitoring healthcare

standards and efficiency. It is also responsible for publishing the NHSperformance ratings and indicators. These ratings (popularly known as starratings) affect how much independence trusts have and their ability to becomea foundation trust. NHS organizations in England are allocated between zeroand three stars based on their performance in areas such as:

Waiting times and waiting lists The number of operations cancelled


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Hospital cleanliness Death rates Financial position Emergency re-admission rates

Monitoring social care standards

The Commission for Social Care Inspection is the body responsible forinspecting and regulating social care services and works in parallel with theHealthcare Commission. Its commissioners are appointed by an independentprocess and its role includes:

Carrying out inspections of all social care organisations, public, privateand voluntary, carrying out inspections of local social service authorities,reporting to Parliament on the performance of social services and publishing

the star ratings for social services authorities.

Monitoring patient safety

The National Patient Safety Agency was set up to improve standards ofsafety throughout the NHS by learning from adverse incidents involving patientcare and safety. It encourages staff to report incidents and, by analysingreports, hopes to develop preventative measures in hospitals in England andWalesBasic financing management

The health care financing system of England is a tax-based financingsystem in that health care is predominantly funded by general go

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