What is tropical healthcare?
1. Healthcare or medicine of the tropics
All healthcare provided within the tropical region → geographical area
2. The medical branch that treats tropical diseases (infectious diseases)
Only tropical diseases that occur in the tropics → Transmission (and vector) & certain conditions
Vicious cycle: poverty poor infrastructure poor sanitation/overcrowding infection malnutrition impaired immunity/disease
History of tropical medicine
Why is tropical healthcare so important?
• Great global burden • Important effect on a community
• Personal distress ‘Psychosocial effects of an Ebola outbreak at individual, community and international levels’ by Van Bortel, et al.
• Tourist versus immigrant ! Role of climate change
Diseases in the tropics
Determinants of health
A. Individual determinants: age, sex ,behaviour, inherited conditions
B. Environmental: water quality, air pollution, working conditions, climate
C. Socio-economic: culture, social support, housing, educational level, job, healthcare
systems, government policy
Noncommunicable versus communicable diseases
Noncommunicable disease = non-infectious diseases : cancer, diabetes, cardiovascular dis, chr
respiratory dis unhealthy eating, tobacco use, physical inactivity, excess alcohol
Lifestyle factors
Often preventable
On the rise in the tropics!
Communicable diseases = infectious diseases
From one person to another
Favourable environment
Cf. Epidemiologic triad
Vector = organism that can transmit infectious diseases form one person to another or from animals to humans
Agent = pathogens (disease causing organisms)
Important characteristics of each one of the elements in the epidemiologic triad:
• Host: age, sex, immunity, nutritional status, pregnancy, immunosuppression,...
• Agent: virulence, host specificity, strain variability, ...
• Environment: living conditions, sanitation, food security, healthcare system,...
• Vector: behaviour, survival, incubation time, ...
→ ! Most tropical diseases = VECTOR-BORNE diseases
So... why is tropical healthcare important? Global impact of tropical disease: Morbidity,
Mortality, Money spent, Productivity lost, Level of disability
The economic, social, political, cultural, behavioural impact of tropical/infectious diseases
is so big that action needs to be taken!
HEALTHCARE SYSTEMS = how health services are organised to deliver healthcare to the public→ combination of institutions & resources
Purpose? To improve health Preventive, Promotive, Curative, Rehabilitative interventions and efforts
~Determinants of health: Responsive, financially fair, respectably, equity
Focus of a responsive health system
Improving the health status of individuals, families and communities Defending the population against what threatens its health
Protecting people against the financial consequences of ill-health Providing equitable access to people-centered care
,WHO building blocks = characteristics of a responsive health system
1. Service delivery = Organisation and content of health services, provision of medical care and supplies to patients, characteristics:
comprehensiveness, accessibility, coverage, continuity, quality, person-centredness, coordination, accountability and efficiency
2. Health workforce = velen migreren v Aruba nr NL omdat het beter betaald w wat een tekort oplevert in hun land
3. Health information systems: data generation, compilation, analysis and synthesis, communication and use identify problems and needs
4. Access to essential medicines: challenging due to inadequate infrastructure, limited resources, poor supply chain management
5. Financing Health financing policies! For improved quality of care; Example: Nyakibale (Uganda)
6. Leadership/governance • State • Health service providers • Citizen
Equity versus equality
Demand versus supply versus need
Health? What’s in a name? Perception! Lack of health → suffering demand
To different perceptions correspond different needs and different answers
Interaction between concepts
Accessibility: different dimensions timely use of personal health services to achieve the best health outcomes
Utilisation of healthcare systems is influenced by the 5 A’s: (Geographical) accessibility, Affordability, Acceptability, Availabilty, Accommodation
Services are both accessible and acceptable when the interaction between both population and health services is an optimal one:
How to increase access to healthcare?
1. Decentralization of services bv kleinere medische posten opstellen
Lack of resources Decentralization requires adequate resources to be effective.
Lack of capacity: Decentralization requires skilled personnel and adequate infrastructure to be effective.
Political interference: Decentralization can be influenced by political factors such as corruption, nepotism, and favoritism.
Inadequate coordination: Decentraliz can lead to fragmentation of health servic if there is inadequate coordination between different levels of
the health system.
, Inadequate monitoring and evaluation: Decentraliz requires adequate monitoring and evaluation mechanisms to ensure that it is effective.
2. Community channels/initiatives: bv menstruatiearmoede ze krijgen een achterstand op school omdat ze tijdens de periode van hun
menstruatie thuis blijven, deze momenten helpen ze thuis op het veld
3. Horizontal integration of vertical programs
Vertical approach: Top-down, curative care model, health problem organises services implement methods to solve it
Horiz: Bottom-up, focus on prevention and facilitating community’s response to their own health problems
4. Implement financial systems enabling affordability
Bismarck model provider = private payer = private
• Uses an insurance system
• Healthcare providers (doctors/hospitals) are often private
Beveridge model provider = mostly govt payer = government
• Fully government controlled heathcare system
• Funded by the government through taks payments
• Many hospitals are owned by the government
National Health Insurance provider = private payer = government
• Uses elements of both Beveridge and Bismarck model
• Providers are private
• Payment comes from government-run insurance program (citizens pay)
• Can control costs by limiting the medical services they will pay for or making patientswait to be treated
Out-of-pocket provider = private (in cities) payer = patient
• Payment made by a patient directly to a provider (out of pocket)
• Only the rich get medical care, the poor stay sick or die
• No insurance or government plan
Healthcare systems in the tropics: a transcontinental view
Remember
• Healthcare system models are based on available health financing mechanisms
• Do not forget that the majority of countries in the tropics are low income countries
South America Different countries in South America have different healthcare systems
Africa Majority of countries in tropical Africa: healthcare = public good → offer free healthcare services
Countries like Rwanda are aggressively undertaking programs to introduce national health insurance
A WHO study by the African region experts found that the majority of health services are paid by the government
The Middle east and Asia Pacific
Basic concept of a local health system
→ 2 types of operational entities
1. First line health service (FLHS) Entry point into health system Point of interaction between community and health service
2. Referral level (hospital) To ensure continuity of curative care, pt who require techn not available at the first level
Access to healthcare in the tropics
1. Healthcare or medicine of the tropics
All healthcare provided within the tropical region → geographical area
2. The medical branch that treats tropical diseases (infectious diseases)
Only tropical diseases that occur in the tropics → Transmission (and vector) & certain conditions
Vicious cycle: poverty poor infrastructure poor sanitation/overcrowding infection malnutrition impaired immunity/disease
History of tropical medicine
Why is tropical healthcare so important?
• Great global burden • Important effect on a community
• Personal distress ‘Psychosocial effects of an Ebola outbreak at individual, community and international levels’ by Van Bortel, et al.
• Tourist versus immigrant ! Role of climate change
Diseases in the tropics
Determinants of health
A. Individual determinants: age, sex ,behaviour, inherited conditions
B. Environmental: water quality, air pollution, working conditions, climate
C. Socio-economic: culture, social support, housing, educational level, job, healthcare
systems, government policy
Noncommunicable versus communicable diseases
Noncommunicable disease = non-infectious diseases : cancer, diabetes, cardiovascular dis, chr
respiratory dis unhealthy eating, tobacco use, physical inactivity, excess alcohol
Lifestyle factors
Often preventable
On the rise in the tropics!
Communicable diseases = infectious diseases
From one person to another
Favourable environment
Cf. Epidemiologic triad
Vector = organism that can transmit infectious diseases form one person to another or from animals to humans
Agent = pathogens (disease causing organisms)
Important characteristics of each one of the elements in the epidemiologic triad:
• Host: age, sex, immunity, nutritional status, pregnancy, immunosuppression,...
• Agent: virulence, host specificity, strain variability, ...
• Environment: living conditions, sanitation, food security, healthcare system,...
• Vector: behaviour, survival, incubation time, ...
→ ! Most tropical diseases = VECTOR-BORNE diseases
So... why is tropical healthcare important? Global impact of tropical disease: Morbidity,
Mortality, Money spent, Productivity lost, Level of disability
The economic, social, political, cultural, behavioural impact of tropical/infectious diseases
is so big that action needs to be taken!
HEALTHCARE SYSTEMS = how health services are organised to deliver healthcare to the public→ combination of institutions & resources
Purpose? To improve health Preventive, Promotive, Curative, Rehabilitative interventions and efforts
~Determinants of health: Responsive, financially fair, respectably, equity
Focus of a responsive health system
Improving the health status of individuals, families and communities Defending the population against what threatens its health
Protecting people against the financial consequences of ill-health Providing equitable access to people-centered care
,WHO building blocks = characteristics of a responsive health system
1. Service delivery = Organisation and content of health services, provision of medical care and supplies to patients, characteristics:
comprehensiveness, accessibility, coverage, continuity, quality, person-centredness, coordination, accountability and efficiency
2. Health workforce = velen migreren v Aruba nr NL omdat het beter betaald w wat een tekort oplevert in hun land
3. Health information systems: data generation, compilation, analysis and synthesis, communication and use identify problems and needs
4. Access to essential medicines: challenging due to inadequate infrastructure, limited resources, poor supply chain management
5. Financing Health financing policies! For improved quality of care; Example: Nyakibale (Uganda)
6. Leadership/governance • State • Health service providers • Citizen
Equity versus equality
Demand versus supply versus need
Health? What’s in a name? Perception! Lack of health → suffering demand
To different perceptions correspond different needs and different answers
Interaction between concepts
Accessibility: different dimensions timely use of personal health services to achieve the best health outcomes
Utilisation of healthcare systems is influenced by the 5 A’s: (Geographical) accessibility, Affordability, Acceptability, Availabilty, Accommodation
Services are both accessible and acceptable when the interaction between both population and health services is an optimal one:
How to increase access to healthcare?
1. Decentralization of services bv kleinere medische posten opstellen
Lack of resources Decentralization requires adequate resources to be effective.
Lack of capacity: Decentralization requires skilled personnel and adequate infrastructure to be effective.
Political interference: Decentralization can be influenced by political factors such as corruption, nepotism, and favoritism.
Inadequate coordination: Decentraliz can lead to fragmentation of health servic if there is inadequate coordination between different levels of
the health system.
, Inadequate monitoring and evaluation: Decentraliz requires adequate monitoring and evaluation mechanisms to ensure that it is effective.
2. Community channels/initiatives: bv menstruatiearmoede ze krijgen een achterstand op school omdat ze tijdens de periode van hun
menstruatie thuis blijven, deze momenten helpen ze thuis op het veld
3. Horizontal integration of vertical programs
Vertical approach: Top-down, curative care model, health problem organises services implement methods to solve it
Horiz: Bottom-up, focus on prevention and facilitating community’s response to their own health problems
4. Implement financial systems enabling affordability
Bismarck model provider = private payer = private
• Uses an insurance system
• Healthcare providers (doctors/hospitals) are often private
Beveridge model provider = mostly govt payer = government
• Fully government controlled heathcare system
• Funded by the government through taks payments
• Many hospitals are owned by the government
National Health Insurance provider = private payer = government
• Uses elements of both Beveridge and Bismarck model
• Providers are private
• Payment comes from government-run insurance program (citizens pay)
• Can control costs by limiting the medical services they will pay for or making patientswait to be treated
Out-of-pocket provider = private (in cities) payer = patient
• Payment made by a patient directly to a provider (out of pocket)
• Only the rich get medical care, the poor stay sick or die
• No insurance or government plan
Healthcare systems in the tropics: a transcontinental view
Remember
• Healthcare system models are based on available health financing mechanisms
• Do not forget that the majority of countries in the tropics are low income countries
South America Different countries in South America have different healthcare systems
Africa Majority of countries in tropical Africa: healthcare = public good → offer free healthcare services
Countries like Rwanda are aggressively undertaking programs to introduce national health insurance
A WHO study by the African region experts found that the majority of health services are paid by the government
The Middle east and Asia Pacific
Basic concept of a local health system
→ 2 types of operational entities
1. First line health service (FLHS) Entry point into health system Point of interaction between community and health service
2. Referral level (hospital) To ensure continuity of curative care, pt who require techn not available at the first level
Access to healthcare in the tropics
