Download - HIV/TB Stakeholder Meeting

WHO Regional Office for Europe

HIV/TB Stakeholder Meeting

Dr Hans KlugeDirector

Health Systems and Public HealthSpecial Representative of the

Regional Director on MXDR-TB

Kiev, Ukraine06 May 2014


Removal of health system bottlenecks

Removal of health system bottlenecks

Core services

Core services

Population levelIndividual level




Expected results

Expected results

Maternal and child health outcomes

Cardiovascular health outcomes

Tuberculosis

Others

From policy to action: HSS operational approach


Health systems in times of global economic crisis: an update, 17-18 April, Oslo, Norway

Aligned health workforce

Aligned health workforce

Financial Protection


Policy responses to economic crisis in the EU


All people have access to needed health services (incl. prevention) of good quality

Derived from World Health Report 2010, p.6 & World Health Assembly Resolution 58.33, 2005

What is Universal Health Coverage?

The use of services does not expose any user (or family members) to undue financial hardship


Ten leading sources of inefficiencyRef: World Health Report 2010, Chapter 4

Medicines: under-use of generics and higher than necessary prices

Medicines: use of sub-standard and counterfeit medicines

Medicines: in appropriate and ineffective use

Services: inappropriate hospital size (low use of infrastructure)

Services: medical errors and sub-optimal quality of care

Services: inappropriate hospital admissions and length of stay

Services & products: oversupply and overuse of equipment, investigations and procedures

Health workers: inappropriate or costly staff mix, unmotivated workers

Interventions: inefficient mix / inappropriate level of strategies

Leakages: waste, corruption, fraud

Continual focus on improving efficiency


Response to the crisis in Latvia

• Major cuts with concurrent structural reforms to health system

– priority given to primary health care, coverage of essential medicines and outpatient specialist services

– reduced hospital capacity and increased day care capacity

– pharmaceutical reimbursement budget cut less than in-patient care budget

• Significant price reductions of pharmaceuticals

– based on cost effectiveness evaluations and international comparisons

– enabled treatment for an increasing number of patients for the same amount of money

– WB funded Social Safety Net subsidy

– provides 100% reimbursement of medicinal products for the poor


Major restructuring in Latvia: 35% reduction of expenditure on hospital in-patient care in two years

2010: 21 emergency care hospital, , 6 care hospitals, 12 specialized hospitals

Number of patients in Day Care Number of Home Care visits

Data source: The Centre of Health Economics data review, Latvia


Shifting from hospital to ambulatory care of TB in the Republic of Moldova

Facilitating factors

1. Higher costs of hospital care

2. Significant risks of re-infection and nosocomial transmission of MDR TB

3. Socio-economic impact related to patients’ long absence from the household

Main obstacles

1. Resistance of medical personnel due to overburden and lack of proper incentives

2. Lack of experience of personnel working at PHC care level in monitoring TB treatment

3. Challenges in ensuring adequate nutrition and additional support in case of adverse effects

Key success factors

1. Introducing bonuses for PHC personnel

2. Ensuring adequate nutritional and other support

3. Important role of NGOs and Community TB centres

4. Rapid diagnostic tools in place


35th Anniversary of Alma-Ata Declaration on PHC,6-7 November 2013


People-centeredness as a cornerstone of sustainable health systems

Services Settings • Health Protection

• Health Promotion

• Disease Prevention

• Diagnosis

• Treatment

• Long-term care

• Rehabilitation

• Palliative care

• Public health

• Primary care

• Secondary care

• Specialist care

• Community, home & social care

• Pharmacies

The management and delivery of health services such that people receive a continuum of services through the different levels and sites of care within the health system, and according to their needs.

“When they change my physician that means that something is going wrong. The first thing I thought was that I wasn’t doing so well

anymore”

“I have a disease that is called COPD (…) no one told me, I found out over time by myself, reading the package inserts of the drugs they

prescribe me.”

“We feel like there are people who really care about us here” [Patient receiving integrated HIV/injection drug services, Ukraine]


Sustainable Human Resources for Health

BMJ, 314, 24May1997

Nurses/ Midwives


120 000 lives and US$ 12 billion saved by implementing the Consolidated Action Plan

The goal is to contain the spread of drug-resistant TB by:

•decreasing M/XDR-TB cases among previously treated cases by 20 percentage points;

•detecting 85% (or 225 000) M/XDR-TB patients;

•successfully treating at least 75% (127 000) of them.


HOW DOES IT FEEL TO TRANSFORM?


(HLC HIA Dec 2013)

• Harvard change mgt steps


Eight Steps to Transforming Your Organization

Institutionalizing New ApproachesArticulating the connections between the new behaviors and corporate successDeveloping the means to ensure leadership development and succession

Forming A Powerful Guiding CoalitionAssembling a group with enough power to lead the change effortEncouraging the group to work together as a team

Creating a VisionCreating a vision to help direct the change effortDeveloping strategies for achieving that vision

Communicating that VisionUsing every vehicle possible to communicate the new vision and strategiesTeaching new behaviors by the example of the guiding coalition

Empowering Other to Act on the VisionGetting rid of obstacles to changeChanging systems or structures that seriously undermine the visionEncouraging risk taking and nontraditional ideas, activities, and actions

Planning for and Creating Short Term WinsPlanning for visible performance improvementsCreating those improvementsRecognizing and rewarding employees involved in the improvement

Consolidating Improvement and Producing Still More ChangeUsing increased credibility to change systems, structures, and policies that don’t fit that visionHiring, promoting , and developing employees who can implement the visionReinvigorating the process with new changes, themes, and change agents

Establishing a Sense of UrgencyExamining market and competitive realitiesIdentifying and discussing crises, potential crises, or major opportunities 1

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http://www.euro.who.int/en/what-we-do/health-topics/Health-systems

THANK YOU