Study Notes

1. What is a Health System?

A health system is an organized framework that delivers preventive, curative, and
rehabilitative health services. It includes institutions, people, policies, and resources
working collaboratively to improve population health and ensure equitable access to care.
2. Describe Guyana’s Health System
Guyana’s health system comprises public and private sectors and regional health
authorities. The Ministry of Health manages public healthcare, offering free or subsidized
services. Private hospitals and clinics mainly serve urban areas, while regional health
authorities deliver decentralized care in rural and hinterland regions.
3. Levels of Guyana’s Healthcare
o Primary Level: Health posts and centers focus on prevention and basic care.
o Secondary Level: District/regional hospitals offer general and specialized care.
o Tertiary Level: National hospitals like Georgetown Public Hospital provide
advanced and specialized services.
4. Personnel Working and In Charge at Each Level
o Primary Level: Community health workers (CHWs), nurses, midwives; overseen
by health center managers.
o Secondary Level: General practitioners, lab technicians, radiologists; directed by
hospital administrators.
o Tertiary Level: Specialists, surgeons, and consultants; led by senior medical
officers or hospital directors.
5. Difference between Primary Care and Primary Health Care
o Primary Care: Individual-focused, treating immediate health concerns.
o Primary Health Care: Community-focused, emphasizing prevention, education,
and health promotion for overall well-being.
6. Health Models: HBM and HIC
o HBM (Health Belief Model): Explains health behavior based on perceived
susceptibility, severity, benefits, barriers, and cues to action.
o HIC (Health Insurance Coverage): Focuses on financial mechanisms to
improve access to healthcare through insurance.
7. In Depth on HBM
HBM emphasizes how beliefs about health risks and benefits influence behavior. For
example, a person is more likely to adopt preventive behaviors (e.g., vaccination) if they
perceive high susceptibility and severity, coupled with low barriers and strong cues to
action.
8. Determine Potentially Efficacious Statements
To determine efficacy, assess if the statement is realistic, evidence-based, and feasible.
For example, "Providing clean water reduces diarrhea in rural communities" is potentially
efficacious due to strong supporting evidence.
9. What is Health?
Health is a state of complete physical, mental, and social well-being, not merely the
absence of disease, as defined by the WHO.
10. Aspects of Well-being
o Physical: Fitness, absence of illness, good nutrition.
 o Social: Positive relationships, community participation.
o Mental: Emotional stability, stress management.
11. Types of Healthcare Systems
o Beveridge Model: Government-funded and provided (e.g., UK).
o Bismarck Model: Employer and employee-funded insurance (e.g., Germany).
o National Health Insurance Model: Government-managed insurance (e.g.,
Canada).
o Out-of-Pocket Model: Direct payments for care (common in developing
countries).
12. Health Financing Models
o Tax-Based: Government uses taxes to fund healthcare.
o Insurance-Based: Pooled resources from public or private insurance.
o Donor-Funded: External aid, often in low-income countries.
o Out-of-Pocket: Patients pay directly for services.
13. Principles and Components of PHC
o Principles: are the values that guide the delivery of PHC (the "why"). Equity,
universal access, community participation, intersectoral collaboration.
o Components: are the actionable services or interventions delivered through PHC
(the "what"). Health education, immunization, maternal care, sanitation, nutrition.
14. Shortcomings of PHC
o Inverse Relationship: This occurs when resources and healthcare services are
disproportionately allocated, favoring populations that are already well-off or in
less need. For example, urban areas with better access to facilities often receive
more resources, while rural and underserved regions struggle with shortages. This
imbalance leads to inequality in healthcare access, undermining the principle of
equity that PHC aims to uphold.
o Other issues include funding gaps, workforce shortages, and lack of
infrastructure.
15. Health Situations in Guyana
Guyana faces a dual burden of communicable and non-communicable diseases, posing
significant public health challenges. Malaria remains prevalent in interior regions due to
poor living conditions and limited access to healthcare, while HIV/AIDS continues to
affect vulnerable populations, hindered by stigma and gaps in service coverage. Non-
communicable diseases like diabetes and hypertension are rising, driven by poor diets,
sedentary lifestyles, and urbanization, contributing to a growing healthcare burden.
Maternal and child health also remains critical, with maternal mortality linked to
inadequate prenatal care and limited emergency services in rural areas, while children
face challenges such as malnutrition and respiratory infections. Mental health is another
pressing issue, with high suicide rates exacerbated by poverty, substance abuse, and
limited mental health services. Additionally, environmental and occupational health risks,
including mercury exposure and inadequate sanitation, affect rural and mining
communities. Geographic disparities, funding gaps, and reliance on donor aid further
strain the healthcare system, highlighting the urgent need for strengthened infrastructure,
targeted policies, and equitable access to healthcare across all regions.
 16. Considerations when Conducting Outreach
Health Information Systems
Accurate and reliable health data is essential for planning and evaluating outreach programs.
This involves collecting, analyzing, and using data on disease prevalence, healthcare access, and
population demographics to tailor interventions. A robust health information system helps
identify priority areas, track program outcomes, and make data-driven decisions for improving
services. In regions with limited resources, ensuring timely reporting and addressing gaps in
technology and training are critical for success.

Politics and Policies

Outreach efforts must align with national health policies and benefit from supportive political
frameworks. Advocacy and collaboration with local governments and stakeholders can help
secure the necessary approvals and resources. Policies should promote equity, enabling services
to reach marginalized and underserved populations. Political will is particularly important for
addressing systemic challenges, such as infrastructure gaps and workforce shortages, which
impact the delivery of outreach services.

Finance, Ethical, and Moral Principles

Adequate funding is crucial for the success of outreach programs. This includes resources for
transportation, personnel, medical supplies, and community education. Financial sustainability
can be achieved through government funding, partnerships with non-governmental
organizations, and donor support. Ethical and moral principles must guide outreach efforts,
ensuring respect for individuals’ autonomy, cultural beliefs, and privacy. Prioritizing fairness and
justice in resource allocation helps build trust and fosters community engagement.

Health Indicators
Outreach programs should focus on improving key health indicators, such as infant and maternal
mortality rates, disease prevalence, immunization coverage, and access to clean water and
sanitation. Monitoring these indicators allows for the assessment of program impact and
highlights areas that need further intervention. By targeting health outcomes that align with
community needs, outreach efforts can effectively address both immediate and long-term health
challenges.

17. System Theory

System theory is a conceptual framework used to understand and analyze complex systems by
viewing them as interconnected and interdependent components working together to achieve a
common goal. It emphasizes the relationships and interactions between the parts of a system
rather than focusing on the individual components in isolation.
 18. System Thinking

System thinking is a problem-solving approach that focuses on understanding how various parts
of a system interact and influence each other. It emphasizes looking at the whole system rather
than focusing on isolated issues, recognizing that changes in one part of the system can have
ripple effects throughout the entire system.

1. Elements
o The individual parts or components that make up the system.
o Examples in Healthcare: Patients, healthcare providers, facilities, equipment,
and policies.
o Role: These are the building blocks of the system, without which it cannot
function.

2. Interconnections
o The relationships, interactions, and linkages between the elements.
o Examples in Healthcare: Communication between doctors and patients,
coordination between departments, or collaboration between hospitals and public
health agencies.
o Role: Interconnections define how the elements work together to achieve the
system’s goals. Disruptions in these linkages can hinder the system's
effectiveness.

3. Purpose
o The overarching goal or objective of the system, which drives its design and
operation.
o Examples in Healthcare: Improving health outcomes, reducing disease burden,
or ensuring equitable access to care.
o Role: The purpose aligns the system’s activities and determines whether its
elements and interconnections are functioning effective
 19. Input, Process, Output
o Input: Resources like staff, equipment, and funding.
o Process: Activities such as service delivery.
o Output: Immediate results (e.g., treatments provided).
o Outcome: Long-term impacts (e.g., improved population health).
20. Non-Maleficence

Non-maleficence is a fundamental ethical principle in healthcare that means "do no harm." It

emphasizes the obligation of healthcare providers to avoid actions or interventions that could
cause unnecessary harm, injury, or suffering to patients. This principle requires careful
consideration of risks and benefits, ensuring that any potential harm is minimized and
outweighed by the benefits of a treatment or intervention.

21. Beneficence

is an ethical principle in healthcare that means promoting the well-being and best interests of
patients. It requires healthcare providers to take actions that benefit the patient, contribute to their
health and welfare, and prevent or remove harm. Beneficence goes beyond avoiding harm (as in
non-maleficence) by actively seeking to do good and improve patient outcomes.

22. Justice

in healthcare refers to the ethical principle of fairness and equality in the distribution of
resources, treatment, and opportunities. It requires healthcare providers and systems to ensure
that all individuals receive fair and equitable access to care, regardless of factors such as
race, gender, socioeconomic status, or geographic location. Justice also involves prioritizing
care for those in greatest need and making decisions that balance individual and societal
health concerns.

23. Autonomy refers to an individual’s right to make their own decisions about their health
and medical care, free from coercion or undue influence. It emphasizes respecting
patients' values, beliefs, and preferences, even when their choices differ from what the
healthcare provider might recommend.

What is a Health Indicator?

A health indicator is a measurable variable or statistic that reflects the health status of a
population or the performance of a healthcare system. Health indicators are used to assess,
monitor, and evaluate health outcomes, identify health priorities, and guide decision-making in
public health and policy development.

Categories of Health Indicators

1. Morbidity Indicators
o Measure the prevalence and incidence of diseases (e.g., diabetes, malaria, or
tuberculosis).
o Example: The rate of new HIV infections per 1,000 population.

2. Mortality Indicators
o Reflect death rates and causes of death in a population.
o Example: Infant mortality rate, maternal mortality ratio, life expectancy.

3. Nutritional Indicators
o Assess the nutritional status of individuals or groups.
o Example: Percentage of children under five with stunted growth.

4. Health Service Indicators

o Evaluate the availability, quality, and accessibility of healthcare services.
o Example: Immunization coverage, doctor-to-patient ratio, or hospital bed
occupancy rates.

5. Behavioral and Lifestyle Indicators

o Track health-related behaviors that influence outcomes.
o Example: Smoking prevalence, physical activity levels, or dietary habits.

6. Environmental Indicators
o Examine the impact of environmental factors on health.
o Example: Access to clean drinking water, air quality index, or sanitation
coverage.

7. Socioeconomic Indicators
o Highlight the relationship between socioeconomic conditions and health.
o Example: Literacy rates, income levels, and employment rates.

Importance of Health Indicators

 Monitoring Health Trends: Helps identify patterns in disease prevalence or

improvements in life expectancy over time.
 Policy Development: Guides governments in designing targeted health interventions and
allocating resources.
 Program Evaluation: Measures the effectiveness of health initiatives or interventions.
 Addressing Disparities: Highlights inequities in health outcomes or access to care
among different populations.
True and false
System theory is a set of theoretical concepts used to describe a system. TRUE
Inputs refer to resources used and outputs refer to a change in status. FALSE
Entropy is a scientific term for a disarrangement of resources. TRUE
The functions of action are goal, attainment, integration, adoption and pattern maintenance.
TRUE
There is one standard definition of systems thinking. FALSE
The term systems thinking originated from Mr. Barry Richmond. TRUE
When applying a systems test, the most important component is the way elements or characters
relate to each other. FALSE