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HEALTH SYSTEM & HEALTH SERVICES IN EGYPT

Health policy is a national task based on meeting community needs and respecting social, geographical and cultural variations. Ministry of health and population (MOHP) is the formal organization responsible for health policy formulation. The Egyptian health care system faces multiple challenges in improving and ensuring the health and wellbeing of the Egyptian people. The system faces not only the burden of combating illnesses associated with poverty and lack of education, but it must also respond to emerging diseases and illnesses associated with modern, urban lifestyle. Emerging access to global communications and commerce is raising the expectations of the population for more and better care and for advanced health care technology.

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HEALTH SYSTEM & HEALTH SERVICES IN EGYPT

  1. 1. HEALTH SYSTEM & HEALTH SERVICES IN EGYPT
  2. 2. LEARNING OBJECTIVES: 1) Identify the types of health systems in Egypt 2) Define organizational structure of MOHP 3) Describe the concept of health sector reform.
  3. 3. HEALTH POLICY National task based on: Respecting variations Social Geographical Cultural Meeting community needs
  4. 4. MINISTRY OF HEALTH & POPULATION “MOPH” Formal organization responsible for health policy formulation
  5. 5. ‫الوزارة‬ ‫تاريخ‬ ‫يناير‬ ‫فى‬ ‫انشئت‬1936‫الملك‬ ‫أيام‬ ‫أواخر‬ ‫فى‬‫األول‬ ‫فؤاد‬ ‫أحمد‬‫كان‬ ‫الذى‬ ‫ه‬ ‫من‬ ‫أفاق‬ ‫وعندما‬ ‫المصرى‬ ‫الخاص‬ ‫طبيبه‬ ‫وعالجه‬ ‫سكر‬ ‫غيبوبة‬ ‫لديه‬‫ذه‬ ‫وزير‬ ‫يا‬ ‫أشكرك‬ ‫للطبيب‬ ‫قال‬ ‫الغيبوبه‬. ‫بأنشاء‬ ‫ملكى‬ ‫مرسوم‬ ‫صدر‬ ‫العبارة‬ ‫هذه‬ ‫على‬ ‫وبناء‬‫العمو‬ ‫الصحة‬ ‫وزارة‬‫مية‬ ‫يناير‬ ‫فى‬1936‫مثل‬ ‫العمومية‬ ‫المصالح‬ ‫من‬ ‫مجموعة‬ ‫اساس‬ ‫على‬ ‫نشأت‬: ‫العامة‬ ‫المستشفيات‬ ‫مصلحة‬ ‫القروية‬ ‫الصحة‬ ‫مصلحة‬ ‫الحميات‬ ‫مصلحة‬
  6. 6. ‫د‬/‫زايد‬ ‫السيد‬ ‫مصطفى‬ ‫هاله‬ ‫الصحة‬ ‫وزيرة‬‫والسكان‬ http://www.mohp.gov.eg/
  7. 7. CHALLENGES Poverty Illiteracy Globalization High birth rate Urbanization Expanded life expectancy
  8. 8. HEALTH SYSTEMS IN EGYPT Administrative Service delivery MOHP
  9. 9. Administrative Structure The central headquarters‫االدارة‬ ‫المركزية‬ The governorate level, health directorates & districts‫المحافظات‬ ‫الصحية‬ ‫والمناطق‬ ‫والمديريات‬ Service Delivery Structure MOHP NHI University, Teaching hospitals, Research institutions Private sector Military hospitals
  10. 10. THE MAIN FUNCTIONS OF THE HIGHER ADMINISTRATIVE STRUCTURE Planning, Supervision, & Program management Central administration for the minister’s office Curative health services Population & Family planning Basic & Preventive health services Administration & Finance
  11. 11. Administrative Structure The central headquarters‫االدارة‬ ‫المركزية‬ The governorate level, health directorates & districts‫المحافظات‬ ‫الصحية‬ ‫والمناطق‬ ‫والمديريات‬ Service Delivery Structure MOHP NHI University, Teaching hospitals, Research institutions Private sector Military hospitals
  12. 12. MOHP Geographic Rural Urban Structural Health units Health centers Hospitals Functional MCH Family Programmatic Immunization Diarrheal disease control Major provider of 1ry, preventive & curative care in Egypt - 5,000 health facilities & > 80,000 beds spread nationwide. Service Delivery Structure I- MOHP:
  13. 13. Peripheral level of care Health office MCH centers Rural HU Family HU Compound unit Health centers
  14. 14. 1ry: Manage 80% of community health problems. “Cheap & cost effective” 2ry: District & general hospitals (15% of complicated cases) “Expensive” 3ry: Specialized hospitals (ophthalmology, dermatology, fever hospitals) “Highly expensive”.
  15. 15.  Covers governmental employee, students, newly born & private sector employee “47% in 2003”  Financed by beneficiaries & taxes.  Mainly curative services & some preventive, promotive services as: II) Health insurance organization “NHI” Recording of health files Screening tests (schools) Micronutrient supplement (infants), growth monitoring, vaccination & health education. Inpatient & outpatient services are available.
  16. 16. University, Teaching hospitals. Research institutions. (mainly Curative services). Private sector (Curative services). Military hospitals “serve military & public sectors” (all level of care)
  17. 17. HEALTH SECTOR REFORM IN EGYPT Improve the quality of health services offered to consumers. All national resources “governmental + non-governmental”
  18. 18. Objectives Provision of good quality services. Complete coverage of the whole citizens by NHI. Provision of holistic, comprehensive, integrated BBP. Up grading PHC to provide family care with ↑ the preventive role. ↑ HCP capacity “training & new medical information”. Motivation of community participation in health care. Decentralization of decision making. Strengthening management systems. Developing the domestic pharmaceutical industry .
  19. 19. STRATEGIC PLAN OF MOHP FOR HEALTH CARE REFORM 1- Development of infrastructure 2-Development of human resources
  20. 20. 1- DEVELOPMENT OF INFRASTRUCTURE • New services to slum & deprived areas. • Renovation of the existing units • Developing a separate system for financial needs • Providing all equipments & materials. • Application of family medicine program • Supporting transportation & communication network to upgrade the efficiency of referral system. • Developing health information system from central to peripheral levels & between public & private health services.
  21. 21. 2-DEVELOPMENT OF HUMAN RESOURCES Expansion & support of family medicine program application “medical schools curriculum, continuous training of physicians, nurses and technicians”. Continuous training in preventive & clinical medicine through fellowship program. Development of managerial capabilities of physicians. Application of quality assurance system according to fixed standards to evaluate the performance of health team.
  22. 22. LEARNING OBJECTIVES: 1) PHC principles and goals. 2) Elements of PHC 3) Describe the services of PHC in Egypt. 4) Define family medicine, principles and application
  23. 23. ALMA-ATA DECLARATION (1978) At a meeting at Alma-Ata (now Almaty, Kazakhstan) in 1978, government ministers from 134 countries met with global health organizations and agencies to discuss the relationship between inequality & illness.
  24. 24. ASTANA DECLARATION (2018) The Global Conference on PHC in Astana, Kazakhstan in October 2018 endorsed a new declaration emphasizing the critical role of PHC around the world. The declaration aims to refocus efforts on PHC to ensure that everyone everywhere is able to enjoy the highest possible attainable standard of health.
  25. 25. Primary Health Care from A to Z
  26. 26. DEFINITION OF PHC: 1st contact between health sector & public. Based on PRACTICAL, SCIENTIFIC, and SOCIALLY ACCEPTED methods & technology. ESSENTIAL health care given to individuals & families through their FULL PARTICIPATION & at AFFORDABLE COST.
  27. 27. Goals : The ultimate goal is WHO has identified 5 key elements to achieving that goal: Better Health for All Universal coverage reforms Service delivery reforms Public policy reforms leadership reforms ↑ Stakeholder participation.
  28. 28. PRINCIPLES OF PHC Availability: all citizens, “Equitable”, 24 hours. Accessibility: geographically “1 h. travel”, socially, functionally Affordability: Cost. Acceptability: Consumer’s satisfaction Appropriateness: scientific. Comprehensiveness: 4 levels + HCWs development Continuous: from womb to tomb. Compatible. Coordinated: Multi- sectional “agriculture + education+ communication +housing +industry” Community participation
  29. 29. PHC APPROACHES GOBI-FFF ELEMENTS
  30. 30. GOBI-FFF Growth monitoring Oral rehydration therapy Breastfeeding Immunization Family planning Female education Food supplementation
  31. 31. ESSENTIAL HEALTH SERVICES IN PHC (ELEMENTS) Education for Health Locally endemic disease control Expanded program for immunization MCH Essential drugs Nutrition TTT of communicable & NCDs Safe water & sanitation
  32. 32. PHC IN EGYPT  Started through maternal health units & endemic diseases units  PHC units
  33. 33. PHC IN EGYPT 1ry prevention services: Counseling Family planning Growth monitoring Vaccination of compulsory vaccines Health education Early detection & screening tests. Supplementing micronutrients to infants Food safety Support environmental sanitation, safety.
  34. 34. 2ry prevention (Curative services): PHC mainly provides preventive services. Curative services constitute 20% only! TTT of Communicable & NCDs. Control of epidemics & endemic diseases. 1st aid & emergency care. Referral of needy cases to higher care level. Provision of some drugs.
  35. 35. CRITERIA OF EFFECTIVE & SUCCESSFUL PHC • Coordination of PHC with different related sectors as education, social, agricultural, environmental organizations as they share in people health. • Community participation in PHC management, in needs assessment, setting priorities, helping in resources & in evaluation of activities. • Customer's satisfaction must be the ultimate & remote objective of PHC providers, through providing quality health care and by meeting people needs. • Health provider satisfaction by continuous education, training, motives & promotion. • Continuous monitoring & evaluation of services by collection & analysis of data, follow up of performance & assess output indicators
  36. 36. PHC IN RURAL SECTOR
  37. 37.  The main job in the rural community is agriculture.  In Egypt more than 50% of population lives in rural areas.
  38. 38. RURAL HEALTH PROBLEMS High Morbidity High Mortality
  39. 39. UNDERLYING FACTORS OF THESE HEALTH PROBLEMS Low socio- economic standards, limited resources & jobs High fertility, young age of marriage Illiteracy Bad sanitary environment Deeply rooted believes, culture, unhealthy habits
  40. 40. THE RURAL COMMUNITY PROBLEMS Endemic diseases Gastroenteritis, Skin & eye infections Parasitic diseases Schistosoma, Ascaris, Amebiasis Malnutrition Iron deficiency anemia, Protein deficiency, Rickets, Vitamin deficiency. NCD HPN, DM
  41. 41. RURAL HEALTH PROGRAM Health services are available every where in rural areas, rural health units, rural health centers, family units, MCH service. The services given are the same as in urban areas:
  42. 42. Care of mother, child & school age groups Home visits for mothers missed antenatal care, or incomplete children vaccination Ensure sanitary environment, frequent monitoring of water supply, food selling places Health education programs Health office services “birth & death certificates” Outpatient clinics Dental care Inpatient care in some rural services Outreach services for isolated areas offering preventive & curative care Referral of complicated cases Lab services for basic investigations Drug supply of essential drugs 1st aid & emergency care
  43. 43. FAMILY MEDICINE
  44. 44. 3-dimensional specialty Process Skill Knowledge FAMILY MEDICINE The medical specialty which provides continuing & comprehensive health care for the individual & family. Integration Behavioral science Clinical science Biological science Its scope includes all ages, both sex, each organ, systems and every disease.
  45. 45. The family A group of people related by blood or marriage or live in one house. A traditional “nuclear family” 2 parents & their children An extended-kind model of family Community of parents, siblings, grandparents & other relatives which should be recognized as a 1ry family
  46. 46. PRINCIPLES Continuity “from birth to death”. Continuing responsibility for individual follow up & community health problems. Comprehensive “all individual & family and in health & disease”. Coordinative function “all the health care needs”. Referral system. Recording system Holistic approach “Biological + psychological + social aspects”
  47. 47. Family type, size, members & their relation Social configuration Environmental condition of the house Past history of the health status Time & type of previous care provided File records is structured format describing:
  48. 48. BASIC BENEFIT PACKAGE (BBP) The main pillar of the family health model Set of integrated services of curative, preventive and public health services within family medicine practice framework. Selection of basic services in the BBP are based on : Most common health needs of population Prevalence & Severity of illness Cost-effectiveness of interventions Availability of financial resources 4 major criteria
  49. 49. Benefits of BBB Limiting possibilities of duplication of services which result from drug dispensing from >1 provider. ↓ No. of investigations required & preventing unnecessary replication. ↑ Society Health awareness → ↓burden of disease.
  50. 50. BBP will be provided through a referral system utilizing 3 levels of care Family health units Family health center Referral hospitals
  51. 51. The BBP is classified into 2 main categories Individual health services • Child health • Woman health • Health services for all age group Public health services & Interventions • Parasitic diseases • Control of communicable disease. • Environment • Vector control. • Food control • Occupational health. • School health.
  52. 52. BBP IMPLEMENTATION Development or improvement of existing guidelines. Upgrading of skills In services & pre- service skills training. Incorporating the enhanced curriculum in medical schools, family health training, nursing schools. Monitoring of health facility performance Using a standard set of indicators, academia & partner agencies. Quality assurance Basic services meet the minimum requirement for quality services in both public & private sectors & at all levels of care.
  53. 53. MATERNAL HEALTH CARE WOMEN HEALTH REPRODUCTIVE HEALTH
  54. 54. LEARNING OBJECTIVES: a) Define reproductive health, maternal-child care. b) List components of reproductive health care c) Describe maternal-child health care program and its objectives d) Calculate vital indices related to maternal-child health care
  55. 55. MATERNAL HEALTH CARE Reproductive health (RH)  It is the state of complete physical, mental and social wellbeing not merely absence of disease or infirmity in all aspects related to the reproductive system.  It is not restricted to child bearing period years but includes adolescent & menopausal periods as well.
  56. 56. COMPONENTS OF RH Safe motherhood Health promotion of adolescents Premarital examination, counseling & screening. Prevention of violence against woman, FGM, early marriage Sexual health education & counseling Family planning services & information Prevention & management of infertility, infections & NCDs.
  57. 57. OBJECTIVES OF MCH CARE Allow safe motherhood by ensuring safe pregnancy, labor & peurperium. Provide physical, social & psychologic al care for mothers Promotion of child health Prevention & control of health hazards for mother & child Family planning services & counseling
  58. 58. MATERNAL HEALTH PROGRAM Essential Health Service Package Pre-marital care Antenatal care Natal care Post-natal care Inter pregnancy care It is a set of actions & services delivered to women before, during & after pregnancy.
  59. 59. 1- PRE-MARITAL CARE It occurs all through her life until pregnancy but actually it is performed before marriage. It is mandatory now by law. Data collection; Personal, family & past medical history General examination. Lab investigations blood, urine. Health education & proper counseling Immunization (rubella) if not immunized & before 3 months of expected pregnancy.
  60. 60.  Every woman has to visit the nearest facility for antenatal registration & to avail prenatal care services.  The standard prenatal visits: 2- Antenatal care 1st As early as possible General assessment as the pre-marital visit. 2nd At 22-26 weeks Assessment of pregnancy development &Tetanus vaccination 3rd 30-32 weeks The same as previous & for 2nd dose of tetanus vaccine 4th 34-36 weeks Assessment of pregnancy & lye 5th 38-40 weeks Decide way of delivery & prepare for the place of delivery WHO recommends visits (every month in the 1st 6 months, every 2 weeks at 7th & 8th month & every week till delivery)
  61. 61. Vaccination Micronutrient Supplementation ttt of diseases & other Conditions Health Education Detection of at risk women Home visiting
  62. 62. Vaccines recommended for all pregnant women: • Influenza viruses infection ↑ risk of hospitalization, serious complications, & adverse pregnancy outcomes. • Immunization with inactivated influenza virus vaccine is effective Influenza • Tetanus in newborn infants is prevented if the mother has been immunized. • A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman 1 month before delivery to protect baby from neonatal tetanus. • 3 booster dose shots to complete the 5 doses following the recommended schedule provides full protection for both mother and child. The mother is then called as a “fully immunized mother” (FIM). Tetanus
  63. 63. Generally, live-attenuated vaccines are contraindicated because of the theoretical risk of transmission of the vaccine virus to the fetus. Examples: Influenza live virus vaccine (nasal spray) Measles- containing vaccines Mumps- containing vaccines Rubella- containing vaccines Smallpox (vaccinia) vaccine Typhoid vaccine Varicella (chickenpox) live virus vaccine Yellow fever vaccine Vaccines that pregnant women should not receive
  64. 64. Micronutrient Supplementation Iron (200mg) & folic acid (300ug) once daily after the 1st trimester Calcium (500mg) twice daily tablets in the 2nd trimester “if its consumption in food is not enough”. Multivitamins
  65. 65. DETECTION OF AT RISK WOMEN Age <18 & >40 years Parity 1st & >5 Height <150 cm Obese Pregnancy spacing <2 years Bad obstetric history Affected health status Family history of congenital diseases Low socio economic level Bad habits “smoking or addiction” Husband is very old
  66. 66. • Other conditions that may endanger her health & complication could occur. ttt of Diseases & Other Conditions • About principle of feeding, allowed & forbidden work activities personal cleaning, signs of normal pregnancy & alarming signs. Health Education • for those drop out cases & for assessment of housing conditions. Home visiting
  67. 67. NATAL CARE : Clean and Safe Delivery & encourage breast feeding Ensure hygiene during labor & delivery. Provide safe & non traumatic care Recognize complications. Manage & refer to a higher level of care when necessary. The presence of a skilled birth attendance
  68. 68. POST NATAL CARE: to ensure safe peurperium & establish breast feeding MOHP recommends 5 visits after delivery. 1st day 4th day 7th day 14th day 40th day
  69. 69. INTER PREGNANCY CARE For preparation of future pregnancy & Family Planning Counseling. Proper counseling of couples on the importance of FP → choose a suitable FP method, proper spacing of birth & addressing the right no. of children. Birth spacing of 3-5 years interval will help completely recover the health of a mother from previous pregnancy & childbirth. This period is a good chance for proper management of any chronic problem.
  70. 70. MATERNAL MORTALITY
  71. 71. No. of deaths of mothers due to causes related to pregnancy, labor and peurperium in relation to live births in the same year & locality. No. of deaths of mothers due to causes related to pregnancy, labor and peurperium in relation to no. of females in pregnancy, labor and peurperium. It can’t be calculated because the actual no. of females in pregnancy, labor and peurperium are not known.
  72. 72. In Egypt the ratio is 84/100000. Deaths of females occurring due to any other cause (as accident) are not included in the maternal mortality ratio.
  73. 73. The underlying causes of maternal deaths Delays in taking critical actions • Seeking care • Making referral • Providing of appropriate medical management. Closely spaced births Frequent pregnancies Poor detection & management of high-risk pregnancies Poor access to health facilities
  74. 74. How to reduce maternal mortality? • Ensure accessibility & quality of MCH centers everywhere. • Health education for antenatal & natal care attended by physician • Delay 1st pregnancy till age of 20 and not >40 years. • Inter pregnancy spacing 2-3 years • TTT of anemia, HPN, DM during pregnancy • Early detection and strict supervision for toxemia. • Training of health care providers for normal labor, diagnosis of abnormal lie of fetus and referral. • Aseptic technique during labor, few attendants, sanitary environment of delivery. • Emergency facilities, blood banks for management of hemorrhage • Rapid referral of complicated cases
  75. 75. CHILD HEALTH CARE
  76. 76. LEARNING OBJECTIVES: 1) Identify the objectives of child health program 2) Describe the integrated management of child illness 3) Identify vaccination during childhood
  77. 77. OBJECTIVES OF CHILD HEALTH CARE Promotion of health of all children <5 years (>5 served by school health program). Prevention of infections, malnutrition & accidents Control of infections, complication of other health hazards, early diagnosis, proper ttt.
  78. 78. Components of child health care program: Health education of mothers Growth & development monitoring Immunization Treatment of diseases HEALTH CARE SERVICES FOR UNDER 5 YEARS CHILDREN:
  79. 79. 1 million children <5 years old die each year in less developed countries. INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) Nearly ½ child <5 ys mortality 5 main diseases Pneumonia Diarrhea Malaria Measles Dengue hemorrhagic fever Malnutrition “often the underlying condition”
  80. 80. IMCI strategy has been introduced in an increasing no. of countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth & development. IMCI is based on the combined delivery of essential interventions at community, health facility & health systems levels. IMCI is the umbrella through which all community health interventions can be delivered to the child. IMCI includes elements of prevention + curative IMCI addresses the most common conditions that affect young children. The strategy was developed by WHO and UNICEF. Key factors in the child’s immediate environment – nutrition, hygiene, immunizations - are as important as medical treatment in improving health.
  81. 81. ↓ Death, frequency & severity of illness & disability Contribute to improved growth & development Objectives of IMCI
  82. 82. Rationale Majority of these deaths are caused by 5 preventable & treatable conditions namely: pneumonia, diarrhea, malaria, measles & malnutrition . Three (3) out of four (4) episodes of childhood illness are caused by these 5 conditions . Most children have more than one illness at one time. This overlap means that a single diagnosis may not be possible or appropriate.
  83. 83. Sick children from birth up to 2 months (Sick Young Infant) Sick children 2 months up to 5 years old (Sick child) Children covered by the IMCI protocol
  84. 84. Strategies/Principles of IMCI All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs & all Sick Young Infants Birth up to 2 months are examined for very severe disease & local bacterial infection. These signs indicate immediate referral or admission to hospital. Children & infants are then assessed for main symptoms. Sick children: cough or difficulty breathing, diarrhea, fever & ear infection. Sick young infants: local bacterial infection, diarrhea & jaundice. All sick children are routinely assessed for nutritional, immunization & deworming status & for other problems Only a limited no. of clinical signs are used. A combination of individual signs leads to a child’s classification within one or more symptom groups rather than a diagnosis. IMCI management procedures use limited no. of essential drugs & encourage active participation of caretakers in the ttt of children. Counseling of caretakers on home care, correct feeding & giving of fluids, and when to return to clinic is an essential component of IMCI
  85. 85. Basis for classifying the child’s illness “Color-coded triage system” Urgent hospital referral or admission Initiation of specific Outpatient ttt Supportive home care
  86. 86. STEPS OF THE IMCI CASE MANAGEMENT PROCESS At the out-patient health facility, the health worker should routinely do basic demographic data collection, vital signs taking, and asking the mother about the child's problems. Determine whether this is an initial or a follow-up visit. The health worker then proceeds with the IMCI process by checking for general danger signs, assessing the main symptoms.
  87. 87. EGYPT VACCINE MARKET
  88. 88. Age Type of vaccine Dose, route At birth OPV BCG 2 drops orally on tongue 0.1ml Intra-dermal injection in left deltoid region 2 , 4 , 6 months OPV DPT & HIb HBV 2 drops orally 0.5ml IM on left thigh 0.5ml IM on right thigh 9 months OPV booster + Vit.A 2 drops orally 12 months MMR OPV booster + Vit. A 0.5ml SCJ on right arm 2 drops orally 18 months OPV booster MMR booster DPT booster 2 drops orally 0.5ml SCJ on right arm 0.5 ml IM on left thigh Obligatory vaccination schedule: (2014) Vit.A supplement is given at 9th month & 12 months (one capsule 100000 IU emptied in mouth) & at 18th month 2 capsules (200000 IU) are given.
  89. 89. HIB immunization:  Prevent diseases caused by Haemophilus influenza type B (HIB).  >90% of all HIB infections occur in children 5 years of age or less; the peak attack rate is at 6-12 months of age.  HIB vaccine is usually given at 2, 4 and 6 months of age & a final booster is given at 12-15 months of age.
  90. 90. Pneumococcal vaccine 1st dose at 2 months 2nd dose at 4 months 3rd dose at 6 months 4th dose at 12 to 18 months Rotavirus vaccine 1st dose at 2 months 2nd dose at 4 months 3rd dose at 6 months (depending upon type of rotavirus vaccine given) HAV 1st dose at 12 months 2nd dose at 18-30 months Influenza vaccine 1st dose at 6 months (requires a booster 1 month after initial vaccine) Annually until 5 years Varicella vaccine 1st dose at 12 to 15 months 2nd dose at 4 to 6 years Meningococcal vaccine 1st dose at 11 years 2nd dose at 16 year Optional vaccines
  91. 91. ADOLESCENT HEALTH
  92. 92. LEARNING OBJECTIVES: 1) Identify health problems and needs of adolescent age 2) Explain the components of school health program
  93. 93. Adolescence is the period of life between puberty & maturity. Roughly between 10 - 19 years. Rapid physical growth “adolescent spurt” • ↑ in height, weight, sexual development due to hormonal changes. Mental (cognitive) change • From concrete operational thinking to abstract, deductive, reasoning thinking. • Understand risk & benefit • Appreciate future consequences of choices. Psychological change • Developing peer relationship • Sexual intimate relation • Determination of educational goals • Establishing identity & self responsibility. • Sensation of independency.
  94. 94. HEALTH PROBLEM
  95. 95. MORBIDITY Infections: Pharyngitis, Measles, Mumps, Meningitis, Typhoid, Viral hepatitis, Food poisoning, Ascaris, Schistosoma & Enterobius. Reproductive system problems: Hydrocele, Varicocele, Breast & Menstrual disorders. Dermatological problems: acne, tenia, Scabies, conjunctivitis. Eating disorders: over eating or severe anorexia Malnutrition: anemia, vit. deficiency & healed rickets. Psychological problems: depression,adolescent abuse. Musculo-skeletal problems: scoliosis, kyphosis Behavioral problems: cigarette smoking, addiction Dental problems Accidents & injuries. Early maternity & sexual abuse
  96. 96. In general is minimal except after Accidents (MVA), injuries, suicide Cancer Complications of severe infections “Pneumonia, TB, STDs” Mortality
  97. 97. HEALTH NEEDS FOR ADOLESCENTS • Needs to accept autonomy, to find way to develop a life style • Needs for trust & confidentiality • Education needs: special teachers understanding adolescent psychology. • Adjusted curricula to meet their needs. Sex & family education. • Needs for good family relationship. • Need or healthy sufficient diet. • Support safe motherhood for married adolescents. • Prevention of child labor by law, supportive working environment, ensure nutrition & health. Prevention of employing adolescents in hazardous occupations.
  98. 98. Health program for adolescents is included in school health program
  99. 99. SCHOOL HEALTH PROGRAM (SHP) Promotion of +ve health of School Children. Prevention of disease. Early diagnosis/ttt/ follow up/ referral. Awakening of health consciousness Provision of healthful environment. Objectives of the program
  100. 100. EIGHT COMPONENTS MODEL
  101. 101. 1-HEALTH EDUCATION: A planned, sequential curriculum that addresses the physical, mental, emotional & social dimensions of health. Allows students to develop health- related KAP. Designed to motivate & assist students to maintain & improve their health, prevent disease, & reduce health-related risk behaviors. Qualified, trained teachers provide health education.
  102. 102. 2-PHYSICAL EDUCATION: Provides cognitive content & learning experiences in a variety of activity areas “basic movement skills; physical fitness; rhythms & dance; games; team, dual & individual sports; tumbling & gymnastics; & aquatics”. Promote each student's optimum physical, mental, emotional & social development. Through a variety of planned physical activities. Promote activities & sports that all students enjoy & can pursue throughout their lives. Qualified, trained teachers teach physical activity
  103. 103. 3-HEALTH SERVICES: Provided for students to appraise, protect & promote health. Designed to ensure access or referral to PHC services or both. Provide educational & counseling opportunities for promoting & maintaining individual, family & community health. Prevent & control communicable disease & other health problems. Provide emergency care for illness or injury. Promote & provide optimum sanitary conditions for a safe school facility & school environment Qualified professionals such as physicians, nurses, dentists, health educators & other allied health personnel provide these services.
  104. 104. 4- NUTRITION SERVICES: Access to a variety of nutritious & appealing meals that accommodate the health & nutrition needs of all students. Offer students a learning lab for classroom nutrition & health education. Serve as a resource for linkages with nutrition-related community services. Qualified child nutrition professionals provide these services.
  105. 105. 5- COUNSELING & PSYCHOLOGICAL SERVICES: Improve students' mental, emotional & social health. Include individual & group assessments, interventions & referrals. Organizational assessment & consultation skills contribute not only to the health of students but also to the health of the school environment. Professionals such as certified school counselors, psychologists & social workers provide these services.
  106. 106. 6-HEALTHY SCHOOL ENVIRONMENT: Physical environment School building & the area surrounding it. Biological or chemical agents that are detrimental to health & physical conditions “temperature, noise, and lighting”. Psychological environment Physical, emotional & social conditions that affect the well-being of students and staff.
  107. 107. 7-HEALTH PROMOTION FOR STAFF: Health assessments Health education Health-related fitness activities Encourage staff to pursue a healthy lifestyle → improve health status & morale + ↑ personal commitment to school's overall coordinated health program. Creates +ve role modeling. Health promotion activities → ↑ Productivity ↓ Absenteeism & health insurance costs
  108. 108. 8-FAMILY/COMMUNITY INVOLVEMENT: An integrated school, parent & community approach for enhancing the health & well-being of students. School health advisory councils, coalitions, and broadly based constituencies for school health can build support for school health program efforts. Schools actively solicit parent involvement & engage community resources & services to respond more effectively to the health-related needs of students.
  109. 109. ELDERLY “GERIATRIC” HEALTH
  110. 110. LEARNING OBJECTIVES 1) Define geriatric, old age and gerontology 2) Enumerate the health problems of the elderly 3) Describe geriatric health program
  111. 111. DEFINITIONS  Geriatric medicine: Specialized branch of medicine dealing with prevention, control and rehabilitation of old persons.  Old age: ≥ 60ys, some countries (65ys).  Gerontology: the scientific study of the aging process
  112. 112. IMPORTANCE OF GERIATRIC GROUP ↑ Old age no. due to: Increased technology Better care Health consciousness In Egypt, the old people reached 7% of population in 2006 → deserve special health care.
  113. 113. CHARACTERISTICS OF ELDERLY POPULATION Have multiple diseases Alter reaction to drugs Impaired temperature regulation Impaired pain sensation ↓ Physiological functions ↓ Lung & heart efficiency. Degenerative changes of bones & joints Loss of teeth
  114. 114. GERIATRIC HEALTH PROBLEMS • Iron deficiency anemia, malnutrition • Atherosclerosis, IHD, arrhythmia, core pulmonale • Emphysema, pneumonia, TB, hypertension • UTI, incontinence • Constipation, altered digestion • Alzheimer’s disease, ↓ memory, Parkinsonism • Visual, hearing loss • Accidents. • Tumors. • Social problems: retirement, social insecurity, loneliness, dependency, social abuse & neglect. Morbidity • Complication of chronic diseases, accidents, homicide, cerebro-vascular hemorrhage, ischemic heart attack, dehydration. Mortality
  115. 115. Health care program for the elderly
  116. 116. Social services: homes, clubs, vacation, ↓ fees in transport & recreation facilities. Medical services: health insurance, religious institutes, general hospitals. For screening, health education, provision of drugs & aids Nutrition support: nutrition education for care giver, supplementary foods Financial support: small projects Curative care Rehabilitation

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