Comparing 3 Health Systems: Thailand, Ethiopia, Bangladesh
November 17, 2015
A quick table comparing health systems characteristics between three countries: Thailand, Ethiopia, Bangladesh
| Country Case Studies | Health Systems Organisation | Health Financing | Other Factors |
|---|---|---|---|
| Thailand | Expert public health doctors involved with policies, 5 year plans for full coverage ensuring one hospital in every province then every district then health centres in sub districts, provincial chief medical officers, at lower level district health officers, hospital directors, then nurses and public health workers with diverse training, mandatory health service for all medical graduates, ex. Must work at rural hospital for 3 years to repay education (what other countries have this scheme? Are there actually senior doctor supervisor or support for these junior doctors?); Established nurse and midwifery college to recruit rural women for training, 2 year training diploma for technical nurses, with rural service then 2 more years of training upgrading them to professional nurses. | Voluntary and recruitment focused on rural and remote areas; insurance schemes, universal health coverage for 64 million people & comprehensive coverage; preventing health impoverishment 20 bhaat per house per month (is this actually enough?) | MDGs achieved, on MDG plus; large population who don’t believe in modern medicine, who hold onto traditional beliefs; strong political leadership, technocrats; many policies on health that are pro-poor and pro-rural |
| Ethiopia
Surrounded by cluster of failed states, terrorist groups, central location for an ideological war, seen as last bastion of democracy in a sea of failed states; agrarian society largely unstable, food instability; healthcare free at point of use. Notes: User fees support decentralization, user fees at point of use goes from bottom - up |
Focus on increasing primary care access to 90%, outpatient services, immunization rates; community participation, committees and health extension program to “change mindset of people”; training of community health extension workers more than 38000, 2 workers per village, teaching community health, bringing services closer to public, task shifting (antibrain drain because low level health workers will not leave area. But who’s doing the training and is it adequate. How are they supervised?) | 16.1% per capita spending on health more than avg (should investigate resource distribution); building numerous health posts to cover isolated populations; recent years decrease in gov’t health funding, rise in international health aid $4B received 2003-2009, development partners/organizations also provide funding; Ethiopian Govt proactive in directing health initiatives | Intersectoral relationships emphasizing health outcomes linked to progress in other sectors (education, agriculture, water, sanitation) |
| Bangladesh Highest rates of diabetes type 2; large number of NCDs in country - is there integration of services? |
Vaccination program; traditionally home based birth delivery, now over 80% now with access to emergency obstetric care (improve maternal mortality and child rate); technocrat approach to policy decisions; health for all model, building of nationwide network of health structures focus on health service and family planning; ministry of health and family welfare, women from villages trained door to door to dispense health education, family planning services, reproduction and other health activities, recruited over 200,000; NGO supported, Brac provided health workers and programs, interventions tested in small communities than going to scale; Services very decentralized. | NGOs recognized by govt and people to help meet deficiencies in health system, NGOs also compliant with govt policies, collaborative, ex. Brac delivery partnered ICDDRB research on oral rehydration solution (ORS) Oxbridge trained doctors running hospitals. | Migration to urban areas, slum issues health such as hygiene, sanitation, water, frequent natural disasters; health system developed after long period of conflict, constitution prioritized health provision, political support, health success was achieved ahead of economic and other developments also resilient to political changes; pop growth identified early as a issue |