| Child Health | Diagnostics | Hospitals | Maternal & Rep. Health | Pharmacy | Primary Care | Public Health | Traditional Healer Definition Public health service refers to the combination of the organization of service delivery and stewardship/ administration that culminates in the delivery of population-based services (e.g. infectious disease prevention, control, and surveillance). At the same time, this service has been defined in a variety of other ways. It can generally refer to health programs that target specific populations (e.g. children) or specific diseases (e.g. tuberculosis). In the US, Public Health is widely defined as health services that are financed by the public. Thus, Medicare and Medicaid, both of which are publicly funded insurance programs in the US, are considered as a public health service. Top Status of Public Health Services The core public health services that are financed by governments are goods that are "public" or goods that have "externalities." The former refers to goods that are non-rival and non-excludable. The latter is linked to goods that not only benefit an individual, but also to those around the individual. Because such goods are under-consumed if they are left to the market, they have high priority for public funding and arranging. An important form of public health service is the delivery of immunizations. Immunizations prevent the occurrence of disease in individuals and reduce the risk of a non-immunized person from contracting an infection through "herd immunity." In addition, health education is another example of a public health service. It attempts to change individual high -risk behavior so that not only individuals can improve or maintain their health, but also those that interact with them. For example, providing HIV education to high-risk individuals can help prevent infection in the individuals and better limit the spread of infection in a population. Top Issues in Public Health Services The main challenges in providing successful public health services in developing countries are often the lack of political will, the difficulty in changing community/individual behavior, and the insufficient level of resources. For detailed information refer to Merson (2001). The lack of political-will, for example, is reflected in the current HIV situation, where many governments show little support for needle exchange programs, despite their proven efficacy in reducing the transmission of HIV in a population. Public health services also experience difficulty in changing peoples' risky behavior because they can go against some cultural or religious values. In addition, the allocation of public expenditure tends to be skewed towards curative services, making the implementation of effective preventative health programs difficult. Decentralization is another often discussed obstacle for public health services because it has been found that local governments have a tendency to refuse to use their budgets for many public health services. Miller (2003) discusses this problem within the context of infectious disease surveillance in a decentralized Indonesian health system. Top Trends in Public Health Services Conducting studies to understand health beliefs and behaviors, advocating for vulnerable populations, and investing in known cost-effective interventions are some of the factors that contribute to the success of public health services. - Beliefs and Behaviors -- This approach applies theories from sociology, psychology, and anthropology to identify factors that most likely influence behavior change. Some examples of theories include the Health Belief Model, the Theory of Reasoned Action, and Diffusion of Health Innovation Model. One project in Ghana used the Health Belief Model to examine the determinants of condom use to prevent HIV infection among youth. For more information view Adih (1999).
- Advocacy -- This approach endorsed by Mehrotra (2002) points out the need to give 'voice' and participation to the marginalized population. As a result, they hope to increase the resource base for public services.
- Cost-Effective -- This approach aims to influence decision makers to invest in cost-effective public health services, which will result in the greatest public health gain possible within resource limits.
Top Key References World Bank - Khaleghian, P. (2003). Decentralization and Public Services: The Case of Immunizations. Washington, World Bank.
 This document examines the impact of political decentralization on childhood immunization. The study finds that this reform has different effects in low- and middle- income nations. - Miller, D. S. (2003). Decentralization in Indonesia's Health Sector: An update. Essential Public Health Functions: Prevention, Control, and Surveillance of Infectious Diseases. Washington, World Bank
Discusses the effects of decentralization in Indonesia on public health services, especially infectious disease prevention, control, and surveillance.
Top External - Adih, W. K. and C. S. Alexander (1999). "Determinants of condom use to prevent HIV infection among youth in Ghana." J Adolesc Health, 24(1): 63-72.
Identifies the psychosocial and behavioral factors that influence condom use to reduce HIV risk. Finds that HIV education programs should emphasize personal vulnerability to AIDS. - Mehrotra, S. and S. W. Jarrett (2002). "Improving basic health service delivery in low-income countries: 'voice' to the poor." Soc Sci Med, 54(11): 1685-90.
Advocates for giving 'voice' and participation to the poor in developing countries. Discusses the role of NGOs and grass-roots organizations in providing public health services. - Merson, M., R. Black and A. Mills (2001). International Public Health: Diseases, Programs, Systems, and Policies. Gaithersburg: Aspen Publishers.
Addresses the broad challenges in international public health. Discusses the factors that impede successful public health services.Scrimshaw, S. (2001). Culture, Behavior, and Health. International Public Health. - M. Merson, R. Black and A. Mills. Gaithersburg: Aspen Publishers: 53-78.
Addresses the difficulty in changing people's behavior. Discusses models to understand factors that predict behavior and attitudes towards health issues.
Top Useful Websites - World Bank: Public Health
· Describes the state of the art in core basic health functions, and basic health, nutrition and population (HNP) preventive and curative services. Also summarizes key interventions proven to be effective in improving health.
For more information please contact the Health and Population Advisory Service (healthpop@worldbank.org) Top |
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