Strategic Plan for the Development of the Health Sector DPR KOREA
Strategic Plan for the Development of the Health Sector DPR KOREA
CONTENTS
LIST OF FIGURES AND TABLES.........................................................................3
Abbreviations: .............................................................................................4
EXECUTIVE SUMMARY ..........................................................................6
Strategic Framework MTSP 2016 -2020.................................... ................8
BACKGROUND............................. ...............................................................11
I. VISION AND NATIONAL HEALTH PRIORITIES 2016-2020 .................15
II. MTSP 2016 – 20:................... ..........................................................15
STRATEGIC AREA 1: Communicable Disease Prevention and Control............. ..15
FOCUS AREA 1: Strengthen HAES nationwide:
FOCUS AREA 2: Immunization and Control of Vaccine Preventable Disease (VPDs): .16
FOCUS AREA 3: Control of Infectious Diseases: .................................................16
STRATEGIC AREA 2: NON COMMUNICABLE DISEASE PREVENTION AND CONTROL.
FOCUS AREA 1: Chronic diseases (CVD, Cancer, metabolic diseases)........... ......22
FOCUS AREA 2: Injury prevention........................... .......................................23
FOCUS AREA 3: Mental Health................... ............................... ..............23
FOCUS AREA 4: Disability and elderly care ....................................................23
FOCUS AREA 5: Tobacco control........... ......................................................24
STRATEGIC AREA 3: WOMENS AND CHILDRENS HEALTH......................26
FOCUS AREA 1: Maternal and Neonatal health: ..............................................26
FOCUS AREA 2: Sexual and Reproductive Health...............................................27
FOCUS AREA 3: Child Health .......................................................27
FOCUS AREA 4: Nutrition................................................................................28
STRATEGIC AREA 4: Improved Quality of Health Service............... ....30
Strategic Area 5 :Development of Medical science and Technology .......... ..34
STRATEGIC AREA 6: Improved Medicine and Medical Supplies for Health Services ...35
STRATEGIC AREA 7 STRENGTHENING HEALTH SYSTEMS: .......................37
FOCUS AREA 1 Leadership and Management of Public Health ..............................37
FOCUS AREA 2 Health Management Information Systems...............................39
FOCUS AREA 3 Human Resource Development....................................................39
STRATEGIC AREA 8 Environmental Determinants of Health.............. ......41
Focus Area 1: Food Safety ............................................... ..............42
Focus Area 2: Healthy and Hygienic living Conditions ............ .....42
Focus Area 3: Climate Change.............................................. .........................42
Focus Area 4: Safe Water ...................................................................................................43
-------------
EXECUTIVE SUMMARY
DPR Korea commitment to Primary Health Care
The commitment of DPRK to the development and maintenance of the primary health care system has been substantial and the health system workforce has developed into 242 341 staff of all categories in 2014. Substantial resources are also invested into the pre-service and continuing education programs. The health sector is also tasked with financing the extensive network of 9 076 health facilities(2014) across the country, including equipping, logistical support, renovation, maintenance and operational support.
According to the 2014 MoPH health report, the state has increased the health share from 5.9% of the GDP in 2000 to 6.1% in 2010. It has been maintained at around 6.4% of the GDP in recent years (2014).
The Medium Term Plan for Development of the Health Sector in DPRK 2016 - 2020 was developed between May and June 2016. This plan is meant to describe a 5-year strategy for the sector, it serves as a framework to plan activities to achieve the specific objectives to address the health needs of the population of DPRK.
The plan was developed guided by the national health priorities and building on the achievements of the last cycle and the WHO/SEAR regional flagship initiative is incorporated in the plan. A thorough review of the literature and health systems development in DPRK together with interviews with MoPH program managers and development partners were undertaken. Two workshops were organized with the MoPH managers to assess the situation and to conclude a strategic framework that reflects the MoPH priorities for the coming 5 years.
A draft plan was finalized in July 2016 and submitted to the MoPH and the WHO for further reviews and inputs. The strategic framework developed for this plan describes 8 strategic areas.
Situation Analysis and Conclusions
(1) Remarkable public health gains were achieved in recent years, from significant reductions in the MMR, IMR and the U5MR to the noticeable improvements in the malnutrition indicators among women and children, the high immunization coverage is being sustained, high success treatment rates of TB patients using the DOTS, substantial declines in the incidence of malaria, expansion of the IMCI strategy, scaling up of essential obstetric care at Ri and county levels, infrastructure development and improvement in blood safety;
(2) This continuous success is attributed to the committed public health policy that incorporates preventive and curative approach with an intensive network of health facilities and staff at the very first levels, this is the solid health system base that ensured universal health coverage. “High Tech” on its own does not guarantee a universal health coverage, it should be balanced with the overall public health approach. Moreover, there was an improvement in the public health management and technical capacity of the health staff that was possible with the health system partnerships developed along the recent years. The multilateral MOPH and WHO program for improving women’s and children’s health has provided the first framework for a wider vision of health development, which was accelerated through the GAVI HSS and Global Fund initiatives and partnerships with UN agencies WHO, UNICEF, UNFPA and NGOs;
(3) On the other hand, there are challenges that have their impact on the health system’s capacity to deliver the very basic care like the operational funds, infrastructure, referral systems and logistics. This calls for innovative managerial approach to rationalize the limited resources through considering a combination of coordination mainly at the central level an integration mainly at the sub-national level;
(4) Areas of growing influence on the people’s health like non-communicable diseases and social determinants of health were identified by the DPRK government as priorities and multi-sectoral steps are being and continue to be taken by the MoPH with support from the development partners to address this area. However, the programs’ funding is “donors’ driven” and there is a need to advocate with the donors and the UN agencies to find innovative means to ensure more flexibility in using the funds, especially in the area of health system that would reflect on all health services delivery;
(5) In the last decade, the WHO have been regularly supporting fellowships mainly in the area of public health and the National Institute for Public Health Administration (NIPHA). Now, with more public health specialists and improving capacity of NIPHA, it is worthy to explore the development of local public health master degree in collaboration with the WHO and a reputable academic institute in the region. The fellowships focus could shift to other areas of growing need like Health economics and Geriatrics;
(6) As mentioned above, there have been remarkable success in the area of CDC. However, two areas of concern are: MDR TB and Hepatitis, much have been and are being done especially in the MRD TB but more efforts are needed to accelerate the pace;
(7) With the nationwide expansion of the telemedicine network, introduction of the WHO Emergency Essential Surgical Package at the first referral level could be considered;
(8) Many activities have been and continue to be undertaken in the cross-cutting areas of training, health information system and supervision. The quality outcome remains a concern. More participation of the development’s partners in training sessions, field visits with the supervisors to follow-up on the impact of interventions, to assist the hands-on training on data analysis and use for planning and to obtain feedback would improve the outcome and ensure the quality;
(9) The considerable research agenda proposed, coupled with the call for technical update, exchange and twinning arrangements with regional scientific and research institutes emphasizes the commitment of the MoPH to pursuit a scientific evidence-based approach in order to deliver better quality health care
(10) The foundation of the DPRK health system, universal coverage and the principles of primary health care are enshrined in the section doctor system. In order to benefit from the strengths of this system, this strategic plan proposes more efforts to strengthen the section doctors’ capacities;
(11) Finally, a longer-term vision, say for the 2030 is worthy of exploring through a think-tank from the MoPH and partners.
CONTENTS
LIST OF FIGURES AND TABLES.........................................................................3
Abbreviations: .............................................................................................4
EXECUTIVE SUMMARY ..........................................................................6
Strategic Framework MTSP 2016 -2020.................................... ................8
BACKGROUND............................. ...............................................................11
I. VISION AND NATIONAL HEALTH PRIORITIES 2016-2020 .................15
II. MTSP 2016 – 20:................... ..........................................................15
STRATEGIC AREA 1: Communicable Disease Prevention and Control............. ..15
FOCUS AREA 1: Strengthen HAES nationwide:
FOCUS AREA 2: Immunization and Control of Vaccine Preventable Disease (VPDs): .16
FOCUS AREA 3: Control of Infectious Diseases: .................................................16
STRATEGIC AREA 2: NON COMMUNICABLE DISEASE PREVENTION AND CONTROL.
FOCUS AREA 1: Chronic diseases (CVD, Cancer, metabolic diseases)........... ......22
FOCUS AREA 2: Injury prevention........................... .......................................23
FOCUS AREA 3: Mental Health................... ............................... ..............23
FOCUS AREA 4: Disability and elderly care ....................................................23
FOCUS AREA 5: Tobacco control........... ......................................................24
STRATEGIC AREA 3: WOMENS AND CHILDRENS HEALTH......................26
FOCUS AREA 1: Maternal and Neonatal health: ..............................................26
FOCUS AREA 2: Sexual and Reproductive Health...............................................27
FOCUS AREA 3: Child Health .......................................................27
FOCUS AREA 4: Nutrition................................................................................28
STRATEGIC AREA 4: Improved Quality of Health Service............... ....30
Strategic Area 5 :Development of Medical science and Technology .......... ..34
STRATEGIC AREA 6: Improved Medicine and Medical Supplies for Health Services ...35
STRATEGIC AREA 7 STRENGTHENING HEALTH SYSTEMS: .......................37
FOCUS AREA 1 Leadership and Management of Public Health ..............................37
FOCUS AREA 2 Health Management Information Systems...............................39
FOCUS AREA 3 Human Resource Development....................................................39
STRATEGIC AREA 8 Environmental Determinants of Health.............. ......41
Focus Area 1: Food Safety ............................................... ..............42
Focus Area 2: Healthy and Hygienic living Conditions ............ .....42
Focus Area 3: Climate Change.............................................. .........................42
Focus Area 4: Safe Water ...................................................................................................43
-------------
EXECUTIVE SUMMARY
DPR Korea commitment to Primary Health Care
The commitment of DPRK to the development and maintenance of the primary health care system has been substantial and the health system workforce has developed into 242 341 staff of all categories in 2014. Substantial resources are also invested into the pre-service and continuing education programs. The health sector is also tasked with financing the extensive network of 9 076 health facilities(2014) across the country, including equipping, logistical support, renovation, maintenance and operational support.
According to the 2014 MoPH health report, the state has increased the health share from 5.9% of the GDP in 2000 to 6.1% in 2010. It has been maintained at around 6.4% of the GDP in recent years (2014).
The Medium Term Plan for Development of the Health Sector in DPRK 2016 - 2020 was developed between May and June 2016. This plan is meant to describe a 5-year strategy for the sector, it serves as a framework to plan activities to achieve the specific objectives to address the health needs of the population of DPRK.
The plan was developed guided by the national health priorities and building on the achievements of the last cycle and the WHO/SEAR regional flagship initiative is incorporated in the plan. A thorough review of the literature and health systems development in DPRK together with interviews with MoPH program managers and development partners were undertaken. Two workshops were organized with the MoPH managers to assess the situation and to conclude a strategic framework that reflects the MoPH priorities for the coming 5 years.
A draft plan was finalized in July 2016 and submitted to the MoPH and the WHO for further reviews and inputs. The strategic framework developed for this plan describes 8 strategic areas.
Situation Analysis and Conclusions
(1) Remarkable public health gains were achieved in recent years, from significant reductions in the MMR, IMR and the U5MR to the noticeable improvements in the malnutrition indicators among women and children, the high immunization coverage is being sustained, high success treatment rates of TB patients using the DOTS, substantial declines in the incidence of malaria, expansion of the IMCI strategy, scaling up of essential obstetric care at Ri and county levels, infrastructure development and improvement in blood safety;
(2) This continuous success is attributed to the committed public health policy that incorporates preventive and curative approach with an intensive network of health facilities and staff at the very first levels, this is the solid health system base that ensured universal health coverage. “High Tech” on its own does not guarantee a universal health coverage, it should be balanced with the overall public health approach. Moreover, there was an improvement in the public health management and technical capacity of the health staff that was possible with the health system partnerships developed along the recent years. The multilateral MOPH and WHO program for improving women’s and children’s health has provided the first framework for a wider vision of health development, which was accelerated through the GAVI HSS and Global Fund initiatives and partnerships with UN agencies WHO, UNICEF, UNFPA and NGOs;
(3) On the other hand, there are challenges that have their impact on the health system’s capacity to deliver the very basic care like the operational funds, infrastructure, referral systems and logistics. This calls for innovative managerial approach to rationalize the limited resources through considering a combination of coordination mainly at the central level an integration mainly at the sub-national level;
(4) Areas of growing influence on the people’s health like non-communicable diseases and social determinants of health were identified by the DPRK government as priorities and multi-sectoral steps are being and continue to be taken by the MoPH with support from the development partners to address this area. However, the programs’ funding is “donors’ driven” and there is a need to advocate with the donors and the UN agencies to find innovative means to ensure more flexibility in using the funds, especially in the area of health system that would reflect on all health services delivery;
(5) In the last decade, the WHO have been regularly supporting fellowships mainly in the area of public health and the National Institute for Public Health Administration (NIPHA). Now, with more public health specialists and improving capacity of NIPHA, it is worthy to explore the development of local public health master degree in collaboration with the WHO and a reputable academic institute in the region. The fellowships focus could shift to other areas of growing need like Health economics and Geriatrics;
(6) As mentioned above, there have been remarkable success in the area of CDC. However, two areas of concern are: MDR TB and Hepatitis, much have been and are being done especially in the MRD TB but more efforts are needed to accelerate the pace;
(7) With the nationwide expansion of the telemedicine network, introduction of the WHO Emergency Essential Surgical Package at the first referral level could be considered;
(8) Many activities have been and continue to be undertaken in the cross-cutting areas of training, health information system and supervision. The quality outcome remains a concern. More participation of the development’s partners in training sessions, field visits with the supervisors to follow-up on the impact of interventions, to assist the hands-on training on data analysis and use for planning and to obtain feedback would improve the outcome and ensure the quality;
(9) The considerable research agenda proposed, coupled with the call for technical update, exchange and twinning arrangements with regional scientific and research institutes emphasizes the commitment of the MoPH to pursuit a scientific evidence-based approach in order to deliver better quality health care
(10) The foundation of the DPRK health system, universal coverage and the principles of primary health care are enshrined in the section doctor system. In order to benefit from the strengths of this system, this strategic plan proposes more efforts to strengthen the section doctors’ capacities;
(11) Finally, a longer-term vision, say for the 2030 is worthy of exploring through a think-tank from the MoPH and partners.
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