CAPITULO I: MARCO TEÓRICO DE REFERENCIA SOBRE LAS GENERALIDADES
E. DESARROLLO LABORAL Y PROFESIONAL
3. CONCEPTO DE DESARROLLO LABORAL
Understand that utilisation rates are not constant. Utilisation rates are given in terms of visits to a health facility per person per year. These rates are not constant and may vary based on the phase of the emergency, population demographics and season etc. Utilisation rates generally increase in displaced populations and populations affected by other public health emergencies. As services are started, there might be a great demand for unmet needs. This is likely to reduce. The demand for services might, also, be higher in children.
Utilization of specific types of health care and facilities can be dramatically different based on the nature of the emergency. An earthquake results in relatively larger numbers of broken bones, fractures and crush injuries whereas a famine in severe malnutrition and can lead to an increase in infectious diseases because of overcrowding and poor sanitation. After a large earthquake, utilisation rates for fracture and musculoskeletal services will be higher than other causes. Note, however, that levels of trauma are seldom as great in absolute numbers as one might expect, even in the beginning of an emergency.
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Problems with rape and domestic violence, however, can provide a permanent need for trauma services.
Generally, utilisation rates among stable populations have approximately 0.5-1.0 new consultations per person per year. Among displaced populations, there are approximately 4.0 new consultations per person per year. 27
Figure 2-25: Example of unusual health needs following an earthquake
On December 26, 2003, an earthquake measuring 6.8 on the Richter scale destroyed the city of Bam in southeast Iran. Over 20,000 homes were destroyed; more than 40,000 out of 90,000 people living in the city died in the acute phase and close to 30,000 were injured. A referral hospital in the capital of Tehran reported a series of unscreened patients who were transferred for care. Nearly 47% of patients had lower limb fractures and nearly 30% had upper limb fractures. A large percentage of limb fractures were associated with nerve injuries. Approximately 15% of the injured suffered head injuries.29
Calculate the utilisation rates for health facilities. If utilisation rates fall below what is expected, it could indicate that populations in need might have quite inadequate access to health facilities. Reasons for limited access can include an inadequate number of staff;
Under-staffed facilities;
Poor security; and
Barriers based upon gender, age or ethnic group.
If utilisation rates exceed those expected, it could indicate an underestimation of the size of the affected population or a specific public health problem such as broken bones from an earthquake or a diarrhoea outbreak among children. Utilisation rates should be re- calculated on a weekly or monthly basis because they change over time as the public health emergency evolves.
Figure 2-26: Determining the health facility utilisation rate
Definition: The number of out-patient visits per person per year. Whenever possible, a
distinction should be drawn between new and old visits. New visits should be used to calculate this rate. However, it is often difficult to differentiate between new and old visits because they are frequently combined as total visits during a disaster.
Formula: Total number of visits in one week = visits/person/year
Total population x 52 weeks
Example: There are 350 visits to health facilities serving a displaced population of
5,000 people.
Utilization Rate = 350 = 3.64 visits per person per year 5,000 x 52
The utilization rate is 3.64, which is just less than the expected value of approximately 4.0 visits per person per year. This could indicate that the population is adequately served at the present time.
Take corrective measures if there is over- or under-utilisation of health facilities. If the utilisation rate reveals that there is significant over- or under use of health facilities, corrective measures must be taken.
In cases of apparent overuse, health information systems can identify the most common causes for visits to health facilities. This information can be used for the appropriate redirection of resources. If a diarrhoeal outbreak is identified as the cause of a high utilization rate, community health workers can be trained to deliver and teach parents the
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correct use of oral rehydration solution. If there is a lower than expected utilisation rate, the system must be evaluated and the barriers to health care identified and removed. Ensure that vulnerable groups are not under represented among health facility attendees. Good record keeping and health information systems can be used to ensure that vulnerable groups such as the elderly, ethnic minorities, the disabled, females etc, have utilisation rates that are similar to the general population. If vulnerable groups’ utilisation rates significantly differ from those of the general population, vulnerable groups’ community leaders should be engaged to identify and remove the barriers to health care promptly.
When planning, take into account the time factor: the patient load after an earthquake or sudden impact disaster peaks between the first three to six weeks. The sequence of injuries can be reduced dramatically in this period but is replaced by more and more chronic disease problems.