Primary health care: how different will it be in the 21st ... Health... · Primary health care: the...
Transcript of Primary health care: how different will it be in the 21st ... Health... · Primary health care: the...
Primary Health Care: How different Primary Health Care: How different will it be in the 21st Century? will it be in the 21st Century?
UNWRA Health Services: Past, Present and FutureCommodore Hotel, Thursday 23rd June 2011
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Primary Health CarePrimary Health Care
Idea of comprehensive primary health care Idea of comprehensive primary health care operates at two levels: operates at two levels:
as as overall approach of health workoverall approach of health work, which , which is part of the overall social and economic is part of the overall social and economic development of the community; and development of the community; and
as a as a level of contact and care level of contact and care within the within the health system reconfigured to emphasize health system reconfigured to emphasize the essential health needs of the the essential health needs of the population population
Primary health care: the vision of Primary health care: the vision of AlmaAlma--AtaAta
Alma Ata Declaration of 1978 is a landmark in Alma Ata Declaration of 1978 is a landmark in the history of public health and for WHOthe history of public health and for WHO
Universal values and principles of Universal values and principles of comprehensivecomprehensive PHCPHC
Health equity, social justice, universal accessHealth equity, social justice, universal access
Community participation, health a human rightCommunity participation, health a human right
regardless of residence, gender, social status and regardless of residence, gender, social status and cultural identity cultural identity
Year 2008, the 30th Anniversary of Alma Ata, Year 2008, the 30th Anniversary of Alma Ata, provided opportunity to reaffirm commitment to provided opportunity to reaffirm commitment to PHC PHC
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Evolution of Primary Health Care: A birdEvolution of Primary Health Care: A bird’’s s eye view eye view
19791979-- Selective PHCSelective PHC: considered pragmatic, : considered pragmatic, financially sustainable, politically palatablefinancially sustainable, politically palatable
1980s 1980s -- Structural Adjustment ProgramsStructural Adjustment Programs: : required reduced spending on social sectors required reduced spending on social sectors and levy charges for primary care and levy charges for primary care
19881988-- WHO advised member states to allocate WHO advised member states to allocate at least 5% of GDP to achieve HFA at least 5% of GDP to achieve HFA
19931993-- World Bank WDRWorld Bank WDR: Investing in Health : Investing in Health defined a defined a basic benefit package basic benefit package of essential of essential health interventions health interventions
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Evolution of Primary Health Care: A Evolution of Primary Health Care: A birdbird’’s eye views eye view
1998- WHO reinvigorated Health For All in the 21st Century
2000-WHO’s millennium World Health Report on health systems
2000- Millennium Development Goals Declaration
2005- WHO Commission on Social Determinants of Health [SDH]
2008- 30th Anniversary and revival of PHC, World Health Report on PHC,
2008 - Report of Global the Commission on SDH
2010 – World Health Report – Path to Universal Coverage
Primary Health Care Primary Health Care -- 19781978
International Conference on Primary Health International Conference on Primary Health Care, AlmaCare, Alma--Ata, USSR, 6Ata, USSR, 6--12 September, 197812 September, 1978
Eight components:•Public Education•Proper Nutrition•Clean Water & Sanitation•Maternal & Child Health Care•Immunization•Local Disease Control•Accessible Treatment•Drug Provision
Values and Principles:•Equity•Social justice•Participation•Appropriate technology•Patient centeredness
1980 – Comprehensive vs. Selective Primary Health Care
Renewal of Primary Health Care calls for universal coverage reform - 2008
Universal coverageequity and social justice
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Four areas of PHC ReformsFour areas of PHC Reforms
Universal coverage reforms that ensureUniversal coverage reforms that ensure health health systems contribute to health equity, social justice systems contribute to health equity, social justice and the end of exclusion, primarily by moving and the end of exclusion, primarily by moving towards universal access and social health towards universal access and social health protection;protection;
Service delivery reforms that reService delivery reforms that re--organize organize health health services around peopleservices around people’’s needs and s needs and expectations, to make them socially relevant and expectations, to make them socially relevant and more responsive to the changing world, while more responsive to the changing world, while producing better outcomes;producing better outcomes;
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Four areas of PHC ReformsFour areas of PHC Reforms
Public policy reforms that secure healthier Public policy reforms that secure healthier communities, by integrating public health actions communities, by integrating public health actions with primary care, by pursuing healthy public with primary care, by pursuing healthy public policies across sectors policies across sectors ………………; and; and
Leadership reforms that replace disproportionate Leadership reforms that replace disproportionate reliance on command and control on one hand, reliance on command and control on one hand, and laissezand laissez--faire disengagement of the state on faire disengagement of the state on the other, by the inclusive, participatory, the other, by the inclusive, participatory, negotiationnegotiation--based leadership based leadership …………....
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DISEASEORIENTED
RISK FACTORORIENTED
Primary Health Care: the Driving Force for developing National Health Systems
WELLNESSWELLNESS
ILLNESSILLNESS
HEALTH PROMOTION HEALTH PROMOTION ORIENTEDORIENTED
Innovations in primary health care in countries of the Eastern Mediterranean Region
District health system
Sultanate of Oman - Welayat Health System
Islamic Republic of Iran - Shabakeh Behdashti
Community Health workers
Pakistan – 100,000 females CHWs recruited by government
IRI – Recruitment of 25 000 male and female Behvarz
Integration of medical education with health services
Islamic Republic of Iran, Tunisia
Experience with public private partnership for PHC services
Lebanon, Afghanistan
Family health practice model
Jordan, Egypt, Bahrain, Oman, Saudi Arabia, Tunisia, UNWRA
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Characteristics of a Family Practice Characteristics of a Family Practice Model Model
Care provided within a community contextCare provided within a community context
PatientPatient--centered centered
WholeWhole--person orientation person orientation
Team approach Team approach
Elimination of barriers to accessElimination of barriers to access
Advanced information systemsAdvanced information systems
Emphasis on quality and safety Emphasis on quality and safety
Commitment to provide family medicineCommitment to provide family medicine’’s s basket of servicesbasket of services
Elements of family practice programElements of family practice program
Universal access to essential package Universal access to essential package of health services, of health services, based on BOD and of acceptable quality ;based on BOD and of acceptable quality ;
Fully registered population Fully registered population with PHC network through a with PHC network through a system of system of family foldersfamily folders, continuity of care;, continuity of care;
Well functioning Well functioning referral system referral system that ensures PHC that ensures PHC facilities serve as facilities serve as gatekeepergatekeeper, appropriate referral, timely , appropriate referral, timely feedbackfeedback
Workforce trained in family practice Workforce trained in family practice and led by a family and led by a family physician, that is motivated to establish a FP program physician, that is motivated to establish a FP program
Hospital is integral component of family practiceHospital is integral component of family practice program program and engaged in referral, training and monitoring support;and engaged in referral, training and monitoring support;
Elements of family practice program [2]Elements of family practice program [2]
Local health management is committed to Local health management is committed to well performing family practice program;well performing family practice program;
Automated health information system Automated health information system (including civil registration) for informed (including civil registration) for informed decisions at the local level;decisions at the local level;
Proactive community Proactive community that understands the that understands the benefits of a family practice program and is benefits of a family practice program and is involved in its establishment; involved in its establishment;
Financial protection Financial protection of households in the of households in the event of serious illnessevent of serious illness
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Benefit package of health services of Benefit package of health services of PHC ServicesPHC Services
Defining and developingDefining and developing
Basis Basis -- Burden of disease Burden of disease and risksand risks
Basic or essential vs. Basic or essential vs. ComprehensiveComprehensive
Public health interventionsPublic health interventions
Clinical interventions Clinical interventions
CostingCosting
Essential interventions Essential interventions includedincluded
Resources availableResources available
Marginal costs [cost of Marginal costs [cost of adding or enhancing an adding or enhancing an intervention] intervention]
FinancingFinancing
Tax basedTax based
Insurance basedInsurance based
Donor fundedDonor funded
Privately financedPrivately financed
ProvisionProvision
PublicPublic
Private for profit, not for Private for profit, not for profitprofit
Skills mix [Physician, nurse, Skills mix [Physician, nurse, medical technician, health medical technician, health worker etc.]worker etc.]
Monitoring Monitoring
IndicatorsIndicators
Means and mechanism Means and mechanism
Countries in Eastern Mediterranean Countries in Eastern Mediterranean –– Family Practice ProgramFamily Practice Program
Islamic Republic of Iran Islamic Republic of Iran
BahrainBahrain
Saudi ArabiaSaudi Arabia
JordanJordan
Iraq Iraq
EgyptEgypt
LibyaLibya
Syria Syria
UNWRAUNWRA
KuwaitKuwait
QatarQatar
United Arab EmiratesUnited Arab Emirates
OmanOman
LebanonLebanon
PalestinePalestine
Tunisia Tunisia
MoroccoMorocco
WHR 2010: Path to Universal CoverageWHR 2010: Path to Universal Coverage
Raising sufficient Raising sufficient resources for healthresources for health
Removing financial Removing financial risks and barriers to risks and barriers to accessaccess
Promoting efficiency Promoting efficiency and eliminating wasteand eliminating waste
Addressing inequalities Addressing inequalities in coveragein coverage
PHC and Social Determinants of Health PHC and Social Determinants of Health [SDH] [SDH] --20082008
Improve Daily Living Improve Daily Living ConditionsConditions
Tackle the Inequitable Tackle the Inequitable Distribution of Power, Distribution of Power, Money, and ResourcesMoney, and Resources
Measure and Understand Measure and Understand the Problem and Assess the Problem and Assess the Impact of Actionthe Impact of Action
Innovations in Primary Health Care: SDH and Community Development Approach
Tackle social determinants of health and health equity
women’s empowerment through education and employment
early child development
migrant workers – movements within and between countries
social dimensions of priority public health conditions
socially determined lifestyle and behaviors
conflicts and emergencies and the resulting health inequities
Community Based Initiatives (CBI)
Healthy Villages
Healthy Cities
Basic Development Needs and
Gender in Health and Development
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Tackling social determinants (SDH) of health through community based initiatives (CBI)
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Poor, rural, disempowered
community
Skills Development
Income Generation
Public Health Interventions
Organized & empowered community
Improved quality of
Life
COMMUNITY BASED INITIATIVES –Basic Development Needs Programme
Sustainability
Reduce Poverty
Address Social Determinants
Social Development
Community Organization
Women Development
Improved health
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Final thoughtsFinal thoughts
Values of PHC are Universal Values of PHC are Universal –– Equity, social Equity, social justice, participation, human rightsjustice, participation, human rights
Develop health systems based on the values of Develop health systems based on the values of PHC, but one size fits all approach will not workPHC, but one size fits all approach will not work
Family practice is the principle approach for Family practice is the principle approach for achieving PHC based health systems achieving PHC based health systems
Focus on financing, provision and governance Focus on financing, provision and governance while establishing health care serviceswhile establishing health care services
Tackling SDH and health equity should be Tackling SDH and health equity should be integral to any future PHC programsintegral to any future PHC programs
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Thank youThank you