“Primary health care: back to Alma-Ata in early 21st century"


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“Primary health care: back to Alma-Ata in early 21st century"

  1. 1. “Primary health care: back to Alma-Ata in early 21st century" Dr Jean-Jacques BERNATAS, MD, MSc – Medical Regional Coordinator – Institut Pasteur/SISEA Project. jjbernatas@gmail.com
  2. 2. Plan 1. Definition – Declaration of Alma-Ata 2. 2008 vision of PHC 3. PHC in practice 4. Conclusion 5. References Primary Health Care - Vientiane - 2 Feb. 21st 2010
  3. 3. DEFINITION – Declaration of Alma-Ata (Sept. 1978): core principles. 1. Essential health care, based on: 1. Evidence-based approach 2. Social acceptability 3. Accessibility of technology 4. Participatory approach involving communities 5. Affordability of services 2. Integration in the national health systems, 3. Integration in the social and economic development of the community 4. Bringing services a close as possible to the people 5. First contact with health care system as the main point of entry Primary Health Care - Vientiane - 3 Feb. 21st 2010
  4. 4. DEFINITION – Declaration of Alma- Ata (Sept. 1978): content (1) 1. Relevance: soco-economic context, sound scientific content (EB-M/PH) 2. In line with the existing local situation 3. Providing: Health promotion services Preventive services Curative services Rehabilitation services Primary Health Care - Vientiane - 4 Feb. 21st 2010
  5. 5. DEFINITION – Declaration of Alma- Ata (Sept. 1978): content (2) 4. Including: Education for health (prevention and control) Promotion of better nutrition Safe water and “watsan” MCH Immunization Prev&control of endemic diseases Appropirate TTT of common diseases&injuries Essential drugs supply Primary Health Care - Vientiane - 5 Feb. 21st 2010
  6. 6. DEFINITION – Declaration of Alma- Ata (Sept. 1978): content (3) 5. Involving all related sectors: agriculture, animal husbandry, education, industry, communication, … 6. Community and individual self-reliance& participation from planning to implementation of PHC activities 7. Comprehensive health care services: Integration Referral system Best offer (quality) for all Prioritizing those most in need 8. Wide range of health workers (physicians to community worker; including traditional practitioners) Primary Health Care - Vientiane - 6 Feb. 21st 2010
  7. 7. DEFINITION – Declaration of Alma- Ata (Sept. 1978): content (4) 9. Government leadership in implementing national policies strategies, and plans of actions, … 10. International cooperation: bilateral, multilateral, NGOs. Strong support from WHO/UNICEF 11. “Health for all by year 2000” ….. Primary Health Care - Vientiane - 7 Feb. 21st 2010
  8. 8. DEFINITION – Declaration of Alma- Ata (Sept. 1978): achievements and limitation (1) 1. Awareness of political leaders and stakeholders in putting people at the centre of health care 2. People are healthier BUT: what is the PHC’s input? Global economic Longer life expectancies develoment could also (mainly?) explain these Lower infant mortality rate achievements … Better access to safe water Etc … Primary Health Care - Vientiane - 8 Feb. 21st 2010
  9. 9. DEFINITION – Declaration of Alma- Ata (Sept. 1978): achievements and limitation (2) BUT …..same problems remains active + discrepancies between high-income and low-income countries, and within countries More financial resources available now than never before even if health financing comes at the top of political agenda Human resources for health comes up as a key issue everywhere, Common shortcomings in health care delivery: inverse care, impoverishing care, fragmented and fragmenting care, unsafe care, misdirected care …. New paradigms tighly linked with health issues: new communication (web), climate change, ageing and growing demography … Primary Health Care - Vientiane - 9 Feb. 21st 2010
  10. 10. 2008 vison of PC – 2008 WHO report. Change of questionning health issues From : « focus of small number of selected diseases, primarily infectious and acute » To: « A comprehensive response to people’s expectations and needs, spanning the range of risks and illness From : « concentration on mother and child health » To: « dealing with the health of everyone in the community » From : « simple technology for volunteer, non-professional community health workers » To: « teams of health workers facilitating access to and appropriate use of technology and medicines » Primary Health Care - Vientiane - 10 Feb. 21st 2010 And so on …
  11. 11. 2008 vison of PC – 2008 WHO report. The 4 sets of PHC reforms 1. Universal coverage reforms to improve health equity 2. Sevice delivery reforms to make health systems people-centred 3. Public policies reforms to promote and protect the health of communities 4. Leaderships reforms, to make health authorities more reliable Primary Health Care - Vientiane - 11 Feb. 21st 2010
  12. 12. PHC in practice - Thailand 1. Health promotion as a key activity 2. Huge health volunteers commitment, especially the Buddhist monks 3. Universal coverage scheme providing health care for its 64 million people. 4. Strong government involvement, f.i. supporting the Thailand’s health promotion Temple project from 2003. Primary Health Care - Vientiane - 12 Feb. 21st 2010
  13. 13. PHC in practice – Emerging diseases in SEA 1. Consequence of the « famous » changing world. 2. Typical obvious exemple of the inefficiency of a vertical fragmented approach. 3. Multisectoral response came up as a part of an evidence-based plan of action. 4. Key of the success related to the community participation and appropriation of this long- term issue. Primary Health Care - Vientiane - 13 Feb. 21st 2010
  14. 14. PHC in practice – TB control 1. Began early as a typical vertical approach of disease control but in line with PHC’s principles (free and afordable high-quality services, essential drugs, community involvement, …) 2. Was included at the vey beginning in the PHC’s « package » 3. Had to face with unexpected issues (HIV/AIDS; health financing; MDR-TB) that force this vertical approach to strenghten multisectoral and transversal links Primary Health Care - Vientiane - 14 Feb. 21st 2010
  15. 15. CONCLUSION 1. PHC is definitely not an old and ineffective bureaucratic concept … 2. On the contrary, it is a modern, comprehensive and updated tool, providing drafts of plans for actions for improving health for all, through a holistic (individual and people-centred) and realistic (addressing financial and political issues) Primary Health Care - Vientiane - 15 Feb. 21st 2010
  16. 16. REFERENCES 1. The World Health Report 2008 - primary Health Care (Now More Than Ever). http://www.who.int/whr/2008/en/index.html 2. Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978. www.who.int/hpr/NPH/docs/declaration_almaata.pdf 3. Carol Perks,a Michael J Toole,b & Khamla Phouthonsyc. District health programmes and health-sector reform: case study in the Lao People’s Democratic Republic Primary Health Care - Vientiane - 16 Feb. 21st 2010