Reflections On The Future Of Primary Health Care


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This presentation was delivered to an Institute of Tropical Medicine (Belgium) colloquium on primary health care by Gerald Bloom

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Reflections On The Future Of Primary Health Care

  1. 1. Reflections on the future of primary health care Gerald Bloom Institute of Development Studies, UK Presented to Colloquium on Primary Health Care in Times of Globalisation Institute of Tropical Medicine, Antwerp November 2008
  2. 2. Alma Ata Declaration <ul><li>Position statement by international organisations (WHO and UNICEF) </li></ul><ul><li>Consensus on post-colonial/post-revolutionary health system development strategies </li></ul><ul><li>State of the art on the organisation of primary care services </li></ul><ul><li>Political statement and vision of ideal health system </li></ul>
  3. 3. … 30 years later the Declaration <ul><li>Many more actors in international health - WHO and UNICEF are redefining their roles </li></ul><ul><li>Emergence of pluralistic health systems - growing gap between reality and language of policy and international agreements </li></ul><ul><li>Continued agreement on value of primary health care and there is much more evidence on good practice models </li></ul><ul><li>The values of universal access persist but there is a tension between the post-colonial vision and current development realities </li></ul>
  4. 4. … 30 years later health and health services <ul><li>Expansion of global health sector (infrastructure, personnel, logistics, programmes, information) </li></ul><ul><li>Major divergence between countries in health system performance and health status </li></ul><ul><li>Growing concern about the implications of health inequalities for political stability, global health and peaceful development </li></ul>
  5. 5. … 30 years later the development context <ul><li>Globalisation, spread of markets and new patterns of inequality and poverty </li></ul><ul><li>Rapid changes in population, demography, ecology and the burden of disease </li></ul><ul><li>Many more health sector actors </li></ul><ul><li>Multiplication of channels for information flow (including on health-related issues) </li></ul>
  6. 6. Building primary health care services: scaling up and rolling out <ul><li>Evidence on effective low-cost interventions </li></ul><ul><li>Gap between actual and potential access to effective services </li></ul><ul><li>Resource commitments to reduce this gap </li></ul><ul><li>Limited evidence on how to improve access to interventions in different development contexts </li></ul><ul><li>Nostalgia, advocacy or practical strategy for health system development? </li></ul>
  7. 7. Markets for health-related goods and services <ul><li>Spread of markets for health-related goods and services and blurring of boundaries between public and private </li></ul><ul><li>Market segmentation between social groups </li></ul><ul><li>New communication technologies and channels of flow of information and influence </li></ul><ul><li>The creation of institutions for influencing these markets has lagged behind </li></ul>
  8. 8. Changing demand for health services <ul><li>Increased burden of chronic diseases including HIV </li></ul><ul><li>Increased availability of treatment (effective and ineffective) </li></ul><ul><li>Many influences on health seeking (mass media, internet, advertising, advocacy groups) </li></ul><ul><li>Political pressure for long-term public finance </li></ul>
  9. 9. Risks of epidemics <ul><li>Rapid urbanisation, industrialisation and changing patterns of animal husbandry </li></ul><ul><li>Large populations with increased susceptibility to infection </li></ul><ul><li>Increased national and international concern about possible epidemics </li></ul><ul><li>Effective responses require effective public health services which command the trust of the public and cross-border cooperation </li></ul>
  10. 10. (Re-)Building effective health systems <ul><li>Strategies based on an understanding of existing systems </li></ul><ul><li>Changing roles of households, citizen groups, private actors (local and international) and government </li></ul><ul><li>Support for the creation of new social contracts between providers and users of health services </li></ul><ul><li>Creation of regulatory partnerships </li></ul><ul><li>Build the government’s reputation for competence and fairness </li></ul>
  11. 11. The politics of primary health care <ul><li>Economic crisis, social protection and access to health care </li></ul><ul><li>Regulating national and international health systems </li></ul><ul><li>Creating partnerships for primary health care </li></ul><ul><li>Building political coalitions that recognise the importance of interests and power </li></ul>