Renewal Of Primary Health Care


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Dr. Patrick Kadama

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  • Title of national research study results published in the American Journal of Medicine: Medical bankruptcy in the United States, 2007
  • The graph shows how people shift to professional care as soon as they're given the chance: red part is proportion relying on professional care at birth
  • The photograf shows the origin of what led to the thai quantum jump towards universal coverage: civil society movement with the chair of the pensioners association reading out the declaration of patient's rights at a gathering of 3000 representatives of civil society organizations
  • Renewal Of Primary Health Care

    1. 1. Health for All: The renewal of primary health care & The resurgence of the primary health care movement Gran Hotel Santa Cruz de la Sierra, Bolivia, 29 July – 30 July 2009 Presented by Dr. Patrick KADAMA, Dept for for Health System Governance and Service Delivery (HSS/HDS) (modified from Carissa Etienne et al 2009)
    2. 2. Renewal of PHC - What is this about? <ul><li>It is NOT about …. </li></ul><ul><li>(poor) care for poor people in poor countries </li></ul><ul><li>BUT It is about …. </li></ul><ul><li>putting people at the centre of health & development, in the whole world </li></ul>
    3. 3. 9.2 M child deaths instead of 16-17M, but unequal improvement and growing gaps
    4. 4. Technical challenge or political problems/obstacles ? <ul><li>Global frustration with fragmentation and unequal results  scaling up services for HIV, TB, malaria, immunization… </li></ul><ul><li>New challenges to health and health systems </li></ul><ul><ul><li>Climate change </li></ul></ul><ul><ul><li>Urbanization, aging, globalization... </li></ul></ul><ul><ul><li>Chronic diseases, multi-morbidity </li></ul></ul><ul><li>National frustration with mismatch of expectations and performance </li></ul><ul><li>The social impact of business as usual </li></ul><ul><ul><li>The Global Financial crisis: Borrowing, asset depletion, poverty – in the USA as well as in Cambodia etc … </li></ul></ul><ul><ul><li>Within-country inequalities </li></ul></ul>
    5. 5. Within-country inequalities in health and health care <ul><li>Better information shows health inequalities tend to increase </li></ul><ul><li>Inadequate, uneven response of health systems </li></ul>
    6. 6. Where are we now? <ul><li>Buenos Aires, Beijing, Bangkok, Tallinn, Ouagadougou, Jakarta, Doha </li></ul><ul><li>The global financial crisis, Executive Board resolution </li></ul><ul><li>Rapidily changing aid environment </li></ul><ul><li>WHA resolution </li></ul>
    7. 7. Convergence of concerns <ul><li>Worries about MDGs and health systems </li></ul><ul><li>Regional reviews and resolutions </li></ul><ul><li>Commission of social determinants </li></ul><ul><li>Initiatives from civil society, academia, the professions, business </li></ul>
    8. 8. What's new with the renewal of PHC: is starting from what people value: <ul><li>Health equity, solidarity, social inclusion </li></ul><ul><li>Effective, safe and people-centered care </li></ul><ul><li>Living in communities whose health is protected and promoted </li></ul><ul><li>Health authorities that can be relied on </li></ul><ul><li>Having a say in what affects their lives and that of their families </li></ul>Health system strengthening PHC renewal
    9. 9. 4 + 1 policy directions to refocus health systems Participation
    10. 10. <ul><li>Move towards universal coverage: access plus social protection </li></ul><ul><li>Sufficient supply </li></ul><ul><li>No barriers to access </li></ul><ul><li>Pooled prepayment </li></ul><ul><li>Plus: local and society-wide efforts to: </li></ul><ul><li>reach the unreached; </li></ul><ul><li>address social determinants; </li></ul><ul><li>address consequences of health inequality; and </li></ul><ul><li>ensure visibility of inequalities </li></ul>Implications for: Financing, Service delivery, Information systems, Technology, Governance Implications for HRH & Nurses: needs, numbers, access, behavior > <ul><li>Address health inequality and social exclusion </li></ul>
    11. 11. 2. Transform conventional health care delivery models into people-centred primary care networks <ul><li>Trust and rights: </li></ul><ul><ul><li>Explicit entitlements </li></ul></ul><ul><ul><li>User voice </li></ul></ul><ul><ul><li>Beyond minimum packages </li></ul></ul><ul><li>Key features: </li></ul><ul><ul><li>Effectiveness </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><ul><li>Comprehensiveness and integration </li></ul></ul><ul><ul><li>Person-centeredness </li></ul></ul><ul><ul><li>Continuity (in synchrony with human life cycle) </li></ul></ul><ul><li>Organizational frameworks (moving away & beyond levels of care) : </li></ul><ul><ul><li>Entry point through close-to-client networks of primary care teams / districts </li></ul></ul><ul><ul><li>A personal relation between services and users </li></ul></ul><ul><ul><li>Explicit responsibility for all members of a defined population </li></ul></ul><ul><ul><li>Coordinate/mobilize inputs from other levels of care (and from social services) </li></ul></ul>
    12. 12. 2. Transform conventional health care delivery models into people-centred primary care networks <ul><li>Desired straight through changes do not happen automatically (because of strong supply side distortions) </li></ul><ul><li>Avoiding current diversionary trends has implications for health programs - different profiles, changed behavior etc. </li></ul>
    13. 13. 3. Moving Beyond Local/Sectoral action: protecting the health of communities through better public policies <ul><li>Correct underinvestment in effective public health policies: </li></ul><ul><ul><li>country-wide public health initiatives </li></ul></ul><ul><ul><li>capacity to anticipate (institutions, strategic intelligence, research) </li></ul></ul><ul><ul><li>rapid response capacity </li></ul></ul><ul><li>Intersectoral policy dialogue and “health in all policies”: </li></ul><ul><ul><li>impact assessments </li></ul></ul><ul><ul><li>capacity building </li></ul></ul><ul><li>Implications for Nursing: recognition of broader responsibilities & for building capacities </li></ul>
    14. 14. 4. Rebuilding trust: (Re-invest in inclusive leadership, effective government <ul><li>Paradigm changes </li></ul><ul><ul><li>The value of activist government </li></ul></ul><ul><ul><li>From command-and-control to steer-and-negotiate </li></ul></ul><ul><ul><li>Do more with less, but prepare to do more with more </li></ul></ul><ul><li>Focus: </li></ul><ul><ul><li>Deliver on universal coverage, people-centred primary care and better public policies; </li></ul></ul><ul><ul><li>Regulatory capacity and instruments to govern the whole sector </li></ul></ul><ul><ul><li>Centrality of national plan / national strategy </li></ul></ul><ul><li>From driven by technocracy to driven by participation </li></ul><ul><li>Implications for HRH: new responsibilities, new behavior, shared power </li></ul>
    15. 15. What does the Resolution say needs to be done? <ul><li>Priority for whom? </li></ul><ul><li>Priority for what? </li></ul><ul><li>Build on inter-country exchange </li></ul><ul><li>Paris </li></ul><ul><li>Money </li></ul><ul><li>Implementation plans and reporting (technical support) </li></ul>
    16. 16. What does this mean for health professions? <ul><li>Priorities </li></ul><ul><ul><li>broader skills development / behaviour change - beyond task shifting - for a central & critical role in people centred services delivery including expanded nurse practioner services </li></ul></ul><ul><li>Engagement and collaboration </li></ul><ul><ul><li>With civil society / communities and across sector for health promotion in implementation of all policies for socio-economic development </li></ul></ul><ul><li>Leadership (both up-stream & at the community level) </li></ul><ul><ul><li>Proactive action for more intense participation in health policy development, system planning, management, professional education and research. </li></ul></ul>
    17. 17. The End