Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20091 |

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)

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)

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20092 |

Renewal of PHC - What is this about?

It is NOT about ….

(poor) care for poor people in poor countries

BUT It is about ….

putting people at the centre of health & development, in the whole world

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20093 |

9.2 M child deaths instead of 16-17M, but unequal improvement and growing gaps9.2 M child deaths instead of 16-17M, but unequal improvement and growing gaps

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20094 |

Technical challenge or political problems/obstacles ?Technical challenge or political problems/obstacles ? Global frustration with fragmentation

and unequal results scaling up services for HIV, TB, malaria, immunization…

New challenges to health and health systems

– Climate change– Urbanization, aging, globalization...– Chronic diseases, multi-morbidity

National frustration with mismatch of expectations and performance

The social impact of business as usual– The Global Financial crisis:

Borrowing, asset depletion, poverty – in the USA as well as in Cambodia etc …

– Within-country inequalities

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20095 |

Within-country inequalities in health and health careWithin-country inequalities in health and health care

Better information shows health inequalities tend to increase

Inadequate, uneven response of health systems

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20096 |

Where are we now?Where are we now?

Buenos Aires, Beijing, Bangkok, Tallinn, Ouagadougou, Jakarta, Doha

The global financial crisis, Executive Board resolution

Rapidily changing aid environment

WHA resolution

SIXTY-SECOND WORLD HEALTH ASSEMBLY WHA62.12

Agenda item 12.4 22 May 2009

Primary health care, including health system strengthening

The Sixty-second World Health Assembly,

Welcoming the efforts of the Director-General, and recognizing the pivotal role that WHO plays, in promoting primary health care globally;

Having considered the report on primary health care, including health system strengthening;1

Reaffirming the Declaration of Alma-Ata (1978) and the United Nations Millennium Declaration (2000);

Recalling the Ottawa Charter for Health Promotion (1986) and subsequent relevant resolutions of WHO regional committees and Health Assemblies; 2

Recalling also the discussions at the series of summits and global, regional and national conferences that have reaffirmed the commitment of Member States to primary health care and strengthening health systems; 3

Noting the growing consensus in the global health community that vertical approaches, such as disease-specific programmes, and integrated health systems approaches are mutually reinforcing and contribute to achieving the health-related Millennium Development Goals;

Recognizing the need to draw on the experiences, both positive and negative, of primary health care in the years since the Declaration of Alma-Ata and the Millennium Declaration;

1 Document A62/8. 2 Resolutions WHA54.13, WHA56.6, WHA57.19, WHA58.17, WHA58.33, WHA60.22, WHA60.24, WHA60.27,

WHA61.17 and WHA61.18. 3 Including summits on health system strengthening, such as the G8 Hokkaido Toyako Summit (2008), International

Conference on Global Action for Health System Strengthening (Tokyo, 2008), International Conference dedicated to the 30th Anniversary of the Alma-Ata Declaration of WHO/UNICEF on primary health care (Almaty, 2008), and G15 Summit (2004); WHO regional meetings on primary health care, such as those at Buenos Aires (2007), Beijing (2007), Bangkok (2008), Tallinn (2008), Ouagadougou (2008), Jakarta (2008) and Doha (2008); and conferences on health promotion, such as Ottawa (1986), Adelaide (1988), Sundsvall (1991), Jakarta (1997), Mexico City (2000), Bangkok (2005) and the MERCOSUR Task Force on Health (since 1995).

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20097 |

Convergence of concernsConvergence of concerns

Worries about MDGsand health systems

Regional reviewsand resolutions

Commission of socialdeterminants

Initiatives from civilsociety, academia, the professions, business

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20098 |

What's new with the renewal of PHC: is starting from what people value:

What's new with the renewal of PHC: is starting from what people value:

Health equity, solidarity, social inclusion

Effective, safe and people-centered care

Living in communities whose health is protected and promoted

Health authorities that can be relied on

Having a say in what affectstheir lives and that of their families

Health system strengthening

PHC renewal

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 20099 |

4 + 1 policy directions to refocus health systems4 + 1 policy directions to refocus health systems

Participation

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200910 |

Move towards universal coverage: access plus social protection

Sufficient supply No barriers to access Pooled prepayment

Plus: local and society-wide efforts to: reach the unreached; address social determinants;

address consequences of health inequality; and

ensure visibility of inequalities

Implications for: Financing, Service delivery, Information systems, Technology, Governance

Implications for HRH & Nurses: needs, numbers, access, behavior

>

1. Address health inequality and social exclusion1. Address health inequality and social exclusion

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200911 |

2. Transform conventional health care delivery models into people-centred primary care networks

2. Transform conventional health care delivery models into people-centred primary care networks

Trust and rights: – Explicit entitlements – User voice– Beyond minimum packages

Key features:– Effectiveness– Safety– Comprehensiveness and integration– Person-centeredness– Continuity (in synchrony with human life cycle)

Organizational frameworks (moving away & beyond levels of care): – Entry point through close-to-client networks of primary care teams / districts– A personal relation between services and users – Explicit responsibility for all members of a defined population– Coordinate/mobilize inputs from other levels of care (and from social services)

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200912 |

2. Transform conventional health care delivery models into people-centred primary care networks

2. Transform conventional health care delivery models into people-centred primary care networks

Desired straight through changes do not happen automatically (because of strong supply side distortions)

Avoiding current diversionary trends has implications for health programs - different profiles, changed behavior etc.

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200913 |

3. Moving Beyond Local/Sectoral action: protecting the health of communities through better public policies

3. Moving Beyond Local/Sectoral action: protecting the health of communities through better public policies

Correct underinvestment in effective public health policies:– country-wide public health initiatives – capacity to anticipate (institutions, strategic intelligence,

research) – rapid response capacity

Intersectoral policy dialogue and “health in all policies”:– impact assessments– capacity building

Implications for Nursing: recognition of broader responsibilities & for building capacities

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200914 |

4. Rebuilding trust:(Re-invest in inclusive leadership, effective government

4. Rebuilding trust:(Re-invest in inclusive leadership, effective government

Paradigm changes– The value of activist government– From command-and-control to steer-and-negotiate – Do more with less, but prepare to do more with more

Focus: – Deliver on universal coverage, people-centred

primary care and better public policies; – Regulatory capacity and instruments to govern the

whole sector– Centrality of national plan / national strategy

From driven by technocracy to driven by participation

Implications for HRH: new responsibilities, new behavior, shared power

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200915 |

What does the Resolution say needs to be done?What does the Resolution say needs to be done?

Priority for whom?

Priority for what?

Build on inter-country exchange

Paris

Money

Implementation plans and reporting (technical support)

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200916 |

What does this mean for health professions?What does this mean for health professions?

Priorities– broader skills development / behaviour change - beyond task shifting - for a central &

critical role in people centred services delivery including expanded nurse practioner services

Engagement and collaboration– With civil society / communities and across sector for health promotion in

implementation of all policies for socio-economic development

Leadership (both up-stream & at the community level)

– Proactive action for more intense participation in health policy development, system planning, management, professional education and research.

Primary health care renewal: 4th PAHO GAVI-HSS Inter-country meeting | 30th July 200917 |

The EndThe End