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“Revitalizing Primary Health Care”

Regional Conference on “Revitalizing Primary Health Care”

Jakarta, Indonesia 6-8 August 2008

I, therefore, conclude that health professions still have to make major methodological contributions in three key research areas:

1. Problem setting:We are still unable to quantify local health problems within holistic interactive trends and within social preference systems and therefore unable to generate the related local synergies.

“The Social Litmus Test”By Dr Halfdan T. Mahler

2. Intervention assessment:We sorely miss a valid input/output correlation methodology for local interventions into normally functioning – including community participation – health care systems without comparable control systems.

3. Information systems:We are still quite unable to generate locally relevant, sensitive and consistent information for decision-making at all political and operational levels of existing health care systems.

Education

Economic

Finance Internal affairs

Agriculture

Public works

Input process output

Inter sectoral collaboration

equity

coverage

Access

Community participation

4. Health Workforce

1. Service Delivery2. Leadership & Governance

5. Information6. Medical products andother logistical supplies

3. FinancingSDH: EducationEconomicFinance

CBHWCBHV

- Gender empowerment- Behavioral change -intervention

- Research- Norms

- PPP

Quality

Efficiency

- Infant- < 5 yr-SBA- HIV-TUB-Safe water-Social insurance

-NMR-IMR-U5MR-MMR

- HIV/AIDS

Outcome

Revitalizing PHC through Health Systems Strengthening

using PHC and SDH approach to achieve health goals and health MDG

- TB

Health mainstreaming

• Three perspectives of PHC (Alma-Ata):– A package or set of activities: minimum 8 elements

Selective and Comprehensive PHC– Level of care: primary-secondary-tertiary care– Approach:

Universal coverage Inter-sectoral collaboration Community participation Appropriate technology

PHC THEN AND NOW

PHC THEN AND NOW

NOW• Misperceptions:

– PHC is only for poor developing countries– PHC is cheap and low quality care– PHC is only for the rural populations– PHC is primary care or first point of contact

• Needs for better partnership with the private sector. Alma-Ata did not specifically address it.

• Health Systems Strengthening using PHC approach to better accommodate the needs of various vertical programmes.

HEALTH FOR ALL 2000• Not achieved in 2000• HFA as a vision for health development, no definite time line• There is misperception also:

in the year 2000 the health professionals provided health care for everybody or that nobody would be sick or disabled.

• Proposed new definition:– “A stage of health development whereby everyone has

access to quality health care or practice self-care protected by financial security so that no individual or family is experiencing catastrophic expenditure that may bring about impoverishment”.

MILLENNIUM DEVELOPMENT GOALS

• A universal framework for:– development and – a means for developing countries and their

development partners to work together • Routine monitoring of MDGs is necessary. • Proxy indicators for U5MR and MMR (e.g.

coverage of Measles immunization; coverage of birth attended by SBA)

Revitalizing PHC to Catalyze MDGs Achievement

2. Achieve universal primary education

3. Promote gender equality and empower women

1. Eradicate extreme poverty & hunger

4. Reduce child mortality

5. Improve maternal health

6. Combat HIV/AIDS, malaria & other diseases

7. Ensure environmental sustainability

8. Develop a global 8. Develop a global partnership for partnership for developmentdevelopment

All MDGs are inter-relatedAll MDGs are inter-related Working towards achieving one Goal will make usWorking towards achieving one Goal will make us closer to closer to

achievements of the restachievements of the rest

HEALTH SYSTEMS USING PHC APPROACH

A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities

• Health systems are highly context-specific; there is no single set of best practices that can be put forward as a model for improved performance

HEALTH SYSTEMS USING PHC APPROACH

CHALLENGES IN IMPLEMENTING PRIMARY HEALTH CARE

• Misinterpretations of the concept of Primary Health Care• Burden of diseases• Inequity in health• Escalating health care cost • Trade agreements • Interdependence of the world• Inadequate performance or low efficiency of the health system • Need for more research• Financing the health system• Need for integrated services• Public Private Partnership• Climate change

REVITALIZING PRIMARY HEALTH CARE, THE WAY FORWARD

• Reaffirm high political commitment toward PHC • Improve health equity through specific actions in health sector as

well as in SDH• Foster more effective multi-sectorial collaboration for

establishment and implementation of Healthy Public Policy • Strengthen health workforce including CBHW and CHV• Implement equitable health care financing• Strengthen partnership with the civil society • Promote better transparency and accountability of the health

systems through improved leadership and governance (stewardship)

• Utilize to its fullest various global health initiatives (e.g. GAVI and GF ATM) and IHP

Strategy must be managed

• A need to put all the diverse aspects of development into order.

• Clear destination statements as to where we shall go from here (by what year?)

• What are the hierarchy of strategic objectives ?

• Who is going to do what, when, where ?

Dr. Amorn Nondasuta

People’ ability to take action in health matters

Local Gov’t support program

People’s project

Surveillance/ Social Measures

Local Gov’t role Central Gov’t agencies’ role Community’ role

Efficient IEC system

Efficient management system (innovation at community level)

Strategy map construction and usage

Data/Information

dissemination

High-performance organization

Human-resource development program

An Example of a Strategy MapD

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P

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ss

S

take

hold

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Peo

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