Primary Health Care: A Framework for Future Strategic Directions PDF

Primary Health Care: A Framework for Future Strategic Directions Dr. Lara M. Al-Natour The Hashemite University. Faculty of Medicine Dep. Of Pharmacology and Public Health [email protected] [email protected] Office number: 1012  THE REVIEW OF PRIMARY HEALTH CARE  Primary health care (PHC) be...

Primary Health Care: A Framework for Future Strategic Directions Dr. Lara M. Al-Natour The Hashemite University. Faculty of Medicine Dep. Of Pharmacology and Public Health [email protected] [email protected] Office number: 1012  THE REVIEW OF PRIMARY HEALTH CARE  Primary health care (PHC) became a core policy for the WHO in 1978. Since then, there have been rapid changes seen in: **Health issues and health status: new health problems such as HIV/AIDS have emerged, with non-communicable diseases reaching epidemic proportions in developed and developing countries, and chronic conditions now presenting challenges for which most health systems are ill-equipped. ** Socio-economic trends: such as globalization, industrialization, and urbanization are transforming how populations live, our sense of community, and the determinants of individual health. **Demography, government priorities, and WHO’s priorities and ways of working. What is meant by primary health care (PHC)? A set of PRINCIPLES. The 1978 Declaration of Alma-Ata proposed that primary health care should: 1. “Reflect and evolve from the economic conditions and sociocultural and political characteristics of the country and its communities” 2. “Address the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly” 3. “Involve, in addition to the health sector, all related sectors and aspects of national and community development, in particular, agriculture, animal husbandry, food, industry, education, housing, public works, communications, and other sectors; and demands the coordinated efforts of all these sectors” 4. “Promote maximum community and individual self- reliance and participation in the planning, organization, operation, and control of primary health care” 5. “Be sustained by integrated, functional and mutually-supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need” 6. “Rely, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.”  A set of CORE ACTIVITIES for PHC, which are normally defined nationally or locally. The 1978 Declaration of Alma-Ata proposed that these should include at least: 1. Education concerning prevailing health problems and the methods of preventing and controlling them 2. Promotion of food supply and proper nutrition 3. An adequate supply of safe water and basic sanitation 4. Maternal and child health care, including family planning 5. Immunization against the major infectious diseases 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Provision of essential drugs.  When PHC is considered in the context of the WHO’s Corporate Strategy, clear STRATEGIC IMPERATIVES emerge: 1. Reducing excess mortality of poor marginalized populations 2. Reducing the leading risk factors to human health 3. Developing Sustainable Health Systems 4. Developing an enabling policy and institutional environment  PRIMARY HEALTH CARE IN A CHANGING WORLD Changing health issues Changing demography Social and economic change Primary health care and changing government roles Primary health care and international development Changing health issues Communicable diseases: The war against communicable diseases has not been won – old enemies such as TB and malaria are gaining some ground, and new diseases such as Severe Acute Respiratory Syndrome (SARS) bring new challenges. The risk factors that lead to both communicable and non- communicable diseases are on the rise, particularly in the poorest countries and communities.  Excessive consumption of fatty, sugary, and salty foods, the failure to take regular exercise, and tobacco and alcohol consumption are resulting in non-communicable diseases reaching epidemic proportions around the world, in both wealthy and developing societies. Many of the most prevalent health problems, whether communicable or noncommunicable, whether in physical or mental health, are chronic in nature. As progress is made in providing child and maternal care, infant mortality rates improve.  Injuries at home and in the workplace, street and domestic violence, and road traffic accidents are adding significantly to the global burden of disease. They are expected to do so increasingly in the future.  Global projections suggest that the burden of diseases and risk factors (expressed as DALYs) will, over the next 20 years, see the burden:  diarrheal diseases will be reduced by 46%  perinatal conditions will be reduced by 60%  unipolar depression will be increased by 40%  road traffic accidents will be increased by 88%  ischemic heart disease will be increased by 44%  Violence will be increased by 109%. Changing demography Overall improvements in diet, sanitation, disease prevention, and health care are resulting in increased life expectancy and a general aging of the population In some countries, the gains of past decades have been reversed by the impact of HIV/AIDS. Countries with some of the best life expectancy figures overall still experience wide disparities between communities, with disadvantaged areas experiencing significantly worse morbidity and mortality and reduced life expectancy For some countries, the most significant demographic change is the increasing number of children, who present a different set of health and development problems to be addressed. Social and economic change How the world is changing, in social and economic terms, has major implications for population health and health systems. One consequence is that some countries address the health needs of populations whose social conditions range from the most primitive and economically deprived to the most advanced and affluent. The traditional community and family values and support systems are eroded.  The habits of tobacco use, alcohol abuse, drug abuse, poor diet, and insufficient exercise seem best learned in deprived urban communities, and sow all the seeds of the noncommunicable disease epidemic. Rapid industrialization and urbanization can leave health systems, especially primary health care, struggling to adapt infrastructures and capacity to meet new needs. Globalization of the world economy, and the development of open markets, have an equally dramatic impact on health and health systems: The resulting increases in population mobility can lead to the rapid transfer of communicable diseases for example SARS The resulting increases in the marketing of public health risks such as tobacco, alcohol, and unhealthy diets are leading to a dramatic increase in noncommunicable diseases  Open labor markets have obvious implications for human resource development in health systems:  Public and private providers of health care compete for the same skilled labor force  The health sector competes with other sectors for scarce talents  More affluent nations with skills shortages can recruit scarce staff from less affluent countries.  WHO acknowledges the problems and impact of fluid labor markets on health systems; high turnover rates of staff dilute results, so attention must be directed at supporting and retaining the staff. Educational progress also has clear implications for health outcomes and health status.  All of these complex social and economic changes combine to create a wider environment in which policy development and health and health services delivery have to assume that: Change will happen fast There are few certainties Today’s priorities may not be tomorrow’s priorities Today’s solutions may not work tomorrow We cannot know in advance all of the problems we will face New opportunities will arise from developments such as the growth in partnership working. Primary health care and government roles The future PHC policy and models will have to be flexible and fast- moving to respond to population needs which can and will change with frightening speed. In practice, this means that, whilst governments continue to accept a central role in policy-making in health, the instruments available to support policy implementation may now be much more wide-ranging. Those instruments will depend on whether governments have developed roles that include some or all of: Funders of health systems Providers of health care Commissioners of health care Regulators/accreditors of health systems and health care providers. Primary health care and international development Globalization requires new approaches to address a range of problems that cross national boundaries and provide a rationale for the implementation of global norms to deal with shared problems. For example, Tobacco Control. The recommendations of the Commission on Macroeconomics and Health, which was established by the WHO in January 2000: ** The reduction of poverty and the improvement of health for the world’s most disadvantaged populations **Its central proposal is that the world’s low and middle-income countries, working in partnership with high-income countries, need to significantly scale up the access of the world’s poor to essential health services  The Millennium Development Goals (MDGs): It is unrealistic to expect the achievement of the MDGs without an organized PHC. MDGs:  reduce child mortality  improve maternal health  combat HIV/AIDS malaria, and other diseases.  The tasks to be undertaken by PHC teams, continue to be affected by programs and interventions which address major areas of morbidity and mortality, and the reduction of risk factors. An example is access to safe water for populations. The Commission on Macroeconomics and Health also argues that the most effective interventions can be delivered through health centers and similar facilities, and through outreach, which they collectively describe as ‘close to client’ (CTC) systems. ‫روح هللا ﴾‪.‬‬ ‫ِ‬ ‫﴿ وال تيأسو من‬ Thank you 