Family and Community Medicine 3 PDF

PCC SOM 2026 FAMILY AND COMMUNITY MEDICINE 3 P.01 THE HEALTH SYSTEMS and PRIMARY CARE APPROACH FAMILY AND COMMUNITY MEDICINE LECTURE PHC AND UHC IN THE DECLARATION OF ASTANA LECTURER: Dr...

PCC SOM 2026 FAMILY AND COMMUNITY MEDICINE 3 P.01 THE HEALTH SYSTEMS and PRIMARY CARE APPROACH FAMILY AND COMMUNITY MEDICINE LECTURE PHC AND UHC IN THE DECLARATION OF ASTANA LECTURER: Dr. NELSON HORA 40th anniversary of the Declaration of Alma-Ata (2018) DATE: AUGUST 14, 2024 → the global health community met in Astana, TOPIC OUTLINE Kazakhstan, to renew its commitment to I. PRIMARY HEALTH CARE comprehensive PHC for all. II. PRIMARY CARE It recognizes the continued relevance of the Alma-Ata III. PHC IN THE DECLARATION OF ALMA-ATA (1978) principles → Identifying PHC as the most "inclusive, IV. PHC AND UHC IN THE DECLARATION OF ASTANA effective and efficient approach to enhance people's V. CORE COMPONENTS OF PHC: TRIANGULAR PYRAMID physical and mental health, as well as social well-being" A. Primary Care and Essential Public Health Functions Other Highlights in the Astana Declaration: B. Multisectoral Policies and Action o Principles of the Ottawa Charter, which are integral C. Empowered People and Communities to PHC VI. PRIMARY CARE AS A SUBSET OF PHC o Identifies universal health coverage (UHC) as the VII. PHC APPROACH "contemporary manifestation of Health for All", where PHC-oriented health system strengthening PRIMARY HEALTH CARE operationalizes universal access to health services, whole-of-society approach that strengthens health systems when and where needed, without financial hardship. and maximizes the level and distribution of health and well- 3 integral components of PHC as defined in the being. Declaration of Astana: As in the Declarations of Alma-Ata and Astana, it shapes the 1) Primary care and essential public health functions as whole health system by: the core of integrated health services o putting primary care and the essential public health 2) Multisectoral policy and action functions together at the core of integrated health 3) Empowered people and communities services o leveraging multisectoral policy and action CORE COMPONENTS OF PHC: THE TRIANGULAR PYRAMID o empowering people and communities as co-creators A. PRIMARY CARE AND ESSENTIAL PUBLIC HEALTH FUNCTIONS of their health core of integrated health services Focuses on the delivery of quality integrated health PRIMARY CARE services that respond to the needs and preferences of is at the heart of the services component of PHC but does people at the population and individual levels (WHO & not have the same whole-of-society breadth. UNICEF, 2018) 4 core characteristics: "Primary Care" full spectrum of services: 1) First contact access o health promotion and disease prevention to 2) Continuity treatment 3) Comprehensiveness o rehabilitation and palliative care 4) Coordination o close to where people live and work o through a person-centered approach and a PHC IN THE DECLARATION OF ALMA-ATA (1978) population-level focus Provided the key normative principles for PHC: "Public Health Functions” (WHO, 2018). o human rights o health protection o social justice o health promotion o equity and solidarity o disease prevention o evidence-informed, context-responsive and o surveillance and response community-based care o emergency preparedness o self-determination, participation and intersectoral Primary care (by public/private facility provider) and action Public health (services regulated by government) reinforce Operational definition: It described primary care services each other through their respective functions to improve as the central and main focus of health systems and first individual-level and population-level health (see Chapter level of accessible, continuous and coordinated care for 5) (Levesque et al., 2013). individuals, families and communities (WHO, 1978). Unfortunately, the principles of the PHC approach B. MULTISECTORAL POLICIES AND ACTION proposed in the Declaration were almost immediately Call for intersectoral action in the Declaration of Alma-Ata abandoned and PHC was largely reduced to its "primary recognizes the important roles of sectors beyond health in care” component as the first level of health care, and to a creating (and damaging) health, and the need for very narrow approach to service delivery NOTE TAKER: BALAO-AS | COLEWAN | GALLEON | GARCIA | LAPEÑA Page 1 | 2  PCC SOM 2026 FAMILY AND COMMUNITY MEDICINE 3 P.01 THE HEALTH SYSTEMS and PRIMARY CARE APPROACH coordinated action across these sectors to achieve health goals and reduce health threats PHC APPROACH: Rationale for Orienting Health Systems Shapes the impact of health-related sectors on health at 1) Improves quality of care and access to services the population and individual level. → Primary health care (PHC) is a worthwhile investment because it makes care more efficient and more equitable. Health in All Policies (HIAP) → PHC has a positive impact on overall health system o approach to intersectoral coordination performance, improving access, quality and patient o systematically considers the broader determinants, satisfaction. o identifies the health implications of policy decisions, → Securing the political will to invest in PHC is complex, but the o seeks synergies between sectors, and evidence shows that the long-term benefits of reorienting o avoids harmful health impacts the system outweigh the costs. C. EMPOWERED PEOPLE AND COMMUNITIES 2) Improves health system efficiency Focuses on the integral right and role of people to be autonomous → PHC improves services because it uses a full range of levers and in control of their own health and acknowledges the for better quality and access, as well as to ensure continuity, importance of eliciting and addressing people's stated health comprehensiveness and coordination. needs (Rasanathan & Evans, 2020). Highlights three broad expressions of empowerment and 3) Improves overall population health by improving engagement. effectiveness of care and lowering all-cause mortality a) People's prerogative, as advocates of their own health, to → Efficiency is enhanced by PH, which reduces unnecessary use participate in formulating, planning and implementing of (costly) specialists and hospitals. multisectoral policies and action for health. b) People should participate as co-developers of health and 4) Improves user experience and people-centeredness social services, contributing to the way health services are → Population health improves with long-term investment in managed and delivered. PHC, which is linked to better health outcomes including for o Includes being able to raise concerns which are acted upon, mental and child health and noncommunicable diseases and to participate in decisions about tailoring health (NCDs). services to the needs of specific communities c) People are recognized as key decision-makers with a central 5) Improves health equity role in co-creating their own health and well-being as self- → PHC is provided in a trusted setting where the patient, family carers and caregivers. and community context are understood, which leads to higher user satisfaction and better self-reported health. Relationship b/n "primary care" & "primary health care" ❖ Primary care is the central focus and an integral 6) PHC strengthens progress towards non-health SDGs component of PHC-oriented health systems. → PHC reduces financial hardship, narrows outcome gaps and (Tarlier, Johnson & Whyte, 2003). improves equity, particularly when adequate funding, ❖ It is the orienting principle for organizing health staffing and training allow it to reach underserved services (Kringos et el., 2015). populations. 7) PHC’s contribution to Improved health fosters overall PRIMARY CARE AS A SUBSET OF PHC economic productivity FUNCTIONAL DEFINITION OF PRIMARY CARE → Long-term commitment to PHC has a wider return on The Declaration of Alma-Ata defines primary care as: the first level investment, keeping people well enough to work and of contact for the population with the health care system, bringing stimulating economic productivity. health care as close as possible to where people live and work. It should address the main problems in the community, providing preventive, curative, and rehabilitation services* (WHO, 1978). 8) PHC has the potential to promote gender equity Building on this definition, Barbara Starfield articulated four → Gender equity is promoted where PHC offers valued roles to characteristics of primary care, also well-known under the labels women - provided they are given the right training and of four pillars, four tenets or simply the "4Cs of primary care" employment terms and if gender imbalances in seniority (Jimenez et al., 2021). and pay are addressed. 1) first contact 2) continuous, 3) comprehensive, and 9) Contributes to emergency preparedness and resilience 4) coordinated care → Emergency preparedness and resilience are reinforced by o provided to populations undifferentiated by gender, PH's prevention function, the way it bridges individual and disease, or organ system population-level approaches and its multidisciplinary approach, but also through the ties it creates with and "the first level of professional care service, where people present within communities. their health problems, and where the majority of the population's curative and preventive health needs can be satisfied" (Kringos et al., 2010b). 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