PHA-Exchange> PHM paper on PHC for World Health Assembly and WHO
Kumanan Rasanathan
kumananr at yahoo.com
Sat May 12 01:32:12 PDT 2007
Vanakkam
Kia ora koutou
Please find below the text of the paper being circulated at the World Health
Assembly which reflects the start of engagement by the People's Health
Movement with the work being done on primary health care (PHC) by the World
Health Organization leading up to the World Health Report on PHC in
2008. Please
circulate to your networks, and for those in Geneva please highlight the
session on PHC hosted by PHM next Thursday described below.
This is a strategic paper to engage WHO staff and delegates of the WHA to
frame the debate around PHC. It is purposely short and not in any way
exhaustive, and the language and scope reflects the target audience. We look
forward to further consultation with PHM members around PHC as we prepare a
more formal contribution to the process. We will post a report on activities
on this issue at the WHA after its completion, at which time we will have a
better idea how best to proceed with our advocacy on this issue.
Any comments on queries on this, or if you would like a pdf version of the
paper, please contact the PHM Secretariat or me directly.
Best
Kumanan Rasanathan
---------------------------------------------------------
* *
* *
* REVITALISING PRIMARY HEALTH CARE: CHALLENGES FOR W.H.O. IN THE NEW
MILLENNIUM*
* *
The People's Health Movement (PHM) welcomes the World Health Organization's
(WHO) renewed focus on primary health care (PHC), as signalled by
Director-General Dr Margaret Chan's address at the Executive Board meeting
in January 2007. Although the world has changed since 1978, *the
comprehensive PHC approach articulated at **Alma** Ata remains highly
relevant today. *
As WHO engages with a revitalisation of PHC it must not only affirm the
underlying principles of the Alma Ata Declaration, but also address the
obstacles that blocked its implementation and incorporate new challenges
that have emerged since.
As a start to an evolving dialogue with the World Health Organization and
other civil society and country delegates, the People's Health Movement is
glad to start the process to dialogue with WHO around core principles and
key challenges that WHO should incorporate into its renewed commitment to
PHC.
*At the 60th World Health Assembly in **Geneva**, **Switzerland**, The
People's Health Movement (PHM) calls on member states, WHO staff and other
global health actors to consider these challenges to PHC and support WHO's
global leadership and co-ordination to develop and implement solutions that
advance towards 'Health for All'. **Answers to these problems exist (with
examples in the experience of many member states and civil society). PHM
will highlight these solutions in more detail to contribute to WHO's
upcoming work towards the World Health Report next year.*
YOU ARE INVITED TO A DIALOGUE
with the People's Health Movement on the Primary Health Care at a Special
Round Table Session at the 60th World Health Assembly in Geneva,
Switzerland
* *
*Date : **Thursday, 17th May 2007***
*Time : **5.30** to **7.00 PM***
*Venue: Palais des Nations, Salle VIII (8) *
Theme: From Policy to Action : Civil Society Revisits Primary Health Care
*Organisers:* People's Health Movement (PHM)
and World Council of Churches (WCC)
* *
Short case studies, experiences and reflections will be shared by delegates
from Asia, Latin America, Africa, Middle East, and other parts of the world.
The interactive participatory dialogue will include short inputs and
responses by delegates from countries. Members of the WHO Task Force on
Primary Health Care and other units will join us to listen to these
experiences in a spirit of dialogue and joint learning (see separate flyer
for further details).
*If you believe in 'Health for All', Primary Health Care and Health as a
Human Right, join us at the dialogue in solidarity. All are welcome.*
**
*For further information contact: *
Manoj Kurian, WCC, Geneva: +41 22 791 63 23
Genevieve Jourdan, PHM Geneva : +41 78 753 22 81
PHM Global Secretariat Team: Hani Serag: +41 79 488 68 79 Azza Salam: +41
79 488 29 36
* *
**
*
*
*REVITALISING PRIMARY HEALTH CARE: CHALLENGES FOR W.H.O. IN THE NEW
MILLENIUM*
*** A People's Health Movement (PHM) Dialogue paper*
* *
CORE PRINCIPLES
The term 'Primary Health Care' is defined and used in different ways. WHO's
revitalisation of PHC must be based on a definition as broad and ambitious
as that described in the Alma Ata Declaration and embedded in the social
processes detailed there. It must incorporate all of the following:
- *A systems-wide approach* that incorporates more than just primary
level health care. It must reflect an approach that includes and
co-ordinates public health interventions, health promotion activities
and hospital services, with referrals to district and tertiary centres.
- *A health system that is progressively financed, inclusive and
equitable.* A PHC approach is not limited to merely providing a
'basic' or 'minimal' package of care for the poor. Instead it strives to
reduce the impact of socio-economic injustice by designing a single system
of health care for all that provides access and care according to need and
fairness.
- *A comprehensive approach* which addresses the social, political
and economic determinants of health and implements multi-sectoral action to
improve health – not just healthcare.
- *A community empowerment approach* which enables individuals,
families and communities to act towards improving their health and the
conditions they live in, especially for those who are most disadvantaged.
- *A health system based on the 'Right to Health' *recognising the
entitlements of citizens.
- *The appropriate use of technology* sensitive to local contexts and
people's traditional culture - helping people learn to combine the best and
reject the worst of both traditional and modern medicine.
NEW CHALLENGES FOR PRIMARY HEALTH CARE
Since the formulation of the 1978 Alma Ata Declaration, new challenges have
emerged which must be addressed in any effort to revitalise the PHC concept.
These include:
The proliferation and dominance of selective health care programmes
- Selective health care programmes are often characterised by a
top-down and vertical approach to health care. Such programmes often
fragment and disorganise the wider health system (especially by drawing away
resources), treat patients as passive recipients of medical care and ignore
the broader social, economic and political determinants of health. While
there may always be a need for focused programmes and specialist
health workers, the current balance between narrow (often disease-specific)
programmes and integrated health care is skewed. **
- *In order to revitalise PHC, there needs to be a revitalisation of
the District Health System model which allows for more integrated,
community-driven and bottom-up health planning and provision - and more
efficient implementation of specialist programs when appropriate. There must
be a renewal of the role of community health workers to extend coverage at
the local level and act as advocates for their communities.***
* *
Global public private partnerships
- Global public private partnerships bring new financial resources to
address health challenges but, up to now, these initiatives have further
reinforced selective programmes by focusing on technocratic solutions to
single issues, without addressing the determinants of health or the needs of
health systems. Such programmes often employ narrow cost-effectiveness
analysis (which ignore benefits to other sectors from health improvement)
and undermine PHC systems. In addition, they raise concerns about
sustainability and accountability.
- *These partnerships need to be reoriented towards more horizontally
integrated sector-wide approaches that build health systems; respond
to local needs; and build new relationships with civil society,
people's organisations and social movements - reasserting the central place
of democratic, participatory decision-making in all health services.*
The new market economy in health
- The last thirty years has seen increasing privatisation and
commercialisation of health systems across the world. This has undermined
public sector health systems; eroded ethical standards of behaviour among
health workers and trust between communities and the health system; and
exacerbated inequity and disparities in access to health care.
- *There is a profound need in many countries to strengthen the public
sector and the 'public ethic' of service provision; direct the existing
private sector towards serving the needs of the public as a whole; and
reduce the presence of profit-seeking and commercial initiatives that
currently harm many interactions between people and health care providers
*.
Unfair globalisation
- Globalisation presents opportunities for increased sharing of
knowledge and information and greater co-ordination of efforts at the global
level to address the determinants of health. However, globalisation also
presents new threats to health such as increased trade in unhealthy
commodities and in health workers ("brain drain") - undermining the ability
of many poor countries to support PHC systems. Furthermore, global
inequalities mean that many poor countries lack any hope of sustainable
domestic funding for their health systems and are therefore increasingly
reliant on external sources of funding.
- *A revitalised PHC strategy must address the globalised nature of
the health worker labour market and provide a framework to generate new
global pools of finance that ensure an adequate resource base for the health
systems of all countries - including compensating poor countries for their
labour losses.*
* *
Intellectual property
- In recent years, the scope and length of patents has increased
greatly. These developments represent a profound transformation of patterns
of ownership within society, with major implications for the development of
technology for the treatment of disease. While technology offers tremendous
potential to improve health, it is sobering to recall that many of the most
useful technologies available in 1978, at the time of Alma Ata, are still
unavailable to most people. The implementation of intellectual property
rules often makes new life-saving medications unaffordable to the people who
need them most.
- *Addressing the challenges to PHC requires universal access to
essential medicines. This will require confronting emerging trade and patent
regimes to be people-friendly rather than market-oriented and supporting
countries to make full and appropriate use of the flexibilities in TRIPS to
make necessary drugs available to all who need them.*
* *
Other new challenges
- Finally, in the three decades since Alma Ata, the global health
situation has changed drastically. The planet's ability to support human
health is at great risk from unsustainable development; inequities have
increased between and within countries; access to food, education, water,
shelter, sanitation and employment are still inadequate for many; the
challenges of poverty, gender inequity and social exclusion continue; both
communicable and non-communicable disease epidemics challenge health
systems; and war, violence and conflict abound.
- *Any renewal of primary health care, while reiterating the core
principles, must address these new challenges at local, national, regional
and global levels, and bring the health of marginalised groups to the centre
of the commitment to 'Health for All'. *
* *
*10th May 2007**. Source:
People's Health Movement*
*
* secretariat at phmovement.org
*
*
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