PHA-Exch> LANCET Series: Alma-Ata: Rebirth and Revision - Supporting the delivery of cost-eff ective interventions in primary health-care systems

Fri Oct 3 23:21:10 PDT 2008

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org

 *Series: **Alma-Ata**: Rebirth and Revision***

* *

*Supporting the delivery of cost-eff ective interventions in primary
health-care systems in low-income and **middle-income countries: an overview
of systematic reviews*

* *

Simon Lewin, John N Lavis, Andrew D Oxman, Gabriel Bastías, Mickey Chopra,
Agustín Ciapponi, Signe Flottorp, Sebastian García Martí,

Tomas Pantoja, Gabriel Rada, Nathan Souza, Shaun Treweek, Charles S
Wiysonge, Andy Haines

*The Lancet.- Vol 372 September 13, 2008*

* *

Available online:
http://www.thelancet.com/journals/lancet/article/PIIS0140673608614038/abstract

[Free subscription required]

"….Strengthening health systems is a key challenge to improving the delivery
of cost-effective interventions in primary health care and achieving the
vision of the Alma-Ata Declaration. Effective governance, financial and
delivery arrangements within health systems, and effective implementation
strategies are needed urgently in low-income and middle-income countries.

This overview summarises the evidence from systematic reviews of health
systems arrangements and implementation strategies, with a particular focus
on evidence relevant to primary health care in such settings. Although
evidence is sparse, there are several promising health systems arrangements
and implementation strategies for strengthening primary health care.
However, their introduction must be accompanied by rigorous evaluations. The
evidence base needs urgently to be strengthened, synthesised, and taken into
account in policy and practice, particularly for the benefit of those who
have been excluded from the health care advances of recent decades….'

*Affiliations*
a. Department of Public Health and Policy, London School of Hygiene and
Tropical Medicine, United Kingdom
b. Health Systems Research Unit, Medical Research Council of South Africa,
South Africa
c. Department of Clinical Epidemiology and Biostatistics, Department of
Political Science, and Centre for Health Economics and Policy Analysis,
McMaster University, Hamilton, Canada
d. Norwegian Knowledge Centre for the Health Services, Oslo, Norway
e. Department of Public Health, School of Medicine, Pontificia Universidad
Católica de Chile, Santiago, Chile
f. Health Systems Research Unit, Medical Research Council of South Africa,
South Africa
g. Institute for Clinical Effectiveness and Health Policy (IECS) and
Iberoamerican Cochrane Network, Buenos Aires, Argentina
h. Norwegian Knowledge Centre for the Health Services, Oslo, Norway
i. Institute for Clinical Effectiveness and Health Policy (IECS), Buenos
Aires, Argentina
j. Department of Family Medicine, School of Medicine, Pontificia Universidad
Católica de Chile, Santiago, Chile
k. Department of Internal Medicine, School of Medicine, Pontificia
Universidad Católica de Chile, Santiago, Chile
l. Department of Clinical Epidemiology and Biostatistics and Health Research
Methodology PhD Programme, McMaster University, Hamilton, Canada
m. Division of Health Sciences Research and Education, University of Dundee,
Dundee, United Kingdom
n. Norwegian Knowledge Centre for the Health Services, Oslo, Norway
o. South African Cochrane Centre, Medical Research Council of South Africa,
Cape Town, South Africa
p. Director's Office, London School of Hygiene and Tropical Medicine, UK

*Series: Alma-Ata: Rebirth and Revision*

*
**Alma-Ata 30 years on: revolutionary, relevant, and time to
revitalise*<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614026/abstract>
Summary: In this paper, we revisit the revolutionary principles—equity,
social justice, and health for all; community participation; health
promotion; appropriate use of resources; and intersectoral action—raised by
the 1978 Alma-Ata Declaration, a historic event for health and primary
health care. Old health challenges remain and new priorities have emerged
(eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the
tenets of Alma-Ata remain relevant. We examine 30 years of changes in global
policy to identify the lessons learned that are of relevance today,
particularly for a.....
Summary<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614026/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614026/fulltext>

*Supporting the delivery of cost-effective interventions in primary
health-care systems in low-income and middle-income countries: an overview
of systematic reviews*<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614038/abstract>
Summary: Strengthening health systems is a key challenge to improving the
delivery of cost-effective interventions in primary health care and
achieving the vision of the Alma-Ata Declaration. Effective governance,
financial and delivery arrangements within health systems, and effective
implementation strategies are needed urgently in low-income and
middle-income countries. This overview summarises the evidence from
systematic reviews of health systems arrangements and implementation
strategies, with a particular focus on evidence relevant to primary health
care in such settings. Although .....
Summary<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614038/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614038/fulltext>

*Improving the prevention and management of chronic disease in low-income
and middle-income countries: a priority for primary health
care*<http://www.thelancet.com/journals/lancet/article/PIIS014067360861404X/abstract>
Summary: The burden of chronic diseases, such as heart disease, cancer,
diabetes, and mental disorders is high in low-income and middle-income
countries and is predicted to increase with the ageing of populations,
urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is
increasingly becoming a chronic disorder. An integrated approach to the
management of chronic diseases, irrespective of cause, is needed in primary
health care. Management of chronic diseases is fundamentally different from
acute care, relying on several features: opportunistic case finding for
assessment .....
Summary<http://www.thelancet.com/journals/lancet/article/PIIS014067360861404X/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS014067360861404X/fulltext>

* *

*
**30 years after Alma-Ata: has primary health care worked in
countries?*<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614051/abstract>
Summary: We assessed progress for primary health care in countries since
Alma-Ata. First we analysed life expectancy relative to national income and
HIV prevalence to identify overachieving and underachieving countries. Then
we focused on the 30 low-income and middle-income countries with the highest
average yearly reduction of mortality among children less than 5 years of
age, describing coverage and equity of primary health care as well as
non-health sector actions. These 30 countries have scaled up selective
primary health care (eg, immunisation, family planning), and 14 have
progresse.....
Summary<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614051/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614051/fulltext>

*Community participation: lessons for maternal, newborn, and child
health*<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614063/abstract>
Summary: Primary health care was ratified as the health policy of WHO member
states in 1978. Participation in health care was a key principle in the
Alma-Ata Declaration. In developing countries, antenatal, delivery, and
postnatal experiences for women usually take place in communities rather
than health facilities. Strategies to improve maternal and child health
should therefore involve the community as a complement to any facility-based
component. The fourth article of the Declaration stated that, "people have
the right and duty to participate individually and collectively in the
planni.....
Summary<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614063/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614063/fulltext>

*Interventions to address maternal, newborn, and child survival: what
difference can integrated primary health care strategies
make?*<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614075/abstract>
Summary: Several recent reviews of maternal, newborn, and child health
(MNCH) and mortality have emphasised that a large range of interventions are
available with the potential to reduce deaths and disability. The emphasis
within MNCH varies, with skilled care at facility levels recommended for
saving maternal lives and scale-up of community and household care for
improving newborn and child survival. Systematic review of new evidence on
potentially useful interventions and delivery strategies identifies 37 key
promotional, preventive, and treatment interventions and strategies for
delive.....
Summary<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614075/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614075/fulltext>

*Integrating health interventions for women, newborn babies, and children: a
framework for action*<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614087/abstract>
Summary: For women and children, especially those who are poor and
disadvantaged, to benefit from primary health care, they need to access and
use cost-effective interventions for maternal, newborn, and child health.
The challenge facing weak health systems is how to deliver such packages.
Experiences from countries such as Iran, Malaysia, Sri Lanka, and China, and
from projects in countries like Tanzania and India, show that outcomes in
maternal, newborn, and child health can be improved through integrated
packages of cost-effective health-care interventions that are implemented
incremen.....
Summary<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614087/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614087/fulltext>

*Making Alma-Ata a reality, now and going
forward*<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614099/abstract>
The last paper in the Alma-Ata series issues a call for action by *The
Lancet *Alma-Ata Working Group. They say "The principles agreed at Alma-Ata
30 years ago apply just as much now as they did then". 'Health for All' by
the year 2000 was not achieved and the Millennium Development Goals for 2015
will not be met in most low-income countries......
Summary<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614099/abstract>|
Full
Text<http://www.thelancet.com/journals/lancet/article/PIIS0140673608614099/fulltext>
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