PHM-Exch> WHA commissions 'operational framework' for strengthening primary health care: transforming vision into action

[Claudio Schuftan]

From: PHM <dlegge at phmovement.org>


Much will depend on how the 'operational framework' is formulated

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WHA commissions 'operational framework' for strengthening primary health
care: transforming vision into action The resurgence of primary health care
as a model for health system development continued at the World Health
Assembly (in May 2019) with the adoption of a resolution
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ac021b9aeb&e=916df65fd1>
committing WHO to develop an 'operational framework' for transforming the
vision of PHC into reality.

According to WHO (para 12 of A72/12
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0933036673&e=916df65fd1>
):
*Primary health care is a whole-of-society approach to health that aims to
ensure the highest possible level of health and well-being and equitable
distribution through action on three levels:*

   - *meeting people’s health needs through comprehensive and integrated
   health services (promotive, protective, preventive, curative,
   rehabilitative and palliative) throughout the life course, prioritizing
   primary care and essential public health functions; *
   - *systematically addressing the broader determinants of health
   (including social, economic and environmental factors, as well as
   individual characteristics and behaviour) through evidence-informed
   policies and actions across all sectors; and*
   - *empowering individuals, families and communities to optimize their
   health as advocates for policies that promote and protect health and
   well-being, as co-developers of health and social services and as
   self-carers and caregivers.*

In the lead up to the Astana Conference on Primary Health Care in October
2018, WHO published a number of 'technical documents' relating to PHC,
including a vision statement
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0f69477fad&e=916df65fd1>
and a draft operational framework
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b0ad7df7ec&e=916df65fd1>
to guide the realisation of that vision. In the new PHC resolution the
Assembly has authorised the Secretariat to proceed to develop and finalise
that Operational Framework.

The draft operational framework published before Astana includes three
'governance, policy and finance levers' and ten 'operational levers'
including:

   1. Engagement of community and other stakeholders to jointly define
   problems and solutions and prioritize actions
   2. Models of care that prioritize primary care and public health
   functions
   3. Ensuring the delivery of high-quality and safe health care services
   4. Engagement with private sector providers
   5. PHC workforce
   6. Physical infrastructure and appropriate medicines, products and
   technologies
   7. Digital technologies
   8. Purchasing and payment systems
   9. PHC-oriented research
   10. Monitoring and evaluation

Assuming that the proposed Operational Framework is adopted by the WHA in
May 2020 these 13 'levers' are likely to figure prominently in WHO's
technical assistance at the country level.

These 13 levers also figure in the Global Action Plan for Healthy Lives and
Well-being for All
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=dc5369e1fa&e=916df65fd1>
(GAP) which is being developed through the WHO Secretariat in association
with 11 other global health agencies (Gavi; the Global Financing Facility;
the Global Fund; UNAIDS; UNDP; UNFPA; UNICEF; Unitaid; UN Women; the World
Bank Group and WFP). The GAP, directed to achieving the health-related
SDGs, is scheduled to be launched at the UN General Assembly in September
2019, and includes a number of 'accelerators', one of which is Primary
Health Care which is constructed around the 13 'levers' included in the
draft operational framework. Presumably financial assistance provided
through these collaborating agencies under the GAP will also be structured
around these 13 levers.

With his triple billion slogan, Dr Tedros has committed to being
accountable for outcomes rather than programs: *1 billion more people
benefiting from universal health coverage, 1 billion more people better
protected from health emergencies and 1 billion more people enjoying better
health and well-being*. He appears to be positioning PHC as a necessary
prerequisite for all three; particularly UHC and the health-related SDGs.

The People's Health Movement (PHM) has welcomed WHO's renewed commitment to
PHC but has been critical of its agnostic approach to health care financing
(single payer versus health insurance markets); its optimism regarding the
role of the private sector in service delivery; and the muted terms in
which WHO refers to the health risks which arise from neoliberal globalised
capitalism.

In contrast, the report of the high level PAHO commission on *Universal
Health in the 21st Century: 40 Years of Alma-Ata
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6bf64440ae&e=916df65fd1>,*
published earlier this year, provides a much more robust assessment of
these issues.

Much now depends on how the vision of PHC is operationalised, in
particular, how the 13 levers are operationalised. The new draft
operational framework is to be submitted to WHA in May 2020 which means an
advanced version will be submitted to the Executive Board in January 2020.
Even before then, the Global Action Plan, which includes reference to the
13 levers, is due to be launched at the UN General Assembly in September
2018.

Much hangs on policy work and advocacy undertaken between now and then. The
PAHO Commission report provides a useful guide.


For full coverage of the WHA debate over PHC see the PHM item page
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f60a705259&e=916df65fd1>,
which includes: summary of issues in focus
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=bffbe28802&e=916df65fd1>
at the Assembly; background notes
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=68bba13f88&e=916df65fd1>;
PHM commentary
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0ba8393c00&e=916df65fd1>
and the WHO watchers' notes
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a506ef4619&e=916df65fd1>
of the debate.

Access all of the papers and debates from the World Health Assembly from
the WHO Tracker at who-track.phmovement.org/wha72
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3810479a85&e=916df65fd1>.
Review previous Update Reports from WHA72 here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a1e99fefdb&e=916df65fd1>.

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