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<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#993300" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#993300;font-weight:bold'>Renewing Primary Health Care in the <st1:place
w:st="on"><st1:country-region w:st="on">Americas</st1:country-region></st1:place><o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><i><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold;font-style:italic'><o:p> </o:p></span></font></i></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>A Position Paper of the Pan American
Health Organization/World Health Organization (PAHO/WHO)<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><st1:place
w:st="on"><st1:State w:st="on"><font size=2 color="#333399" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#333399'>Washington</span></font></st1:State></st1:place><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399'>, D.C: PAHO, 2007.ISBN 92 75 12698 4<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>Available online as PDF file [48p.] at: <a
href="http://www.paho.org/English/AD/THS/primaryHealthCare.pdf"><font
color="#333399"><span style='color:#333399'>http://www.paho.org/English/AD/THS/primaryHealthCare.pdf</span></font></a>
<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>“………For more than a quarter of a century
Primary Health Care (PHC) has been recognized as one of the key components of
an effective health system. Experiences in more–developed and
less–developed countries alike have demonstrated that PHC can be adapted
and interpreted to suit a wide variety of political, social, and cultural
contexts. A comprehensive review of PHC –both in theory and
practice–and a critical look at how this concept can be
“renewed” to better reflect<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>the current health and development needs of people around the
world, is now in order. <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>The goal of this paper is to generate ideas and recommendations
to enable such a renewal, and to help strengthen and reinvigorate PHC into a
concept that can lead the development of health systems for the coming quarter
century and beyond.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>There are several reasons for adopting a renewed approach to
PHC, including: the rise of new epidemiologic challenges that PHC must evolve
to address; the need to correct weaknesses and inconsistencies present in some
of the widely divergent approaches to PHC; the development of new tools and
knowledge of best practices that PHC can capitalize on to be more effective;
and a growing recognition that PHC is an approach to strengthen society’s
ability to reduce inequities in<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>health.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>In addition, a renewed approach to PHC is viewed as an essential
condition for meeting the commitments of internationally agreed–upon
development goals, including those contained in the United Nations Millennium
Declaration addressing the social determinants of health and achieving the highest
attainable level of health by everyone………”<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Content:<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>Executive Summary <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>I. Why Renew Primary Health Care? . Table 1: Approaches to
Primary Health Care <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><br>
<b><span style='font-weight:bold'>II. Building Primary Health Care–Based
Health Systems<o:p></o:p></span></b></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>A. Values Figure 1: Core Values, Principles and Elements in a
PHC–Based Health System <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>B. Principles . <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>C. Elements <st1:address w:st="on"><st1:Street w:st="on">Box</st1:Street>
1</st1:address>: Renewing PHC: Implications for Health Services Box 2:
PHC–Based Health Systems and Human Development <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>D. What are the Benefits of a PHC–Based Health System?<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><br>
<b><span style='font-weight:bold'>III. The Way Forward .<o:p></o:p></span></b></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>A. Learning from Experience . <st1:address w:st="on"><st1:Street
w:st="on">Box</st1:Street> 3</st1:address>: Human Resource Challenges in the <st1:place
w:st="on"><st1:country-region w:st="on">Americas</st1:country-region></st1:place>
<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>B. Building Coalitions for Change <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>C. Strategic Lines of Action <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><br>
Appendix A: Methods <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>Appendix B: Regional Declaration on the New Orientations for Primary
Health Care (Declaration of <st1:place w:st="on"><st1:City w:st="on">Montevideo</st1:City></st1:place>)
<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>Appendix C: Some PHC Milestones in the <st1:place w:st="on"><st1:country-region
w:st="on">Americas</st1:country-region></st1:place>, 1900–2005 <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>Appendix D: Facilitators and Barriers to Effective PHC
Implementation in the <st1:place w:st="on"><st1:country-region w:st="on">Americas</st1:country-region></st1:place>
<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>References<o:p></o:p></span></font></p>
<p class=MsoNormal style='text-autospace:none'><font size=2 color=black
face=Frutiger-Bold><span style='font-size:10.0pt;font-family:Frutiger-Bold;
color:black'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:8.0pt;font-family:Arial;
color:#333399'>This document was written by James Macinko of the <st1:PlaceName
w:st="on">New York</st1:PlaceName> <st1:PlaceType w:st="on">University</st1:PlaceType>,
and Hernán <st1:place w:st="on"><st1:country-region w:st="on">Montenegro</st1:country-region></st1:place>
and Carme Nebot from the Pan American Health Organization/World Health
Organization (PAHO/WHO). Its contents benefited greatly from the guidance,
advice, and discussions resulting from the PAHO Working Group on Primary Health
Care (PHC), national discussions carried out in the countries of the <st1:country-region
w:st="on">Americas</st1:country-region>, and the Regional Consultation in <st1:place
w:st="on"><st1:City w:st="on">Montevideo</st1:City></st1:place>. Members of
PAHO Working Group on PHC are: (Experts from outside PAHO) Barbara Starfield,
Enrique Tanoni, Javier Torres Goitia, Sarah Escorel, Yves Talbot, Rodrigo Soto,
Alvaro Salas, Jean Jacob, Lilia Macedo, Alcides Lorenzo and James Macinko;
(Experts from PAHO): Carissa Etienne, Fernando Zacarías, Pedro Brito, María Teresa
Cerqueira, Sylvia Robles, Juan Manuel Sotelo, Socorro Gross, Humberto Jaime
Alarid, José Luis Di Fabio, Monica Brana, Carme Nebot, and Hernán Montenegro.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:8.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
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<p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:0in;margin-bottom:
12.0pt;margin-left:.5in'><font size=2 color="#333399" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#333399'> *
* * * </span></font><font
color="#333399"
title="http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/13
http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/2"><span
title="http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/13
http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/2"><span
lang=EN style='color:#333399'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'
title="http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/13
http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/2"><font
size=1 color="#333399" face=Arial
title="http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/13
http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/2"><span
lang=EN-GB style='font-size:7.5pt;font-family:Arial;color:#333399'>This message
from the Pan American Health Organization, PAHO/WHO, is part of an effort to
disseminate<br
title="http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/13
http://heapol.oxfordjournals.org/cgi/content/abstract/22/1/2">
information Related to: Equity; Health inequality; Socioeconomic
inequality in health; Socioeconomic<br
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health differentials; Gender; Violence; Poverty; Health Economics; Health
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