<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div>From: <b class="gmail_sendername" dir="auto">PHM</b> <span dir="auto"><<a href="mailto:dlegge@phmovement.org">dlegge@phmovement.org</a>></span><br><div class="gmail_quote"><br><br><u></u>
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<span class="m_-6891424524844600799mcnPreviewText" style="display:none;font-size:0px;line-height:0px;max-height:0px;max-width:0px;opacity:0;overflow:hidden">Much will depend on how the 'operational framework' is formulated</span>
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<h1 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">WHA commissions 'operational framework' for strengthening primary health care: transforming vision into action</h1>
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 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ac021b9aeb&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">resolution</a> committing WHO to develop an 'operational framework' for transforming the vision of PHC into reality.<br>
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According to WHO (para 12 of <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0933036673&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">A72/12</a>):<br>
<i>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:</i>
<ul>
<li><i>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; </i></li>
<li><i>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</i></li>
<li><i>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.</i></li>
</ul>
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 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0f69477fad&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">vision statement</a> and a <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b0ad7df7ec&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">draft operational framework</a> 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.<br>
<br>
The draft operational framework published before Astana includes three 'governance, policy and finance levers' and ten 'operational levers' including:
<ol>
<li>Engagement of community and other stakeholders to jointly define problems and solutions and prioritize actions</li>
<li>Models of care that prioritize primary care and public health functions</li>
<li>Ensuring the delivery of high-quality and safe health care services</li>
<li>Engagement with private sector providers</li>
<li>PHC workforce</li>
<li>Physical infrastructure and appropriate medicines, products and technologies</li>
<li>Digital technologies</li>
<li>Purchasing and payment systems</li>
<li>PHC-oriented research</li>
<li>Monitoring and evaluation</li>
</ol>
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.<br>
<br>
These 13 levers also figure in the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=dc5369e1fa&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Global Action Plan for Healthy Lives and Well-being for All</a> (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.<br>
<br>
With his triple billion slogan, Dr Tedros has committed to being accountable for outcomes rather than programs: <i>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</i>. He appears to be positioning PHC as a necessary prerequisite for all three; particularly UHC and the health-related SDGs.<br>
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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.<br>
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In contrast, the report of the high level PAHO commission on <i><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6bf64440ae&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Universal Health in the 21st Century: 40 Years of Alma-Ata</a>,</i> published earlier this year, provides a much more robust assessment of these issues.<br>
<br>
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.<br>
<br>
Much hangs on policy work and advocacy undertaken between now and then. The PAHO Commission report provides a useful guide.<br>
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<br>
For full coverage of the WHA debate over PHC see the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f60a705259&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM item page</a>, which includes: summary of <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=bffbe28802&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">issues in focus</a> at the Assembly; <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=68bba13f88&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">background notes</a>; <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0ba8393c00&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM commentary</a> and the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a506ef4619&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WHO watchers' notes</a> of the debate.<br>
<br>
Access all of the papers and debates from the World Health Assembly from the WHO Tracker at <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3810479a85&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">who-track.phmovement.org/wha72</a>. Review previous Update Reports from WHA72 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a1e99fefdb&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>.
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left"><br>
Spread the word</h2>
The purpose of WHO Watch is to contribute to democratising global health governance, through new alliances and new information flows. You can help by forwarding our updates, disseminating on social media and inviting others to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=678268c2d5&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe to the Updater</a>.<br>
<br>
WHO Watch is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b62d6660db&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in cooperation with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=8c440b52ff&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b4fad87ab3&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks.
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