The World Health Organisation (WHO) is seeking to reverse the decline in primary health care, which is occurring despite enormous progress in health globally and which primarily affects the poorest and most vulnerable people in the world.
The World Health Report 2008 ‘Primary Health Care – Now More Than Ever’ examines how health care is organized, financed and delivered in countries across the world.
Since the primary health care approach, which outlines a set of values, principles and approaches aimed at raising the level of health in deprived populations, was initiated three decades ago there has been a notable change, the WHO said, adding that health systems, even in the most developed countries are falling short of objectives.
It identifies the source of the problem as the evolution of health systems and health development agendas into a patchwork of components, evident in excessive specialization in rich countries and donor-driven, single disease-focused programmes in poor ones.
“Rather than improving their response capacity and anticipating new challenges, health systems seem to be drifting from one short-term priority to another, increasingly fragmented and without a clear sense of direction,” the report stated.
According to the report, health systems are unfair, disjointed, inefficient and less effective than they could be, and “moreover, without substantial reorienting, today’s struggling health systems are likely to be overwhelmed by the growing challenges of aging populations, pandemics of chronic diseases, new emerging diseases such as SARS, and the impacts of climate change”.
Primary health care is documented in the report as embracing a holistic view of health that goes well beyond a narrow medical model, and also recognizing that many root causes of ill health and disease lie beyond the control of the health sector and thus must be tackled through a broad whole-of-society approach. It is seen as offering a way to improve fairness in access to health care and efficiency in the way resources are used, and in so doing meet many objectives: better health, less disease, greater equity, and vast improvements in the performance of health systems.
WHO said it hopes to revive the conversation on primary health care, which was officially launched in 1978, when WHO member states signed the Alma Ata Declaration, and according to the organization, a few countries pursued the ideal. The approach was almost immediately misunderstood, WHO noted, since primary health care was misconstrued as poor care for poor people; it was also seen as having an exclusive focus on first-level care.
In the report, WHO proposes that countries make health system and health development decisions guided by four broad, interlinked policy directions that represent core primary health care principles: universal coverage; people-centred services, healthy public policies and leadership.
Further, the report said, by aiming at these four primary health care goals, national health systems can become more coherent, more efficient, fairer and vastly more effective.
Countries such as Brazil and Cuba were singled out for their primary health care systems, which the report, said were working effectively.
