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Review of 40 Years of Primary Health Care Implementation at Country Level Evaluation Brief - December 2019 Are Living Longer Today Than 40 Years Ago

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Review of 40 Years of Primary Health Care Implementation at Country Level Evaluation Brief - December 2019 Are Living Longer Today Than 40 Years Ago Review of 40 years of primary health care implementation at country level Evaluation brief - December 2019 are living longer today than 40 years ago. Accordingly, Context of the evaluation numerous Member States focused on the end In the Alma-Ata Declaration of 1978, the signatory outcome, namely improvements in both the level and Member States to this seminal document “express[ed] equity of health in their populations as one of the the need for urgent action by all governments, all foremost achievements over the past four decades. As health and development workers, and the world the review highlighted, various aspects of PHC community to protect and promote the health of all implementation were considered to have been the people of the world”. In so doing, they declared instrumental in achieving these outcomes, with their commitment to the broad principles of primary particularly significant progress in coverage of basic health care (PHC). health care, immunization coverage and the On the occasion of the fortieth anniversary of the eradication and control of a number of infectious Alma-Ata Declaration, participants at the Global diseases. Underpinning these accomplishments have Conference on Primary Health Care held in Astana, been policy changes aimed to integrate the principles Kazakhstan, in October 2018 issued the Astana and goals of PHC within countries’ health systems. Declaration, which redoubled Member States’ support One of the main elements of these reforms has been for PHC by “reaffirming the commitments expressed in the move towards greater intersectoral collaboration. the ambitious and visionary Declaration of Alma-Ata of Such intersectoral approaches have encompassed, first 1978 and the 2030 Agenda for Sustainable and foremost, collaboration between ministries of Development, in pursuit of Health for All.” Within this health and various other ministries whose work is context, a review of 40 years of PHC implementation at mutually reinforcing with the goals of the health country level was requested by the WHO Executive sector. Board at its 142nd session in January 2018. The review emphasized that implementation of PHC Objectives and scope of the evaluation has not been a formulaic undertaking, but rather has Covering the 40-year period from the 1978 Alma-Ata been accomplished through a wide range of Declaration on primary health care to 2018, the overall innovations that constitute a subcategory of purpose of the review was to: achievements themselves. (a) document global progress towards PHC Although vast gains have been made in health implementation, identifying achievements and outcomes over the past four decades, it is unclear to success stories, best practices and key challenges what extent these gains can be attributed directly to encountered; and PHC implementation. Many Member States nevertheless maintain that implementation of PHC has (b) make recommendations on the way forward in indeed contributed to overall improvement in health order to accelerate national, regional and global outcomes as well as equity. health strategies and plans for universal health coverage (UHC)/PHC and the SDGs. Challenges in implementing PHC – key shortfalls: The review primarily relied on a combination of desk Despite the significant gains achieved globally in the review and a survey of Member States. implementation of PHC, the review highlighted that Key findings and conclusions such progress has been uneven both between and within countries, posing ongoing challenges to achieve Progress in implementing PHC - key achievements: equity. The area of human resources for health has As Member States noted in their overall positive self- been a longstanding issue and remains an outstanding assessment of their respective countries’ progress, the challenge in most countries’ PHC implementation past 40 years have witnessed a number of significant efforts. Similarly, although most countries – regardless achievements in the implementation of PHC. Many of their development stage – have increased their health indicators have continued to improve in most funding to PHC, health financing has remained countries and, on the whole, people are healthier and inadequate. WHO Evaluation Office Another broad category of challenges revolves around • A sufficiently large, and sufficiently qualified, the many facets of quality of care. At the broadest health workforce is necessary to attain the goals of level, numerous Member States maintained that low PHC. quality of services, long waiting times and difficulties • Various aspects of PHC implementation can be obtaining medical appointments represented some of incentivized. their key challenges. • To develop and sustain PHC systems in the future, One critical challenge highlighted in the review centres continued innovation will be crucial. on the very intent of the Alma-Ata and Astana • Evidence-based approaches can help maximize Declarations: the political will of governments to success in PHC implementation. implement PHC, including the related area of Recommendations governance. Numerous Member States indicate that they still face challenges in generating and sustaining Recommendation 1: WHO should continue to harness this political will. In other countries, political will might its convening role to foster intersectoral collaboration be present, but the policy context is less than in the various forms described in the review, both at conducive to undertaking the ambitious changes the global policy level and in individual countries in its necessary to implement PHC. support to governments. Key factors affecting PHC implementation: Recommendation 2: In its normative role, WHO should continue to lead in the development of standards and The review revealed a wide range of interrrelated policy and operational guidelines for the further factors that help explain the range of achievements implementation of primary health care pursuant to the and challenges encountered over the past four commitments outlined in the Astana Declaration and, decades. For example, political will is one of the key by extension, the 2030 Agenda for Sustainable factors consistently cited as supporting PHC Development and Sustainable Development Goals. implementation while its absence is seen as constituting a key challenge for many Member States. Recommendation 3: In its technical cooperation role, Conversely, financial protection measures are reported WHO should tailor its capacity-building efforts to the as positively affecting PHC implementation as well as specific primary health care-related areas requiring an achievement in many countries. further support identified in specific countries. However, the review revealed a much broader set of Recommendation 4: In its advocacy role, WHO should contextual factors that have affected PHC identify and target the specific primary health care- implementation globally. Rapid globalization of the related issues requiring such advocacy in individual world economy has significantly shaped PHC in a wide countries, for example by advocating for increased range of ways, some positive and others less so. Broad health expenditure, identifying specific policy gaps demographic trends have resulted in older populations requiring action and emphasizing the need for greater living longer lives, but not necessarily longer and intersectoral collaboration and greater equity. healthier lives, and often without the population Recommendation 5: In fulfilling all of these roles, WHO replacement by economically active younger cohorts should enhance its support to evidence-based policy to adequately support increased longevity. action – for instance, by supporting systematic Lessons learned research and evidence generation to support policy- making in health, and documenting and disseminating In keeping with the overarching objectives of the lessons and best practices. review, a range of lessons emerging from 40 years of PHC implementation were highlighted. These include Contacts the following: For further information please contact the evaluation • The translation of political will into action is a office at the following address: [email protected] prerequisite for achieving the principles and The evaluation report is available here: objectives of PHC. https://www.who.int/docs/default- • Successful PHC implementation calls for broad- source/documents/about-us/evaluation/phc-final- based partnership. report.pdf?sfvrsn=109b2731_4 • Intersectoral collaboration, a core component of PHC implementation, requires concerted effort. • Equity remains an ongoing challenge. .
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