Conceptual and strategic approach to family practice Towards universal health coverage through family practice in the Eastern Mediterranean Region Conceptual and strategic approach to family practice Towards universal health coverage through family practice in the Eastern Mediterranean Region WHO Library Cataloguing in Publication Data World Health Organization. Regional Office for the Eastern Mediterranean Conceptual and strategic approach to family practice: towards universal health coverage through family practice in the Eastern Mediterranean Region / World Health Organization. Regional Office for the Eastern Mediterranean p. ISBN: 978-92-9022-035-0 ISBN: 978-92-9022-033-6 (online) 1. Family Practice 2. National Health Programs - Eastern Mediterranean Region 3. Universal Coverage - trends 4. Health Care Reform 5. Insurance, Health I. Title II. Regional Office for the Eastern Mediterranean (NLM Classification: W 275) © World Health Organization 2014 All rights reserved. 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Contents Executive summary ........................................................................................... 5 Introduction ...................................................................................................... 6 1. Rationale of family practice in universal health coverage ........................ 7 1.1 Universal health coverage and family practice ................................................................................................................. 7 1.2 Why family practice? ...................................................................................................................................................... 8 1.3 Evolution of family practice ............................................................................................................................................. 8 1.4 Characteristics and attributes of family practice ............................................................................................................... 8 1.5 Family practice and its link with people-centred integrated care ...................................................................................... 10 1.6 Developing a family practice team led by family physician .............................................................................................. 11 1.7 National commitment and policies to support family practice approach ............................................................................ 12 1.8 Community awareness and engagement in family practice ............................................................................................. 13 1.9 Scaling up of training programmes (postgraduate and on-the-job training) ....................................................................... 15 1.10 Financing of family practice programmes ...................................................................................................................... 16 2. Elements for implementation of family practice ..................................... 18 2.1 Registration of catchment population and development of family folders ......................................................................... 19 2.2 Patient rostering in family practice ................................................................................................................................ 20 2.3 Community engagement .............................................................................................................................................. 20 2.4 Essential health services package ................................................................................................................................ 21 2.5 Essential medicine list .................................................................................................................................................. 24 2.6 Staff patterns for family health facilities and job descriptions .......................................................................................... 24 2.7 Family health centre facility with standard set of medical equipment and furniture ............................................................ 26 2.8 Training programmes based on the new job descriptions ............................................................................................... 26 2.9 Short-term on-the-job training for general practitioners ................................................................................................... 27 2.10 Management and treatment protocols ........................................................................................................................... 28 2.11 Referral system ........................................................................................................................................................... 30 2.12 Primary health care information system for family practice.............................................................................................. 30 2.13 Quality and accreditation programme ............................................................................................................................ 31 2.14 Key messages............................................................................................................................................................. 32 3. Family practice programmes in countries of the Eastern Mediterranean Region ...................................................................................................... 33 3.1 The regional context and challenges ............................................................................................................................. 33 3.2 Commitment to family practice in countries of the Eastern Mediterranean Region ............................................................ 33 3.3 Situation analysis of family practice in the Eastern Mediterranean Region ....................................................................... 34 3.4 Case studies on family practice from the Eastern Mediterranean Region ......................................................................... 39 3.5 Integrated district health system based on the family practice approach: a regional initiative ............................................. 41 3.6 Conclusions and lessons learnt .................................................................................................................................... 42 Glossary ........................................................................................................... 43 References ....................................................................................................... 45 Annex 1 ............................................................................................................ 49 Executive summary Countries of the WHO Eastern Mediterranean Region face many challenges that are generally cross-cutting in nature and apply to most countries irrespective of socioeconomic and health development. Addressing these challenges is key to the achievement of universal health coverage. The need for high-level political will and commitment to move towards universal health coverage with high-quality health care is the predominant challenge in many countries. The path to universal health coverage brings attention to various barriers in access to health services linked to significant shortage in resources, fragmentation of health care systems and lack of comprehensiveness and people-centredness. Improving access to high-quality health care services is one of the seven priorities for health system strengthening in the Eastern Mediterranean Region. In October 2012, the 59th session of the Regional Committee for the Eastern