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Printed in India ii Revitalizing Primary Health Care Contents Acronyms and abbreviations .............................................................. iv Foreword ........................................................................................ v Executive summary ......................................................................... vii 1. Introduction ............................................................................... 3 2. Inaugural session ....................................................................... 7 3. Keynote addresses ................................................................... 13 4. Working paper ......................................................................... 19 5. Technical discussions ................................................................ 25 6. Recommendations .................................................................... 53 7. Closing session ........................................................................ 59 Annexes 1. Agenda .............................................................................. 63 2. List of participants .............................................................. 64 3. Address by Dr Samlee Plianbangchang Regional Director, WHO South-East Asia Region ................................................ 82 4. Speech by H.E. Mr Aburizal Bakrie, Coordinating Minister for People’s Welfare,Republic of Indonesia .............................. 88 5. Remarks by H.E. Dr Siti Fadilah Supari, Minister of Health, Republic of Indonesia .......................................................... 91 6. Keynote Address by Dr Halfdan T. Mahler, WHO Director-General (Emeritus) ......................................... 95 7. Keynote speech by Dr. Amorn Nondasuta, former Permanent Secretary of Health, Ministry of Health, Royal Thai Government ....................................................... 108 8. Working paper on Revitalizing Primary Health Care ................ 114 9. Revised MDG monitoring framework including new targets and indicators, as noted by the 62nd General Assembly, and new numbering, as recommended by the Inter-agency and Expert Group on MDG Indicators at its 12th meeting, 14 November 2007 ............................................................ 163 10. Panel discussions: Health System Strengthening using Primary Health Care approach ............................................. 166 Revitalizing Primary Health Care iii Acronyms and abbreviations ANC antenatal care ASHA accredited social health activist BRAC Bangladesh Rural Advancement Committee CBHW community-based health worker CHV community health volunteer CSMBS Civil Servants’ Medical Benefit Scheme DOTS directly observed therapy, short-course GAVI Global Alliance for Vaccines and Immunization GFATM Global Fund to fight AIDS, Tuberculosis and Malaria GNH Gross National Happiness IHP International Health Partnership IMR infant mortality rate IPHS Indian Public Health Standards MDG Millennium Development Goal MMR mumps, measles and rubella (vaccine) MOH Ministry of Health NGO nongovernmental organization NRHM National Rural Health Mission (India) PHC primary health care RHC rural health centre SEWA Self-Employed Women’s Association SOP standard operating procedure SSS Social Security Scheme TB tuberculosis UC Universal Healthcare Coverage (Scheme) UNICEF United Nations Children’s Fund VO village organization WHO SEARO WHO Regional Office for South-East Asia WHO World Health Organization iv Revitalizing Primary Health Care Foreword The Regional Conference on “Revitalizing Primary Health Care” held in Jakarta, Indonesia, from 6 to 8 August 2008 was an important milestone in our quest for achieving the health-related Millennium Development Goals and ultimately health for all. It not only commemorated the 30th anniversary of the historic Declaration of Alma-Ata on Primary Health Care (PHC), but also signified renewed determination by Member countries in the South- East Asia Region to strengthen equitable health development. A lot of progress has been made but good health for all people needs to be pursued with more vigour. The social goal of health for all continues to be an inspirational target, which all countries are striving to achieve. And PHC is still considered to be vital to the attainment of this social goal. It is realized that during the past three decades, there have been many changes in all spheres: social, economic, political and technological. At the same time, significant environmental, ecological, demographic and epidemiological transitions have taken place. These changes and transitions have had a profound effect on the way we plan and manage our health policy and programmes today. It is a fact that, through the application of the principle of the goal of health for all, health has gone far beyond the confines of the health sector. The roles of other sectors are considered indispensable for the attainment of the goal. The results will be healthy public policy and better social determinants of health. Increasingly, health issues are becoming the concern of the general public, as well as subjects for public debate. The reflection of health issues in the political agenda for social and economic development is very clear today. Health is becoming more prominent on the international Revitalizing Primary Health Care v development agenda. With rapid global changes and the prevailing formidable health challenges, it is time to revisit PHC. We must ensure that PHC will continue to be firmly embedded as an indispensable element of public health interventions at all levels. The Regional Conference also served as Technical Discussions prior to the Sixty-first session of the WHO Regional Committee for South-East Asia, convened in September 2008. The participatory process in both panel and group discussions yielded important recommendations covering areas of leadership and governance; human resources; multisectoral collaboration; managing financial resources; and knowledge generation. The important messages from this conference are: Member countries in South-East Asia Region reaffirm their political commitment to revitalizing PHC as an effective approach to strengthen health systems. This approach is anchored at the community level and responsive to its health needs; emphasizes overall health system strengthening to improve equity and efficiency; and shifts from a focus on service delivery to a development orientation in the country’s social, political and economic contexts. I hope that this report of the Regional Conference will be found useful in applying primary health care as a tool for policy formulation and programme implementation, as well as for monitoring and evaluation purposes. Dr Samlee Plianbangchang Regional Director vi Revitalizing Primary Health Care Executive summary The Regional Conference on Revitalizing Primary Health Care was held on 6–8 August 2008 in Jakarta, Indonesia. The overall objective of the Regional Conference was to revitalize primary health care (PHC) in the changing context of health development and its risk factors and social determinants to achieve the Millennium Development Goals (MDGs) and Health for All. The specific objectives were to take forward the PHC agenda in the South-East Asia Region, and provide recommendations on revitalizing PHC. H.E. Mr Aburizal Bakrie, Coordinating Minister for People’s Welfare, Republic of Indonesia, inaugurating the Conference. Over 200 participants attended the Conference. These included representatives from all 11 Member countries of the South-East Asia Region as well as health-related stakeholders