primary health care: transforming vision into action. operational … · 2019-08-16 · primary...

Primary health care: Transforming vision into action.

Operational Framework- DRAFT for consultation

1. Despite remarkable improvements in the health outcomes of the global population during the

Millennium Development Goals (MDG) era, important gaps persist in people’s ability to enjoy

healthy lives and wellbeing. About half of the world population lacks access to the services they

need and poor health disproportionally affects those faced with adverse social, environmental,

economic and commercial determinants of health, driving health inequity both within and

between countries.1

2. Health is central to the 2030 Agenda for Sustainable Development as it relates to many

Sustainable Development Goals (SDGs) and is the specific focus of SDG3 to ensure healthy lives

and promote well-being for all at all ages. Commitment to equity and leaving no one behind is

captured by target SDG3.8 on universal health coverage (UHC). UHC means that all individuals and

communities receive the health services they need – including promotive, protective, preventive,

curative, rehabilitative and palliative – of sufficient quality, without suffering financial hardship.

3. Primary health care (PHC) has been acknowledged as an approach to strengthen health systems,

an essential condition to achieving UHC. At the 2018 Global Conference on Primary Health Care:

From Alma-Ata towards Universal Health Coverage and the Sustainable Development Goals in

Astana, Kazakhstan, countries adopted the Declaration of Astana, reaffirming their commitment

to strengthen PHC as an essential vehicle to achieving UHC and health-related SDGs. The global

commitments to PHC towards UHC made in the Declaration of Astana were again expressed in the

adoption of resolution WHA72.9 during the 2019 World Health Assembly. They are:

i. Make bold political choices for health across all sectors;

ii. Build sustainable PHC;

iii. Empower individuals and communities; and

iv. Align stakeholder support to national policies, strategies and plans.

4. The “Vision for primary health care in the 21st century: Towards universal health coverage and the

sustainable development goals”, presents PHC as a whole-of-government and whole-of-society

approach to health that combines multisectoral policy and action, engaged people and

communities, and integrated health services with primary care and essential public health

functions at their core. These three integral components of PHC, and its demonstrated link to

better outcomes, improved equity and better cost-efficiency underpin its essential role in

achieving UHC through health services designed with people, for people.

5. The commitments of the Declaration of Astana build on previous WHO commitments and

resolutions to strengthen PHC: the World Health Report 2008: Primary health care - Now more

1 WHO and World Bank Group. Tracking Universal Health Coverage: 2017 Global Monitoring Report. https://www.who.int/healthinfo/universal_health_coverage/report/2017/en/

https://www.who.int/healthinfo/universal_health_coverage/report/2017/en/

than ever; WHA69.24 (2016) Strengthening integrated, people-centered health services; WHA65.8

Outcome of the World Conference on Social Determinants of Health; and WHA62.12 Primary

health care, including health system strengthening which requested the Director-General to

prepare implementation plans for four broad policy directions, including people at the centre of

service delivery.

6. WHO regions have also called for PHC strengthening, notably through the development of

regional reports on PHC for the Global Conference on PHC and commitments such as:

i. The launch of the High-level commission for universal health, CD53.R14 Strategy for

universal access to health and universal health coverage, CD52.R13 Human resources

for health: Increasing access to qualified health workers in primary health care-based

health systems, and CD49.R22 on integrated health service delivery networks based on

primary health care and resolution in the region of the Americas;

ii. AFR/56/R6 that called upon countries to incorporate in their national and district health

plans priority interventions for revitalization of health services based on PHC,

AFR/RC58/R3 endorsed the Ouagadougou Declaration on Primary Health Care and

Health Systems in Africa : achieving Better Health for Africa in the New Millennium.

AFR/RC62/R3 Road map for scaling up the human resources for health for improved

health service delivery in the African Region 2012–2025, AFR/RC64/R3 Progress

towards the achievement of the health-related Millennium Development Goals in the

African Region. The 67th Regional Committee with three resolutions related PHC, (i)

AFR/RC67/9 on reducing health inequities through intersectoral action on the social

determinants of health, (ii) AFR/RC67/10 that proposed a framework to guide UHC

implementation in the context of the SDGs in African region and (iii) T AFR/RC67/11

another framework for the region to facilitate the effective implementation of the

Global Strategy on Human Resources for Health : Workforce 2030.

iii. EM/RC63/R.2 Scaling up family practice: progressing towards universal health coverage,

EM/RC60/R.2 Universal health coverage in the Eastern Mediterranean region, and

EM/RC59/R.3 Health systems strengthening in countries of the Eastern Mediterranean

Region: challenges, priorities and options for future action in the Eastern Mediterranean

region;

iv. EUR/RC62/R4 Health 2020 – The European policy framework for health and well-being;

EUR/RC65/R5, on priorities for strengthening people-centred health systems (2015),

EUR/RC66/R5, on the European Framework for Action on Integrated Health Services

Delivery (2016), EUR/RC67/R5, Towards a sustainable health workforce in the WHO

European Region: framework for action (2017), and EUR/RC68/R3, Reaffirming

commitment to health systems strengthening for universal health coverage, better

outcomes and reduced health inequalities (2018);

v. SEA/RC68/R6 Community-based health serviced and their contributions to universal

health coverage, and SEA/RC61/R3 on Revitalizing Primary Health Care in the South-East

Asian region; 2019: Strengthening frontline services for universal health coverage by

2030: Regional Consultation, 23-25 July 2019, New Delhi, India; 2016: SEARO Regional

consultation on health, the SDGs and role of UHC: next steps in South-East Asia, New

Delhi, India; 2015: SEARO Technical consultation on strengthening community-based

health services, New Delhi, India and

vi. WPR/RC66.R2 Universal health coverage, WPR/RC61.R2 Western Pacific Regional

Strategy for Health Systems Based on the Values of Primary Health Care and

WPR/RC59.R4 Health Systems Strengthening and Primary Health Care

7. PHC-oriented systems are required to effectively tackle the WHO’s current priorities including a)

the WHO’s Thirteenth General Program of Work 2019-2023, and its triple focus on promoting

health, safety and serving the vulnerable; b) the SDG Global Action Plan (SDG GAP) for healthy

lives and wellbeing for all, including the efforts of the SDG GAP PHC accelerator and c) the

Integrated People-Centered Health Services (IPCHS) Framework whose principles and strategies

echo both the overall approach of PHC and the levers that comprise the Operational Framework.

Operational Framework and the levers

8. The global commitment to PHC accentuated in the Astana Declaration needs to be transformed

into visible actions to bring about demonstrable change. The Operational Framework “Primary

health care: transforming vision into action” proposes fourteen levers needed to translate the

commitments made in the Declaration of Astana into actions and interventions that can be used

to accelerate progress on PHC and ultimately lead to improvement in health and well-being for all.

9. Actions and interventions related to each of the levers are not intended to be addressed

independently: they are intimately interrelated, and impact and enable each other. They need to

be an integral part of the National Health Strategy, complementary to other actions, prioritized,

optimized and sequenced in a way that guarantees overall results along the three dimensions of

UHC namely more people having access and being covered, coverage including more and better

health services, and improved financial protection.

10. For each lever, the Operational Framework provides a narrative description, a non-exhaustive list

of proposed actions and interventions to be considered at the policy level, the operational or

implementation level and through the engagement of people and communities (Annex 1). The

Operational Framework also includes case studies that illustrate how action can be taken around

one or, more commonly, around several levers to advance PHC.

11. The four governance and finance levers include political commitment and leadership, governance

and policy framework, funding and allocation of resources, purchasing mechanisms, as well as

engagement of community and other stakeholders, including the private sector. Without these

levers, action and intervention through other levers is unlikely to lead to effective PHC. Actions

and interventions related to all levers, in particular governance and finance, need to be developed

using an inclusive and ongoing policy dialogue process. Strategy development must provide

guidance on how to action and sequence all the levers, taking into consideration the contexts, the

strengths and weaknesses of the health system, and the national, subnational and local priorities

for UHC (See Table 1).

Table 1- Operational Framework proposed levers

Title Full description

Core/Strategic levers (?)

Political commitment and leadership Political commitment and leadership that place PHC at the heart of efforts to attain universal health coverage and that recognize the broad contribution of PHC to the SDGs

Governance and policy frameworks Governance structures and policy frameworks in support of PHC that build partnerships within and across sectors, and promote community leadership and mutual accountability

Funding and allocation of resources Adequate financing for PHC that is mobilized and allocated in ways that minimize financial hardship and promote equity

Engagement of community and other stakeholders

Use of engagement approaches to define problems and solutions and prioritize actions by involving people and communities

Operational levers

PHC workforce Adequate quantity, competency levels, and distribution of a multidisciplinary PHC health workforce that includes facility-, outreach- and community-based health workers

Physical infrastructure Effective, secure and accessible primary care facilities with reliable water, sanitation and waste disposal/recycling, telecommunications connectivity, and power supply, and with transport systems that can connect patients to other care providers

Medicines and other products to improve health

Availability and affordability of appropriate, safe, effective, quality medicines and other products that can improve health

Models of care Models of care that promote quality people-centred primary care and essential public health functions as the core of integrated health services

Engagement with private sector providers

Sound partnership between public and private sector for the provision of PHC services

Purchasing and payment systems Purchasing and payment systems that foster a reorientation in models of care towards more prevention and promotion and care delivered closer to where people live and work, provide incentives for the delivery of quality primary care services and facilitate integration and coordination for more equitable and efficient care.

Digital technologies for health Use of digital technologies for health in ways that improve effectiveness and efficiency and promote accountability

Systems for quality improvement Systems at the local, subnational and national levels to continuously assess and improve the quality of PHC

PHC-oriented research Research and knowledge management, including dissemination of lessons learned, as well as the use of the knowledge to accelerate scale-up of successful approaches to strengthen health systems based on a primary health care approach.

Monitoring and evaluation Monitoring and evaluation through well-functioning health information systems that generate reliable data and support their use for improved decision-making by local, national and global actors.

12. In order to implement policy changes, strategically direct resources to the areas of greatest need,

and document PHC progress over time, decision-makers need better high-quality data on all three

components of primary health care. To that end, a related PHC monitoring and evaluation

framework with indicators aligned with the Operational Framework levers and other routine

planning, monitoring and evaluation will be presented in a separate technical document as a

supplemental tool that is aligned with existing UHC monitoring effort.

13. The Operational Framework is not meant to be prescriptive. It is expected that countries will

select the levers and indicators that are most pertinent to their settings based on an assessment

of their needs and the capacity of their systems. It is also assumed that the specific actions,

interventions and strategies used to translate any given lever into concrete PHC improvement will

vary between settings and over time. As economies, institutions and resources evolve, both the

levers used and the ways in which they are operationalized should? also evolve.

Enablers of success

14. The levers presented in this Operational Framework are based on evidence and experience

matured along these years of implementing system reforms. They align with the well-known

building blocks and functions of effective health systems. The added value of this framework is to

provide guidance to countries regarding how a PHC-approach can be translated into health and

wellbeing for all through cross-sectoral actions and integrated services centered on people, along

the national planning cycle, within a whole-of-government and whole-of-society policy dialogue

process.

15. The experience of the last decades, including the pre-MDG era, provides important insight

about the factors and conditions that have either enabled or hindered PHC strengthening. To be

effective, a PHC-orientation needs to be integrated into policies and action across sectors. The

Operational Framework provides the elements (levers) that should be considered in the

development of a contextualized health system strengthening strategy, through a PHC approach as

the cornerstone for UHC, that both strengthens and integrates the national planning cycle and

implementation across sectors. As such, the PHC Operational Framework should be used

throughout the different steps of the operational planning process, understanding that in the 21st

century, the role of the Ministry of Health is to create enabling conditions and conducive

environment to improve health and wellbeing, to empower actors and hold them accountable and

to steer the sector as a whole – in an inclusive manner including public, private and civil society

actors as outlined in the NHPSP handbook.

16. For many countries, the necessary integration of PHC across a wide range of policies, strategies,

activities and services into a coherent whole-of-society approach is likely to require substantial

transformation of the ways in which health-related policies and action are prioritized, funded and

implemented. This reorientation of the health system requires expressed political commitment and

strong leadership at all levels to effectively enable all levers and achieve the desired results.

17. The engagement of people, as individuals and communities, and of stakeholders from across

sectors to work together in defining health needs, identifying solutions and prioritizing action is

central to PHC. Special efforts should be made to reach and meaningfully engage vulnerable and

disadvantaged populations who are disproportionally affected by poor health while often lacking

the resources to participate in traditional engagement mechanisms. Promotion of social

accountability will strengthen the community engagement. Optimally, engagement of the

community and stakeholders should be integrated across sectors and inform actions and

interventions related to all levers.

18. Incremental adjustments in health systems along any of the levers included in this Operational

Framework will not be sufficient to achieve the vision proposed by 2030. It requires, bold action

based on clear and explicit political leadership, engagement of the community and key

stakeholders, guided by evidence and a PHC-relevant monitoring and evaluation framework.

19. A number of countries will still require external support to achieve successful PHC improvement

strategies for UHC. In these countries, largely dependent of external aid, a strong global leadership

and advocacy for harmonization and alignment of donors and technical partners with the PHC for

UHC strategies is more than ever needed. The international community, through platforms such as

for example the International Health Partnership for UHC 2030 (UHC2030) should support

harmonization and alignment through renewal of IHP+ compacts.

Action by the Executive Board

20. The Executive Board is invited to note this report and provide guidance for further development

of the Operational Framework as well as to consider recommendation for review by the Seventy-

third World Health Assembly

Annex to draft secretariat text

Draft not to be shared outside of MS consultation on draft PHC Operational Framework 1

Political commitment and leadership

National • Cultivate champions for PHC from across influential sectors of society (government, community, religious, business), either

through formal structures (e.g., high-level groups) or individually (e.g., ambassadors) (Macro)

• Develop a comprehensive vision of PHC and formalize commitment to PHC as a priority throughout the government (e.g., through

formal declarations, policies or laws, by integrating it as a core component of national strategies, including through broader

development strategies [e.g., national development plans, plans to achieve the SDGs] and health sector-specific strategies, and by

ensuring that there are adequate cross-governmental structures in place to oversee PHC)

• Communicate extensively about the commitment to improve PHC

• Ensure that the rhetoric on commitment is matched by the provision of adequate financing for PHC (see also Section 2.3)

• Hold accountable those responsible for implementation of PHC (including not only ministries of health but also other government

ministries required to address other determinants of health)

• Create an enabling environment for participation by proactively identifying barriers and opportunities for empowering people and

communities, by building community capacities for meaningful dialogue, and by providing and regularly evaluating policy

dialogue mechanisms

• Follow through on commitments to adopt human rights-based approaches

Subnational • Collaborate with higher administrative levels to ensure that community needs and views are given appropriate attention in decision-

making

• If appropriate given the level of decentralization, carry out the same efforts at the subnational level as at the national level:

• Cultivate local champions

• Formalize commitments to PHC (including by integrating PHC as a core component of local development and health strategies)

• Communicate about the commitment to PHC

• Provide adequate financing

By and

through the

community

• Hold political leaders accountable for improving PHC

• Develop networks at community level to ensure that community voices are heard

• Participate in efforts to establish inclusive processes

• Demonstrate leadership as a champion for the comprehensive vision of PHC

• Share information about good practices around accountability among peers (both within and between countries)



Governance and policy frameworks

National • Legitimize the role of communities in local health governance by creation of institutional mechanisms and processes that allow

for greater community and civil society involvement in a non-discriminatory manner (e.g., community-elected representatives in

governance structures, community advisory boards)

• Provide funding and oversight to community through local health governance of PHC to ensure availability of adequate

resources and their equitable use

• Establish legislative mandate and a clear governance and accountability framework for a Health in All Policies approach, and

dedicate resources to support and sustain multisectoral work

• Ensure accountability for PHC in the ministry of health in a manner that works across the traditional departmental boundaries

and is linked to the team(s) responsible for UHC and SDGs

• Use evidence to document the linkages between health and other government policy priorities (including by using methodologies

more commonly used in other sectors, such as economic modelling and qualitative research)

• Support the use of audit tools, such as health impact assessments and policy audits, to enable transparency in the examination of

health and equity outcomes of policies

• Support efforts to make public data about the performance of health services, even if the findings are not positive

• Reflect a PHC orientation across all relevant policy and strategy frameworks

Subnational • Reform and align the integrated PHC-oriented governance mechanism and planning processes at the subnational level to respond

to its three components

• Create community-based multistakeholder forums for collective accountability and action on health and health-related issues

• Create a culture that supports monitoring and evaluation, through knowledge sharing, feedback, and demand for data in decision-

making

• Strengthen PHC management protocols that encourage provider report cards, patient satisfaction surveys, patient-reported

outcomes and balanced scorecards

• Support public, private and community actors to develop competencies for engaging across the PHC components

By and

through the

community

• Advocate for community-steered institutional arrangements to which government officials responsible for PHC are accountable

• Participate in efforts to establish inclusive processes (e.g., by engaging in planning forums)

• Disseminate widely data about health service performance



Funding and allocation of resources

National • Develop health financing strategies that explicitly mention allocations for and spending on PHC, based on data about current

patterns of revenue mobilization (including areas in which a country is significantly lower than its peers)

• Estimate level of spending on PHC through national health accounts analysis and public expenditure reviews

• Increase allocation to PHC programmes and initiatives in national health plans and medium-term expenditure frameworks

• Strengthen public financial management systems to monitor spending on PHC and minimize wastage and abuse

Subnational • Minimize disparities in allocations and spending between primary and tertiary care, and inequalities in PHC allocations to

districts

• Develop capacity at subnational level to monitor costs and improve utilization of PHC services for greater efficiency

By and through

the community • Advocate increased transparency with regard to PHC expenditure, improved efficiency in spending existing allocations, and

increased allocations

• Build capacity to monitor budget and expenditure review processes

• Form alliances with civil society groups that conduct broad-based (i.e., non-health sector specific) reviews of budgets and

expenditures



Engagement of people and community and other stakeholders

National • Collaborate with communities to identify and implement the best mechanisms to engage them in the processes of governance,

planning and priority-setting (including resource allocation), and service delivery

• Make special efforts to engage parts of the community that might otherwise not be involved in community engagement

activities, such as the vulnerable and disadvantaged and young people

• Promote health literacy, in order to broaden the share of community members able to actively engage

• As appropriate, engage in capacity building efforts to ensure that communities know their roles and rights and have the tools

and information necessary to participate fully

• Support efforts of communities to engage more actively by capturing and disseminating information about health system

performance

• Develop training programmes for community engagement and integrate into the national curricula on medical education

Subnational • Support the development of structures (e.g., health committees) at district, town and village levels and support participation of

all social groups in these structures

• Support efforts to foster dialogue between different elements of the community (e.g., between community-based organizations

and academia)

• Develop community monitoring mechanisms for monitoring outbreaks, epidemics, and diseases of high priority

• Appoint focal points for community engagement in various parts of the ministries of health (e.g. those responsible for planning,

budgeting, and monitoring) and in sub-national (e.g., district) health committees

By and through

the community • Advocate for community engagement in governance, planning and priority-setting, and implementation

• Participate in mechanisms established to facilitate community engagement

• Consider forming associations or networks to enable more representative engagement in governance, planning and priority-

setting, and implementation



PHC workforce

Policy level • Develop or update health workforce strategies that prioritize investments in the PHC workforce to address community and

population needs

• Establish appropriate forums that engage ministries of education, labour, finance and planning to ensure the alignment of different

constituencies and stakeholders around issues of health workforce production and remuneration (including supporting those

ministries to incorporate the needs of health workers into their own sectoral plans)

• Mobilize adequate funding from local sources to sustain recruitment and retention of PHC workforce and minimize premature exit

• Improve the distribution of the workforce through appropriate strategies (e.g., regulations, incentives) to deploy PHC workers in

underserved areas

• Strengthen education and training institutions to scale up and sustain the production of PHC workers in appropriate quantity,

quality and relevance to respond to local health needs

• Consider policies on task-shifting as a strategy to expand access to critical services

• Strengthen capacity of regulatory and accreditation authorities to provide and monitor certification, recertification and discipline of

PHC workers

• Support the development of professional bodies that can engage actively in policy dialogue and can provide oversight

Implementation • Develop and implement competency-based post descriptions for all PHC workforce cadres that enhance merit-based recruitment,

deployment, performance appraisal, and career development

• Institutionalize and offer interprofessional continuing educational programmes for PHC teams that are equipped with broad-based

skills, avoiding overreliance on subspecialists and tertiary care

• Improve management to optimize motivation, satisfaction, retention and performance by promoting decent working conditions that

ensure gender-sensitive employment free of violence, discrimination and harassment; manageable workload; adequate

remuneration and non-financial incentives; hardship, housing and educational grants; occupational health and safety and all

measures aligned with gender-sensitive employment

• Provide career development opportunities through job security, supportive supervision, and career development pathways

(including for CHWs)

• Strengthen health workforce information systems and/or implementing national health workforce accounts to strengthen the

monitoring of performance

People and

communities • Monitor PHC staff at community, outreach and facility levels and provide feedback for performance improvement

• Develop professional bodies that can represent PHC staff



• Engage in selection and deployment of staff at community, outreach and facility levels

• Participate in consultations and care plan development

• Participate in patient experience and satisfaction surveys



Physical infrastructure

Policy level • Establish national standards for infection prevention and control

• Develop implementation plans to ensure that all health facilities have WASH systems, telecommunications connectivity and a power

supply

• Develop policies that promote access to facilities for people of all abilities

Implementation

level • Ensure that all newly constructed health facilities have reliable WASH systems, telecommunications connectivity and a power supply

• Ensure proper management and maintenance of health facilities, prioritizing reliable infection prevention and control and WASH

systems, telecommunications connectivity, and power

• Develop an approach that ensures that transport is not a barrier to accessing services

People and

communities • Use mechanisms established to facilitate reporting on health facility standards and functions (e.g., citizens’ scorecards)



Medicines and other health products to improve health

Policy level • Strengthen national regulatory bodies to ensure safety, effectiveness/performance and quality, including by using the WHO Global

Benchmarking Tool for the formulation of institutional development plans

• Engage in collaborative approaches to the registration of health products

• Use evidence-based selection methods including health technology assessments to guide procurement and reimbursement

decisions

• Establish pricing policies to make full use of generics and other procurement strategies that maximize resources and reduce out-of-

pocket payments.

• Strengthen supply chain management to ensure availability of health products (including maintenance of medical devices) at the

point of use

• Ensure adequate domestic resources to access health products appropriate to primary care

• Ensure national capacity to prepare for and respond to the needs for health products, including diagnostics, personal protective

equipment and medicines, in health emergencies

Implementation

level • Implement technical guidelines, norms and standards for quality assurance and safety of health products

• Strengthen governance and oversight, including on the efficiency and integrity of the supply chain

• Ensure capacities for appropriate prescribing, dispensing, and use of medicines and proper management and maintenance of

medical devices, especially before new products are introduced

• Undertake periodic random surveys of storage, availability and quality of health products

• Ensure maintenance of health products (particularly medical devices)

• Establish local capacity to mobilize health technology during health emergencies, including needed personal protective equipment

People and

communities • Participate in decision-making around the adoption of new health technologies

• Participate in monitoring of price, availability, safety and quality of health products



Models of care

Policy level • Develop models of care that are suited to the situation of the country but that advance the key principles of promoting a

comprehensive vision of PHC (including combining public health and primary care), placing primary care as first and regular point

of contact, ensuring that care is continuous, comprehensive, coordinated and people-centred, and addressing both existing and

emerging issues

• Ensure that policy frameworks are updated to reflect the evidence about successful models of care, such as the importance of

connecting CHWs with facility-based staff

• Consider adopting new technologies that can facilitate holistic models of care

• Support the development of new models of care through targeted training programmes for health professionals and policy-makers

• Develop and strengthen information systems for monitoring and facilitating evaluation of models of care and benchmarking

Implementation • Support development of local leadership and empowerment, within models of care suited to local needs

• Formalize collaborative relationships within multidisciplinary teams

• Establish referral systems that ensure that primary care facilities (as the first point of contact for most people) can refer seamlessly to

higher levels of care

People and

communities • Advocate for models of care that embody key PHC principles

• Participate in designing new models of care and reviewing performance of them



Engagement of private sector providers

Policy level • Develop an approach to engage with the private sector around policy development (e.g., through a regular consultative

engagement process or platform), including how to manage conflicts of interest

• Identify challenges (e.g., elements of service delivery that are lagging) and assess whether greater private sector engagement

could improve performance

• Develop the approach (e.g., constraint, encouragement, purchasing) for engaging with the private sector that is best suited to the

addressing the challenge identified

• Assess legal and regulatory frameworks to ensure that they adequately address the private sector, including issues of

accountability

• Conduct provider mapping or a private sector assessment to ensure accurate information about the scope of private sector service

delivery

• Proactively reach out to private providers to ensure inclusion in national monitoring and evaluation systems

Implementation • Strengthen capacity to conduct oversight/control of the private sector, in line with laws and regulations

• If appropriate given extent of decentralization, develop and approach to engage with the private sector around policy development

(e.g., through a regular consultative engagement process or platform), including how to manage conflicts of interest

People and

communities • Organize alliances or networks that can improve the representation of the private sector in policy dialogue with the government

• Engage actively in existing policy-making bodies

• Contribute data to health information systems



Purchasing and payment systems

Policy • Develop a strategic approach to provider payment in primary care as part of the wider health financing and strategic purchasing

strategy

• Define the PHC service package before selecting payment methods

• Strengthen monitoring systems to ensure that payment mechanisms are based on robust data

• Use a combination of costing and other information to match resources to the PHC package

• Consider introducing P4P

Implementation • Adapt the PHC service based on national package before selecting payment methods

• Support continuous improvement of PHC payment systems through regular monitoring of the incentives and possibly adjustment

in payment method

• Promote transparency by releasing to the maximum extent possible data on budgets and expenditures

People and

communities • Monitor facility or provider performance to ensure desired quality of care that minimizes under provision or overprovision

• To the extent possible, avoid making under-the-table payments or unnecessarily high levels of co-payments for primary care

services



Digital technologies for health

Policy • Develop, as appropriate, national eHealth strategies and plans, and legislation and data protection policies around issues such as

data access, sharing, consent, security, privacy, interoperability and inclusivity, consistent with international human rights

obligations

• Examine whether the conditions are appropriate for introducing digital health interventions in areas such as birth registration,

commodity management, telemedicine, client communication, health worker decision support, digital tracking of clients’ health

status, and digital provision of education and training

• Establish mechanisms to learn about new developments around ICT globally and identify gaps in existing efforts that could be

addressed through new technologies

Implementation • When evidence demonstrates effectiveness, move digital health interventions from pilots to scale, including by integrating digital

technologies into existing health systems infrastructures and regulation

• As appropriate, conduct health technology assessments

• Accelerate efforts to implement electronic health information systems, including electronic health records

People and

communities • Utilize ICT to become informed consumers of health information

• Use new avenues enabled by technology to provide feedback on health services



Systems for quality improvement

Policy level • Develop a national quality policy and/or strategy involving PHC stakeholders and in alignment with national health policy and

planning processes

• Routinely measure and publicly report on the quality of PHC, including measures of patient experience

• Ensure quality improvement efforts in primary health care are adequately financed, sustained and scaled up

• Define and implement a set of quality interventions relevant to PHC

• Include principles of quality in the pre-service and in-service training of PHC professionals as well as in continuous professional

development

• Routinely measure and publicly report on the quality of PHC providers using internationally comparable measurements where

feasible, and including patient assessments

Implementation

level • Institute mechanisms to enable individuals, families, and communities to provide feedback on quality (e.g., patient complaint forms)

and then to incorporate the feedback in improvement efforts

• Develop and sustain governance and leadership for quality and safety at the local level, for example district and primary care quality

teams and focal points

• Develop systems to monitor adherence to standards of care

• Put in place an infrastructure for generating and sharing learning on quality within PHC

People and

communities • Use reporting mechanisms and feedback loops to inform health professionals about clinical performance in order to facilitate

improvement



PHC-oriented research

Policy • Increase targeted funding of research for PHC research capacity infrastructure (such as national PHC research institutes or schools)

and dedicated financing, including for complex PHC systems research through standard and specific calls for proposals

• Adopt efficient models of knowledge transfer, potentially as part of the specific remit of PHC research institutes

• Adopt multisectoral approaches to research to understand PHC as an entry point into intersectoral collaboration

• Apply an equity lens to PHC policy research and evaluation

• Develop and implement approaches to co-production of PHC research (including research questions, design, dissemination and use)

with people and communities, including by establishing the involvement of people and communities as a requisite for access to

publicly funded projects

Implementation • Support the development of primary care research networks

• Support implementation research to inform scale-up of effective interventions and models

• Involve communities in developing a shared research agenda for public health

People and

community • Advocate for the involvement of people and communities in research questions, study design and conduct, and dissemination

• Participate when public and patient involvement is introduced (e.g., through community advisory boards)



Monitoring and evaluation

Policy • Ensure the availability of an updated national health information strategy

• Agree on key, nationally appropriate indicators to track progress on PHC

• Strengthen systems to collect data, including through routine systems, household surveys, facility surveys and evaluations

• Employ ICT to extend reach of health management information systems, including to the private sector and remote areas

• Build a culture of reviewing data and using it to make decisions, including by conducting regular multistakeholder reviews

•

Implementation • Strengthen systems to collect and use data, particularly those gathered through routine systems

• Develop incentives (financial and non-financial) to promote improvements in data quality

• Supervise the system of data collection, using techniques such as a system of random assessments or lot quality assurance

approaches

• Build capacity to process and use data at the subnational level for local decision-making

• Use information from routine systems as a starting point for improving supportive supervision of front-line workers

People and

communities • Use new ICT to improve personal tracking of health

• Engage in efforts to improve the quality of health services by using reporting mechanisms to identify good or bad practices

primary health care: transforming vision into action. operational … · 2019-08-16 · primary...

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