WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
Pre-meeting Summary
Shannon Barkley, MD MPH
Primary Health Care
Service Delivery and Safety Department (SDS)
World Health Organization
11 April 2016
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
INTERVIEWS & ONLINE SURVEY
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
Respondents
•7 qualitative interviewswith countryrepresentatives acrossregions
•50 Survey Respondents
–12 country representatives
–33 organizationrepresentatives
•Country representativeslargely from Ministries ofHealth (AFRO/SEARO)
–Planning managers
–PHC
–M&E
•Organizationalrepresentatives
–WHO HQ/RO, Academics,NGOs, Civil society
Thank you!
Respondents
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
•Essential, comprehensive health services for thepopulation
•In some settings, PHC was confined to maternaland child health only, or seen to provide a “basicpackage of care”.
•key characteristics of high quality PHC includedholistic, patient-centered care that wascontinuous, integrated and embedded into thebroader cultural context
•Active engagement with the community
PHC conceptualization
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
What services are included?
Other:
Oral, Other communicable diseases, adult health/elderly health,community participation, traditional medicine, violence and injury
Country/Organization difference:
Countries: TB, NCD, Mental Health, Home Health, Social care, WASH
Organizations: Long term care
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
–Infrastructure
–Information systems
–Improved access/utilization
–Provider performance
–Coordination/integration
–Organization/management
–Community engagement
–Health partnerships
–Financing
–National healthinsurance/financial protection
–Equitable, efficient, effective andresponsive
–sustainable, does not burdenpublic budget, leverages privatesector & harness sector asengine of economic growth
–Improved access (financial)
–Infrastructure
–Decentralization
–Integrated district-based servicedelivery
64% of surveyed countries have undertaken a PHC reform in past 5years.   All were supported by partner organizations.
Major areas of reform:
Reforms
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
•Greater community empowerment andparticipation in health care delivery
•Reinforcement of decentralised monitoringfor action
•Increased utilization/coverage of services(facility based deliveries, immunizations,etc).
Reform Outcomes
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
Top 3 challenges
•Political will (governments and donors)
–Governance and leadership
–Engaging communities/civil society
•Financing/Resource allocation
•Human resources development
–quantity, quality, distribution, turn over
–Including management capacity
–HIS capacity
•Lack of data on quality
Top 3 Challenges
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
•“Politically, primary health care is not the main purposeof politicians”
•“Resource allocation is not based on routine data”
•“...More donors need to harmonize and align withgovernment systems. That should be the way forward”
•“There is a general question about what is the point ofproviding high quality data that is never used”
•The information system we have now is only ‘what’ -what have you vaccinated? It needs [the] essentialquestion of ‘why’?
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
Prioritized domains for indicator development
% Respondents
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
•100% surveyed countries Involved inincreasing data use for improvement
–100% national, 63% at subnational & facility, 50%at community
Data Use for Improvement
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
•Use of tablets to collect data instead of paper
•Data verification at all levels
•National Diabetes Registry to improve patient care bymonitoring quality of clinical care and audit ofprocesses of patient management
•"e-notification" to improve disease surveillance fromthe primary care facilities
•annual health congress where sector players cometogether to review performance and define prioritiesfor next planning cycle infomed by the performance
•contextual and simplified systems for practical use at primarycare and district level  (use of score cards e.g RMNCHscore card; facility scorecards )
Sample Successful Interventions
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
•Funding for research, consultants, joint learningwith peers with similar health system in transition
•Capacity building in health informationmanagement in the following forms:
–Technical support to strengthening the capacity offield health worker.
–Improving health manager’s capacity.
–Developing health information dashboard
–Implementing evidence based planning andbudgeting
•Training, equipment and logistics, infrastructure
Partner Support
WHO-AR-W-H
WHO-CH-W-H
WHO-EN-W-H
WHO-SP-W-H
WHO-RU-W-H
WHO-FR-W-H
THANK YOU