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POPULATION HEALTH AND PRIMARY HEALTH CARE ACTION Vivian Lin Director, Health Sector Development World Health Organization (Western Pacific Regional Office)

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Presentation on theme: "POPULATION HEALTH AND PRIMARY HEALTH CARE ACTION Vivian Lin Director, Health Sector Development World Health Organization (Western Pacific Regional Office)"— Presentation transcript:

1 POPULATION HEALTH AND PRIMARY HEALTH CARE ACTION Vivian Lin Director, Health Sector Development World Health Organization (Western Pacific Regional Office)

2 2Universal Health Coverage Providing an international perspective From PHC to UHC Post 2-15 Development Agenda and Universal health coverage (UHC) Reviewing Community-oriented Primary Care Population health planning for primary health care Moving to integrated, partnership-based approach Conclusion

3 3Universal Health Coverage 3 PHC–based health system an overarching approach to the organization and operation of the health system makes the right to the highest attainable level of health its main goal maximizes equity and solidarity

4 4Universal Health Coverage 4 PHC–based health system Composed of a core set elements that guarantee universal access to services that are: – acceptable to the population – equity-enhancing Provides comprehensive, integrated, and appropriate care over time Emphasizes prevention and promotion, and assures first contact care Families and communities are its basis for planning and action

5 5Universal Health Coverage 5 Experience says PHC works International evidence suggests that health systems based on strong PHC orientation – have better and more equitable health outcomes – are more efficient – have lower costs – achieve higher user satisfaction than health systems with only weak PHC

6 6Universal Health Coverage PHC transformed into UHC? 2008 World Health Report – renewal of primary health care – need for health systems to respond better and faster to changing health challenges 2010 World Health Report – health financing – to achieve universal health coverage and improve population health outcomes

7 7Universal Health Coverage THE POST-2015 DEVELOPMENT AGENDA High-level Eminent Persons Panel pillars for development – leave no one behind, inclusive growth, sustainable development, good governance, quality of life Health related aspects: – Complete MDGs – NCDs – UHC

8 8Universal Health Coverage Access to good quality of needed services – Prevention, promotion, treatment, rehabilitation and palliative care Financial protection – No one faces financial hardship or impoverishment by paying for the needed services. Equity – Everyone, universality What is Universal Health Coverage (UHC)?

9 Three Dimensions of UHC

10 10Universal Health Coverage UHC contributes to good health and beyond… UHC improves or maintains health through coverage for needed services. UHC contributes to poverty reduction. –Good health enables adults to earn income and children to learn, giving them more opportunities to escape from poverty. UHC is a vehicle to build social solidarity, national pride and trust in the government. UHC offers a way of sustaining gains and protecting investments in the current set of health- related MDGs.

11 11 UHC – core to WHO work UHC in WHO’s history  WHO's constitution (1948)  Alma-Ata Declaration (1978)  WHR on Primary Health Care (2008)  WHR on Health Systems Financing-The Path to Universal Coverage (2010)  Rio Declaration on SDH (2011)  UN High-level Meeting on NCDs (2011) Post-2015 Agenda – All countries (rich or poor) can make progress – Offers a way of sustaining gains and protecting investments of health-related MDGs – Accommodates the changing agenda for global health and other internationally agreed health goals, such as NCDs – Concerns health equity and the right to health Independent of post 2015 agenda, UHC remains core to WHO work

12 Universal Health Coverage (UHC) Financial protection Equity ServicesQuality

13 13 COMMUNITY-ORIENTED PRIMARY CARE AT THE CORE KEY PRINCIPLES Use epidemiological and clinical skills Address determinants and consequences of health and illness Concern with environment/ family/ individual; with health services and behaviors IDEAL FEATURES Population - identified community Governance - allow community involvement Information - facilitate planning and evaluation Funding - incentives for cost- effective services Workforce - team-based, combine public health and clinical medicine skills Service - comprehensive, coordinated, consumer focused

14 COPC= Partnership between Population Health and Clinical Services


16 A partnership-based PHC system Clinical Care Communicable Disease Control Dietary Advice Environmental Health Community Nutrition Counselling Mental Health Promotion Child Health Early Childhood Development Social Work Community Development Community Nursing Home Support

17 17Universal Health Coverage HEALTH NEEDS – Central to population health planning and prevention Groups! – health is not randomly distributed People live, work and play in context – demographic, social, economic, cultural factors matter Objective measures + subjective status – perceptions are realities Health hazards and risks – present and future Relativities - comparison with peer communities/population groups

18 18Universal Health Coverage PLANNING FOR POPULATION HEALTH Starting points: – Health: diseases and conditions (eg diabetes, cancer, mental health), risk factors (eg alcohol, tobacco, physical inactivity), protective factors (eg social support) – People: children, older people, ATSI, CALD communities, homeless – Places and settings: localities, schools, workplaces Outcomes: health improvement; disease prevention; health maintenance; quality of life

19 19 CONTRASTING MODELS OF HEALTH PLANNING Population-based 1. Select health issue 2. identify risks 3. evaluate population risk level 4. compared need with current program 5. adjust resources 6. evaluate Institution-based 1. Select health service 2. determine current demand 3. forecast future demand 4. compare demand with current capacity 5. adjust resources 6. evaluate

20 20Universal Health Coverage NEEDS ASSESSMENT

21 LIFE COURSE Health promotion Disease prevention Early detection and intervention Episodic and acute care Sub-acute care and rehabilitation Long term care Palliative and terminal care children youth Young adult Middle aged Older adults A PLANNING TAXONOMY

22 Population Health Model

23 23Universal Health Coverage POPULATION HEALTH AND THE CARE CONTINUUM Well Population At Risk Living with controlled chronic disease Uncontrolled chronic d isease Community -based programs Primary prevention Screening Early intervention Secondary prevention Self- management Continuing care Case- coordination Complications management Tertiary prevention & Disease management

24 24Universal Health Coverage UTLISATION AND SERVICE SYSTEMS – understanding from population perspective Diverse patient journeys Falling through the cracks Parallel primary care systems Financial, cultural, psychological barriers to care seeking Level of health literacy

25 25Universal Health Coverage Social Determinants of Health

26 26Universal Health Coverage DEVELOPING STRATEGIES AND SELECTING INTERVENTIONS Ottawa Charter a useful checklist: – Healthy public policy – Supportive environment – Community action – Personal skills – Health services Review evidence and consider applicability, gaps in current system, and scale needed to effect change (population strategy vs individual strategy) Weigh up options using multiple criteria, ensuring acceptability, feasibility, and cost-effectiveness (or return on investment) are considered Use multi-voting amongst stakeholders

27 27 Essential Packages of Services - MCH Promotion of healthy lifestyle (alcohol, diet, smoking, physical activity, etc.) Promoting breastfeeding Antenatal care Safe delivery Postpartum care Management of childhood illness Vitamin A, micronutrients Deworming Immunization Insecticide-treated nets and indoor residual spraying Improved sanitation, Better nutrition and food access, and Health protection Housing, Education, Employment, Early childhood development, Empowerment of women and gender equity Pre-pregnancy  Pregnancy  Birth  Postnatal  Neonatal  Infancy  Childhood

28 28 Address service coverage gaps Pre-pregnancy  Pregnancy  Birth  Postnatal  Neonatal  Infancy  Childhood GAPGAP GAPGAP

29 29Universal Health Coverage PARTNERSHIPS – Coordinated service delivery and action on social determinants of health Health services Social services Local government Community and consumer/patient organisations Private sector Frontline staff

30 30Universal Health Coverage Need for Integrated/Coordinated Service Delivery People experience multiplicity of issues - multiple determinants have multiple outcomes, and clustered in localities and populations Shared interests and objectives at service delivery level (operational/informational needs, common clients and partners) Co-benefits across service providers and sectors

31 31Universal Health Coverage Possible approaches for coordination and integration Clustering of health issues Linking of service providers Settings as basis for intervention Population groups as frame of reference Clinical care and public health partnership

32 Organisational Shifts ( Marquardt)

33 33Universal Health Coverage GOVERNANCE – Managing the networks and the course of events Participation ladder: information – consultation – collaboration – ownership Who participates – advisory or decision-making? Who decides in the first place? Accountability to whom? And how? Successful partnerships – safe environment, clear decision-making procedures, focus on joint priorities, win-win, draw on complementarities, share the credit


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