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Presentation on theme: "POPULATION HEALTH AND PRIMARY HEALTH CARE ACTION"— Presentation transcript:

Vivian Lin Director, Health Sector Development World Health Organization (Western Pacific Regional Office) Professor Akira Ogawa, colleagues, ladies and gentlemen: I am pleased to be in this beautiful campus to share with you WHO’s work in health. I would like to take this opportunity to thank Professor Ogawa for the invitation. I appreciate this special arrangement to deliver this lecture.

2 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 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 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 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 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

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 What is Universal Health Coverage (UHC)?
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

9 Three Dimensions of UHC

10 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 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)
High quality people-centered and integrated interventions Affordability Accessibility Acceptability Availability Financial protection Equity Quality Services

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 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

14 COPC= Partnership between Population Health and Clinical Services


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

17 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

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

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 NEEDS ASSESSMENT Stakeholder consultation
Analyse information and confirm key issues Collect quantitative data Analyse problem and review evidence Determine strategic issues and missing information Collect qualitative data

21 A PLANNING TAXONOMY 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

22 Population Health Model
Care Coordinated Self-managed At Risk Population Well Population

Living with controlled chronic disease Uncontrolled chronic disease Well Population At Risk Community -based programs Primary prevention Screening Early intervention Secondary prevention Self- management Continuing care Case- coordination Complications management Tertiary prevention & Disease management

24 Diverse patient journeys Falling through the cracks
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 Social Determinants of Health

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 Essential Packages of Services - MCH
Pre-pregnancy  Pregnancy  Birth  Postnatal  Neonatal  Infancy  Childhood Promoting breastfeeding Promotion of healthy lifestyle (alcohol, diet, smoking, physical activity, etc.) 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 27 27

28 Address service coverage gaps
Pre-pregnancy  Pregnancy  Birth  Postnatal  Neonatal  Infancy  Childhood 100 80 60 50 40 20 GAP GAP Improving maternal and child health requires coverage of high impact interventions all along the continuum of care. The Countdown to 2015 is an international initiative that advocates for and monitors coverage of effective interventions to reduce maternal and child mortality. Their latest report shows these coverage levels in the 68 high mortality countries monitored by the Countdown. Rates vary from a high for immunization to very low for newer interventions (insecticide treated bednets) and for those that depend on curative services (for diarrhoea, pneumonia, and malaria) and 24 hr. access to care (providing emergency child birth services such as cesarean sections). Improved linkages are needed among the different components of care, often delivered by the same workers or through the same delivery channel. Many services can be delivered by workers selected and supported by the community. 28

29 Community and consumer/patient organisations
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 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 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 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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