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This presentation was delivered to an Institute of Tropical Medicine (Belgium) colloquium on primary health care by Gerald Bloom
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Reflections on the future of primary health care
Gerald BloomInstitute of Development Studies, UK
Presented to Colloquium on Primary Health Care in Times of GlobalisationInstitute of Tropical Medicine, AntwerpNovember 2008
Alma Ata Declaration
Position statement by international organisations (WHO and UNICEF)
Consensus on post-colonial/post-revolutionary health system development strategies
State of the art on the organisation of primary care services
Political statement and vision of ideal health system
…30 years later the Declaration
Many more actors in international health - WHO and UNICEF are redefining their roles
Emergence of pluralistic health systems - growing gap between reality and language of policy and international agreements
Continued agreement on value of primary health care and there is much more evidence on good practice models
The values of universal access persist but there is a tension between the post-colonial vision and current development realities
…30 years laterhealth and health services
Expansion of global health sector (infrastructure, personnel, logistics, programmes, information)
Major divergence between countries in health system performance and health status
Growing concern about the implications of health inequalities for political stability, global health and peaceful development
…30 years laterthe development context
Globalisation, spread of markets and new patterns of inequality and poverty
Rapid changes in population, demography, ecology and the burden of disease
Many more health sector actors
Multiplication of channels for information flow (including on health-related issues)
Building primary health care services: scaling up and rolling out
Evidence on effective low-cost interventions
Gap between actual and potential access to effective services
Resource commitments to reduce this gap
Limited evidence on how to improve access to interventions in different development contexts
Nostalgia, advocacy or practical strategy for health system development?
Markets for health-related goods and services
Spread of markets for health-related goods and services and blurring of boundaries between public and private
Market segmentation between social groups
New communication technologies and channels of flow of information and influence
The creation of institutions for influencing these markets has lagged behind
Changing demand for health services
Increased burden of chronic diseases including HIV
Increased availability of treatment (effective and ineffective)
Many influences on health seeking (mass media, internet, advertising, advocacy groups)
Political pressure for long-term public finance
Risks of epidemics
Rapid urbanisation, industrialisation and changing patterns of animal husbandry
Large populations with increased susceptibility to infection
Increased national and international concern about possible epidemics
Effective responses require effective public health services which command the trust of the public and cross-border cooperation
(Re-)Building effective health systems
Strategies based on an understanding of existing systems
Changing roles of households, citizen groups, private actors (local and international) and government
Support for the creation of new social contracts between providers and users of health services
Creation of regulatory partnerships
Build the government’s reputation for competence and fairness
The politics of primary health care
Economic crisis, social protection and access to health care
Regulating national and international health systems
Creating partnerships for primary health care
Building political coalitions that recognise the importance of interests and power