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Strengthening Primary Health Care Services: Findings and Challenges

This summary highlights the key findings and challenges from interviews and surveys conducted with country representatives and organizations regarding the delivery and reform of primary health care services. It discusses the concept of primary health care, the services included, reform outcomes, and the top challenges faced. The summary also explores successful interventions and the support needed from partners to improve primary health care services.

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Strengthening Primary Health Care Services: Findings and Challenges

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  1. Pre-meeting Summary Shannon Barkley, MD MPH Primary Health Care Service Delivery and Safety Department (SDS) World Health Organization 11 April 2016

  2. Interviews & Online Survey

  3. Respondents Respondents • 7 qualitative interviews with country representatives across regions • 50 Survey Respondents • 12 country representatives • 33 organization representatives • Country representatives largely from Ministries of Health (AFRO/SEARO) • Planning managers • PHC • M&E • Organizational representatives • WHO HQ/RO, Academics, NGOs, Civil society Thank you!

  4. PHC conceptualization • Essential, comprehensive health services for the population • In some settings, PHC was confined to maternal and child health only, or seen to provide a “basic package of care”. • key characteristics of high quality PHC included holistic, patient-centered care that was continuous, integrated and embedded into the broader cultural context • Active engagement with the community

  5. 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

  6. Reforms 64% of surveyed countries have undertaken a PHC reform in past 5 years. All were supported by partner organizations. Major areas of reform: • Infrastructure • Information systems • Improved access/utilization • Provider performance • Coordination/integration • Organization/management • Community engagement • Health partnerships • Financing • National health insurance/financial protection • Equitable, efficient, effective and responsive • sustainable, does not burden public budget, leverages private sector & harness sector as engine of economic growth • Improved access (financial) • Infrastructure • Decentralization • Integrated district-based service delivery

  7. Reform Outcomes • Greater community empowerment and participation in health care delivery • Reinforcement of decentralised monitoring for action • Increased utilization/coverage of services (facility based deliveries, immunizations, etc).

  8. Top 3 challenges 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

  9. “Politically, primary health care is not the main purpose of politicians” • “Resource allocation is not based on routine data” • “...More donors need to harmonize and align with government systems. That should be the way forward” • “There is a general question about what is the point of providing high quality data that is never used” • The information system we have now is only ‘what’ - what have you vaccinated? It needs [the] essential question of ‘why’?

  10. Prioritized domains for indicator development % Respondents

  11. Data Use for Improvement • 100% surveyed countries Involved in increasing data use for improvement • 100% national, 63% at subnational & facility, 50% at community

  12. Sample Successful Interventions • Use of tablets to collect data instead of paper • Data verification at all levels • National Diabetes Registry to improve patient care by monitoring quality of clinical care and audit of processes of patient management • "e-notification" to improve disease surveillance from the primary care facilities • annual health congress where sector players come together to review performance and define priorities for next planning cycle infomed by the performance • contextual and simplified systems for practical use at primary care and district level (use of score cards e.g RMNCH score card; facility scorecards )

  13. Partner Support • Funding for research, consultants, joint learning with peers with similar health system in transition • Capacity building in health information management in the following forms: • Technical support to strengthening the capacity of field health worker. • Improving health manager’s capacity. • Developing health information dashboard • Implementing evidence based planning and budgeting • Training, equipment and logistics, infrastructure

  14. Thank you

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