Health Systems Based on Primary Health Care in the Eastern Mediterranean

1. Health Systems Based on Primary Health Care in the Eastern Mediterranean Dr Sameen Siddiqi, Regional Adviser, WHO EMRO International Conference on Primary Health Care and Health Systems in Africa 28-30 April 2008, Ouagadougou, Burkina Faso Regional Office of the Eastern Mediterranean

2. EMRO’s Commitment to Health Systems based on Primary Health Care • EM/RC53/R.8 (2006) • Role of Governments in Health Development • EM/RC51/R.7 (2004) • Health system priorities in the EMR: Challenges and strategic directions • EMR/RC50/R.12 (2003) • Primary health care: 25 years after Alma Ata • EM/RC48/R.3 (2001) • Health system development based on PHC • EM/RC/47/R.6 (2000) • Quality assurance and improvement in health systems with special reference to primary health care: a shared responsibility • EM/RC46/R.X (1999) • Regional Health for all Policy and Strategy for the 21st Century

3. Community Based Initiatives: Basic Development Needs (BDN) Approach Health cannot be achieved in isolation -many determinants are outside the domain of the health system. BDN aims at achieving a better quality of life thru integrated socio-economic development and community involvement. Promotes self-reliance through self -management and self-financing by the people . Peoples-oriented strategy that offers vital support to intersectoral collaboration.

4. Community Based Initiatives in the Eastern Mediterranean BDN Healthy cities Healthy villages 13 BDN Healthy Cities 8 Healthy Villages 4 Women in Health & Development 18

5. Tackling Social Determinants of Health and Equity through Community Based Initiative

6. Primary Health Care: Country Experiences • ‘Velayat’ (District) Health System in Oman • Successful PHC based health system in the EMR • ‘Behvarz’ – CHW based PHC delivery system in Iran • Reconfigure PHC to tackle the changing epidemiologic and demographic challenges • National Program for PHC and FP in Pakistan • 100,000 government financed and organized female CHWs • Contracting out of PHC services in Afghanistan • PHC services financed by donors and provided by NGOs

7. Infant Mortality and Under 5 Mortality Oman 1970-2006 200 181 150 100 118 50 11.0 10.25 // // // // 0 1970 1975 1980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 2000 2006 Infant Mortality Rate Under 5 Mortality Rate DGHA - MOH

8. Health System based on PHC Initiatives in the Eastern Mediterranean Region • Policy and systems research • Contracting out of health services • Trade in health services • Health system governance • Patient safety • Catastrophic health expenditure • Private health sector • In depth reviews and policy dialogue on health systems • Capacity Development in Health Systems • Regional Health System Observatory

9. Contracting out of PHC health services? • Should publicly financed PHC services be provided by the public sector or provided through contracting out to the private sector?

10. Globalization: Trade in health services million US$

11. The challenge ofGovernance of the health system Develop assessments tools and instruments Piloted in several EMR countries Delineate strategies for improving governance Reform ministries of health Pakistan Strengthen legislative, regulatory capacities Improve aid effectiveness

12. Health System Capacity Development Workshops for Policymakers and WHO staff Objectives: Orient policymakers to contemporary issues in health systems Develop capacity of WHO staff working in country and regional offices on health systems to engage in policy dialogue with governments

13. Health Systems Reviews and Policy Dialogue with national governments • Elements • Health system desk review • Country missions– all WHO levels • Engagement of development partners • Policy dialogue • Follow-up with specific proposals • During 2005-07 • Afghanistan, Pakistan, Sudan, Syria, Yemen

15. Health Systems Challenges in the EMR • HFA through PHC for all member states but not – “one size fit all” strategy • Update tools and methods for health system performance monitoring • Organizational challenges • Public-Private partnership • Strengthen district health system & making decentralization effective • Enhancing the role of MOH for ‘better health care’ to ‘ better health’ • Working with disrupted health systems due to conflicts - Palestine, Iraq, Afghanistan, Sudan, Somalia • Investing in Strengthening Institutions in the EM Region

16. Develop/institutionalize tools for improving health system performance • Evaluation and Assessment tools • Policy analysis tools (BOD, NHA, CEA, FFC, political mapping) • In-depth health system reviews • Enabling tools for improved management • Standard operational procedure • District team problem solving • Management effectiveness programs • Accreditation, re/licensing of staff and facilities • Carte Sanitaire • Empowering tools for communities • Basic Development Needs (BDN) Instruments

17. Celebrating the 30th Anniversary of PHC in the EMR - Qatar, 1-4 November 2008 • ‘PHC: the Foundation for Health and Well-being’ • Eight Themes • Innovative Primary Health Care; • Health and Wellness Promotion; • Community based Care; • Healthy Workplaces; • Mental Health; • Clinical Updates in Primary Care; • Primary Health Care for the Future; • Professional Development in Primary Health Care

18. Approaches to health system development Thank you for your attention!