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PHC and decentralisation SDC Health network - F2F Meeting Morges 8 th April 2014

Swiss Centre for International Health. PHC and decentralisation SDC Health network - F2F Meeting Morges 8 th April 2014 Xavier Bosch-Capblanch. 1978 Alma-Ata Declaration 1981 Health For all in the Year 2000 1993 Investing in Health 2000 MDG. Alma-Ata (1978)

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PHC and decentralisation SDC Health network - F2F Meeting Morges 8 th April 2014

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  1. Swiss Centre for International Health PHC and decentralisation SDC Health network - F2F Meeting Morges8th April 2014 Xavier Bosch-Capblanch

  2. 1978 Alma-Ata Declaration • 1981 Health For all in the Year 2000 • 1993 Investing in Health • 2000 MDG

  3. Alma-Ata (1978) [PHC] forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. Alma-Ata Declaration. VI

  4. Health for All 2000 (1981) (2) Mechanisms for involving people in the implementation of strategies have been formed or strengthened, and are actually functioning, i.e., active and effective mechanisms exist for people to express demands and needs; representatives of political parties and organized groups such as trade unions, women's organizations, farmers' or other occupational groups are participating actively; and decision-making on health matters is adequately decentralized to the various administrative levels. Global Strategy for Health for All by the Year 2000. WHO 1981

  5. “the transfer of authority and power in planning, management, and decision-making from higher to lower levels of organizational control” Bankauskaite V, Saltman RB, Vrangbaek K. The Role of Decentralization of European Health Care Systems. Report to IPPR. 2004.

  6. Deconcentration Delegation Privatisation Devolution Rondinelli D. et al. Decentralization in developing countries: a review of recent experience. Washington DC, World Bank, 1983 (Staff working paper 581).

  7. Political, administrative, fiscal, market decentralisation....

  8. Issues: • Decentralising with other sectors • Decentralising problems versus decentralising solutions • Human resources: • Capacity • Conditions of work • Management

  9. EVIDENCE • … private contracts with international NGOs for district health systems management: • may not affect people’s illness reporting, diarrhea incidence or infant death • may increase the likelihood that a health facility is open 24 hours • may increase the availability of medical equipment and supplies • may increase people’s use of antenatal care and public facilities

  10. EVIDENCE ,..this review found that attrition appears to be lower in partial decentralisation models of treatment, where antiretrovirals were started at hospital and continued in the health centre; with antiretroviral drugs started and continued at health centres, no difference in attrition was detected, but there were fewer patients lost to care.

  11. That’s all andthanks

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