Past, present, and future primary health care: Alma-Ata at 40



hello everyone welcome to our pop-up session on primary health care at the 71st World Health Assembly we're very happy you're all joining us we're going to be talking today about the past present and future of primary health care Amata at 40 years and we have with us today some very distinguished panelists who are going to share their perspectives on how primary health care has changed over the last four decades on my left here we have Minister Yeltsin and Burton off of Casta of Kazakhstan who is going to be graciously hosting this year's global conference on primary health care and he'll be sharing more information about that shortly we also have Vidya a Ganesh who is joining us from UNICEF where she is the director a deputy director of UNICEF program division on my right we have Hans Kluge who is the director of the division of health systems and public health and the euro office for the World Health Organization and Ed Kelly the director of service delivery and safety in the health systems cluster at w-h-o headquarters so thank you all for joining us as I mentioned this year is the 40th anniversary of the Declaration of Amata which was really a landmark statement about how primary health care contributes to health and health systems globally and we're really excited that on the occasion of the 40th anniversary we have an opportunity for the world to recommit to this really crucial principles and approach to health systems administer I'd like to start with your perspectives if possible could you share a little bit about the legacy of the declaration of AMA ahta and why this year it's important for us to revisit primary health care in particular Thank You Shannon very pleased to be here on this event on this very important topic for all of us yes our Mater declaration it's known as the historic declaration in global health care and that set up their prey the highest priority of primary care for all health systems and the main I would say issue when we talk about legacy is that based on the declaration all countries in the world they put the primary care at the basis of the national health system so as Kazakhstan so based on that approach today we talking about the extremely best outcomes of health systems around the world with decreased mortality and raising the average of length of stay and quality of life around the world so I think the primary care is actually the main factor that contributed to that including my country Kazakhstan because of course hosting the declaration as a part of the Soviet Union at that point we were proud to have the system that was designed according to the declaration and for my country for this 40 years it was the highest priority even in difficult period of economical transition when we became independent state back in 1991 the political priority is to keep primary care service going on so today primary care is involved not only like a first entry point for every citizen to the system but actually the main tool for disease protection disease prevention prophylactics you know vaccination raising the awareness of population but also of course as as a tool that primary care specialists can lead people through complex health system so that's why it is important and and of course since 40 years there are a lot of new trends with demographics with epidemiology we have more elderly population aging population we have a lot of issue of migration and growing number of chronic diseases and non communicable diseases and of course technology called breakthrough that really need to for us to discuss the future of primary care having this historical basement but we have to think about the future so we hope this conference this year that will happen in my country will help us to bring all the best stories all those success stories to define the future ways for development thank you that's really wonderful thank you and we're very fortunate to have a minister hosting us this fall who's so invested in primary health care as an approach for his country so appreciate that hons over to you now we've heard a lot at this year's World Health Assembly about universal health coverage and it's often said that we won't be able to achieve universal health coverage without primary health care could you shed a little light on why that is true why is that the case yes thank you very much Shannon indeed universal health coverage is the overarching priority in the GP w13 is the new vision of whu-oh in a nutshell universal health coverage means that every patient every person in the community should have access to quality health services including as dr. Burton was telling also prevention and promotion in fact up to rehabilitation palliative care without being pushed into poverty due to ill health the way to do this the core strategy is integrated primary health care why and I speak both as a director Health System and a previous general practitioner it's that people find their way very easy to the primary health care which includes also community care so it reaches the otherwise unreached and a key value durr is the trust this was the same for me as GP you are the general practitioner the family doctor not only of your patient but a friend of the family so it puts people in the center you look at their health needs but also their social needs and that's the spirit of the alma mater declaration the so called social the terms of health in the United Kingdom for example last year 10% of the consultations in the primary health care had nothing to do with health it was about housing people didn't know where to go and that's my final point the health care workers the health professionals of the future the current ones are so important because they are the ones who are trusted by the community and what we hope to do among other things at the reference in Astana is through this global movement of UHC underpinned by Phe to increase the prestige of the health professionals because without health professionals without the volunteers without the community we are not going to have strengthens primary health care to go to USC Thank You Hans I think with this idea of the community and people really being the heart of primary health care and the essence of why primary health care is important primary health care also being the point where people and the community meet the health system I wonder Vidya if you could say a bit more about how primary health care promotes multi sectoral approaches and community participation Thank You Shannon the primary health care is at its best when the community and the service delivery seamlessly integrate there's almost no point where one stops and the other starts and for that integration to happen it means we are not dealing with one issue we're dealing with with issues that affect the community and the people and it means all of the issues around health efficient water and sanitation and and even access to primary education because all of them actually have to have to come together and whether we call it multi sectoral or I almost call it obvious so and and the penny primary health care through the healthcare delivery system and where the community groups can prioritize what their local needs are and actually make the system and the community mutually socially accountable it achieves them many benchmarks that would be the ideal success for a primary health care and when it comes to the second point primary health care is also at its best when it reaches the most vulnerable and the most marginalized and the most left behind of course we don't say that it's only the women and children are the most vulnerable but in fact they do face more vulnerabilities than many others so I mean we look at child survival growth development outcomes those outcomes are not just about avoidance of diseases but every but it's also about prevention and Prevention and promotive and more and more recently we've started to really emphasize the importance of early stimulation and early nurturing so the the idea that we just heard from hands that the health outcomes are actually the products of what happens at the household and that are supported by the communities and then supported by the system just a quick follow-up to your last point could you share a little bit more about how you see the platform of primary health care really being able to impact the health of children and adolescents in particular well the primary health care has brought about a revolution in in child in reducing infant mortality and maternal mortality that won't have happened without the vision of a primary health care which first of all puts health as a human right at the center of it so it's it's non-discriminatory it's it reaches all and the other thing was the primary health care because of its wanting to reach every every child every woman everywhere it put the emphasis on really coming up with high-impact interventions that are low cost and easy to deliver that's the hallmark of the of the primary health care but as the minister said that that same primary health care system has to deal with other issues that children women and adolescents face it's no longer only about drugs interventive all diseases or malnutrition malnutrition along with with obesity there's the psychosocial support services that so the primary health care also therefore needs to start looking at how how it's going to build in the future needs because you can't primary health care can't be selective about what it will do it will not do for if it's truly about responding to the community needs and needs of the people one of the things that the global community is struggling with right now building on what you all have said that primary health care is extremely effective it's the best way to organize a health system to get the outcomes that we're all seeking for all people it's cost effective meaning you can do the same thing within this platform that might cost more at other SEC parts of the health system such as hospitals or specialty services and it has this emphasis on equity so really in the era of the SDGs are focused on leaving no one behind it's so essential but one of the things we as the global community have to recognize is that we haven't made the progress that we would have liked to have seen in the last 40 years so and I wonder if you could tell us a little bit about where we stand now with primary health care where we've been successful where we still have some lessons to learn and how we can apply those lessons to make primary health care the approach for achieving universal health coverage in the 21st century yeah it's a great question and it's one obviously we as a group thinking about this conference get a lot none of us was there personally in 1978 in our current capacity even though a few of us are older than others but the we had very interestingly some of the people here listening would have been in the side event that that was scheduled here at whas technical briefing rather yesterday where we had young professionals saying that they sat in the chair 10 years ago and and and and attended the 30th anniversary kindly hosted by Kazakhstan and many of the same things were said that emphasizing primary care that equity agenda we really need to advance together on this and so I think there is always this point to be making that we have to realize that it takes many times saying something before it happens and it takes a lot of work before thing happens but I think there's clearly some lessons that we can learn that we approached probably if we can boil it down the challenges of the past 40 years in two separate of a manner different organizations didn't work enough together and different sectors didn't work enough together so I think that's our big first lesson is that the in order to accomplish the promise that we have in front of us it has to be a multi sectoral work and it has to be the whole international community working together secondly I think this whole idea of partnering with the private sector needs to really come to fruition it's something that in many of the countries that WTO works with delivering on primary care won't happen unless the private sector is involved and third it's a big change now in terms of the technology and what it's allowed us to do the types of services we can offer in primary care would have boggled the mind of a primary care provider 40 years ago and most of our patients now maybe not my dad but certainly me and my children we use this to get their first health information rather than talking to their private their primary care provider and so we need to be where people need that information and where they want to be treated so the sort of future orientation of this has us with a different kind of supply of services it's much more digital that's not about four walls it's much more in the community but it's also because it's a different demand people want something different so I think that's will be one of the big changes that will try to take on board in Kazakhstan and take forward say that the comforts in Kazakhstan sounds like it will be an extremely important event with lots of really critical topics to advance us forward on this agenda we have a few minutes left in our time together to take some questions from the audience here with us so if anyone in the group might have a question I would just ask that you come here to the podium and please feel free to inquire on burning questions about primary health care while we're waiting for our first question yes please good afternoon Minister I'm very pleased to join my name is your story Goa International Telecommunication and thank you very much for the invitation to this Astana conference our secretary-general is pleased to come to this conference may ask Minister was the expectation to collaborate with this multi sectoral multi agency in particular ITU is very committed to connect the people wherever and what whatever the means so what's the expectation of this collaboration for this conference Thank You Minister yeah thank you for asking this question thank you for overall supporting us in this event so of course for for us is a hosting country we have a very we're very excited about this event and and our main target and my main is to bring the best discussion on the table to bring the best successful stories that we have at the moment all the best lessons we've learned not only the good stories but also a bad stories because during this assembly and previously during the meeting of international expert advisory group many experts were saying that we haven't reached all goals of our matter declaration so this time we have to be very strict on the ideas but also on implementation of those and also we want we our expectation is that there will be more of participation of younger generation future health leaders and we can really talk about a key issue of Technology and that's also for us it's a we want to bring all the best experience already that we have in digital health system specifically in primary care level as ed mentioned today the role of mobile devices could be critical for overall redesigning not only primary care but the whole health care sector so we also expect that countries will share with the successful stories and experience that they have in this area so we can see what directions we have to move and what are the future in this area thank you thank you very much I believe we have another question from the audience from the ministry from Estonia and as all of you some of you might know that we are also hosting the Italian charter du Bellay conference this year on health system strengthening and I wanted you to elaborate on that how do you see what role the strong primary healthcare fiddles in the strong health care systems what is your perspective on on that and I hope also dear Minister that you have the chance to participate and the talent conference and you can find some input to the Almaty declaration anniversary event thank you that's an excellent question Hans I wondered since you're intimately involved in both processes if you would be willing to take a first answer it's great to point out the altar anniversary the pins are never of the talent charter which will be on the health systems strengthening for prosperity and solidarity so we're going to exchange the experiences and health system strengthening since 2008 the current Charter not only from a perspective of the Ministry of Health but also the Minister of Finance to sharpen our dialogue that investing in health and health systems is investing in inclusive economic growth coming to the primary health care at the end of the conference or ambition it's quite ambitious is to put forward the vision of people centered health systems resilient health systems for the 21st century and it will be centered around a integrated primary health care system for the reasons I was mentioning at the start but very important the word integrated so the primary healthcare being very close to the communities being very cost-effective having the trust of the communities is central but in very good relation with the other parts of the service delivery like the hospitals this is something that was a little bit antagonized in the past in fact the better the primary healthcare works the better for the hospitals because then they can focus on what they should focus on to manage complicated cases because we know that in many countries up to 70 75 % of the disease events managed in hospitals can be managed in a more cost-effective patient friendly way in the primary healthcare so a strong primary health care doesn't mean on the hospital it means also a stronger hospital system the same for the public health services the same for the long term care because we're fading ageing of the population in medicine so that's in a nutshell that the primary health care also underpin D let's say new outcome statement of the talent charter thank you thank you very much we are drawing our time here to a close before we leave I wonder if each of you would share some brief closing thoughts about what you're hoping for the future of primary healthcare for us in my country we I would say grew up under the historical filling of Almaty declaration oh we were not there but for Kazakhstan it's very critical to be part of this process and of course we want to participate actively to host the conference to have the best minds the best ideas and to set up as as long as possible a long-term vision for the future of primary care and our vision is that it primary care should provide really equal access to all people for the best technology and for best care thank you I think I'll have to two thoughts if I'm allowed the one is the the Almaty declaration has inspired generations of public health professionals I hope this conference in Astana continues to enthuse many many more because a good strong public health which is multi sectoral in its orientation is is the best investment for the future of for any country which means that the children and benefit the most it me and my second thought is I think we finally have a creative opportunity to think out of the box about what does prevention actually mean a prevention that is inclusive of participation of adolescents participation of community so that they're generating their own health where they are so I think the opportunity to think about prevention and promotion through this new new vision for a primary health care is going to be very exciting thank you for me it is Kazakhstan once again and the first leadership of dr. Britain ov as well and the president putting it on the stage that primary health care is the core strategy lead to universal health coverage leaving no one behind because we are a continent and global health community which believes in the social values of equity and solidarity and we see in many places there are under threats particularly for minorities so that the conference will make it very clear at a very high level we are leaving no one behind primary health care is a big part of the solution for me I would have the thought since that he got many that we have for actually working together as an international community Roma these kind of events don't come around that often that go back to the very history of the organizations and it's a chance really to bring everybody on the same page somehow we've you often work in this world where everything is a sum game and somehow some and I think this provides this opportunity of us all moving a common agenda and secondly I think that the the opportunity for kind of advancing the and coming back to the roots of the equity agenda and said within the UHC movement it makes at some points as someone who spent a lot of time talking about UHC in people centered services people say what does that mean I don't understand it but in its very concrete entry point to advance this seriously it's not an amorphous thing universal health coverage it starts with primary care and moves on from there but I don't know lastly I think it would just be it's a many parts of the world many countries rich and not-so-rich the people have lost trust with their governments somehow there's a disconnect in many parts of the world and even if it's not the whole populations its subpopulations and I honestly think that this the primary health care and universal coverage movement is the opportunity for governments to recreate trust with their peoples it's about people thinking that their governments care for them so I think that's a big do we have thank you very much for those closing thoughts and for spending the time with us today to discuss this really important topic I want to thank our viewers both here in person and online for joining us today we hope that whoever you are wherever you are whatever your role is in health systems that you'll join with us in the global community this year and moving forward to the Future to advance primary health care thank you so much [Applause]

8 comments

  1. Love Shannon Barkley's comment: "Primary Health Care… is the best way to organize a health system."

Leave a Reply

(*) Required, Your email will not be published