Back to Basics at the WHO

On October 15, 2008, in global health, primary health care, by Karen Grepin

The World Health Organization released the annual World Health Report yesterday. To celebrate the 30th anniversary of the Alma-Ata declaration, the report was actually released from Almaty, now in the present day Kazakhstan. Like most of the previous reports, the report highlights some of the great health inequalities and inequities that exist in the world:

Differences in life expectancy between the richest and poorest countries now exceed 40 years. Of the estimated 136 million women who will give birth this year, around 58 million will receive no medical assistance whatsoever during childbirth and the postpartum period, endangering their lives and that of their infants

What does the WHO recommend to end these massive differences? The WHO recommends a refocus on primary health care to steer health systems towards better performance, to make more efficient use of limited resources, and to reduce these inequalities. In addition, while the focus on primary health care the first time around was primarily on maternal and child health programs as well as infectious disease control, the WHO also notes that”

Primary health care also offers the best way of coping with the ills of life in the 21st century: the globalization of unhealthy lifestyles, rapid unplanned urbanization, and the ageing of populations. These trends contribute to a rise in chronic diseases, like heart disease, stroke, cancer, diabetes and asthma, that create new demands for long-term care and strong community support. A multisectoral approach is central to prevention, as the main risk factors for these diseases lie outside the health sector.

Is primary care really the panacea prescription for health systems? While I absolutely agree in principle that a refocus on primary health system is a good thing for most developing countries, in particular Africa, I wonder about two things. First, how does one really operationalize a refocus on primary health care, in particular in the present context where private sectors has been relatively unregulated in many countries for so many years, and the current focus of global health policy on scale up of large vertical programs? Second, I am also curious about this last claim. How appropriate are models of primary care at addressing chronic diseases (any ideas?)?

I eagerly await to read the whole report, if only my internet connection here in Accra here was a bit faster….

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