WHO/UNICEF: A vision for primary health care in the 21st century (2)

1 November, 2018

Neil and HIFA colleagues

The two WHO documents to which, in your first post on this topic (30th October) you gave links ( http://www.who.int/docs/default-source/primary-health/vision.pdf?sfvrsn=... and http://www.who.int/docs/default-source/primary-health-care-conference/op... ) are very interesting, and I think important for HIFA.

1. The first (the vision) adds many points, which reinforce and add to those made in the Astana declaration, that provide markers for HIFA.

Ones that stood out for me are shown in the text extracts below:

- People have access to the knowledge, skills and resources needed to care for themselves and their loved ones, leveraging the full potential of health technologies as well as information and communications technologies (ICT). (page vii)

- Treating people and communities as key actors in the production of their own health and well-being is critical for understanding and responding to the complexities of the changing context. (page 4)

- For many people, herbal medicine, traditional treatments, and traditional practitioners are the main sources of health care. Appropriate integration of evidence-based, safe and effective traditional medicine as part of primary

care can lead to better health outcomes and economic advantages. Traditional medicine draws on and enhances societal knowledge of health preservation and management, supporting the vision of a knowledge-based healthy society equipped for self-care. (page 15)

- Surveillance and response combine monitoring and prevention, and highlight the importance of readily usable health information at the population and community level, including through engagement of primary care workers.(page 15)

- In the PHC approach, the health system (along with other sectors) contributes to empowering people through improved education and health information. Particular attention should be given to populations in situations of vulnerability, seeking to meet their information needs and provide guidance towards improved health. This component highlights the essential roles of people and communities as active participants in the creation of health and well-being, through three broad and necessary expressions of empowerment and engagement: as advocates for multisectoral policies and action for health; as co-developers of health and social services; and as self-carers and caregivers.(page18)

- Individuals ­ as the people experiencing the impact of their heallth and as decision-makers ­ have a central role to play in co-creating their own health and wwell-being and in providing informal care to their peers and loved ones. The possibilities for this have been revolutionised over the past 40 years as a result of technological changes, in particular the rapid expansion of new health technologies and information and communication technologies. At the time of the International Conference on Primary Health Care in Alma-Ata in 1978, access to health information was often quite limited and typically required access to a health professional. Today, in contrast, the first thing that many people across the world do when faced with a health problem is to use their mobile phone to seek more information, from the Internet or another source of information that previously would not necessarily have been accessible. Even newer technologies, such as point of care diagnostics that can be used by health care workers as well as patients, artificial intelligence and low-cost genetic testing, are also starting to create new possibilities for self-

care, the potential of which is only beginning to emerge. Measures will be needed to ensure equitable access as well as reliable information and support for the interpretation of complex information. ...... A PHC approach treats self-care and caregiving as integral components of efforts to improve health and well-being. For this to happen, individuals and communities must have access to the knowledge, skills, and resources required to meet their specific needs and sociocultural circumstances. These include financial resources, reliable information and technology, and ­ when needed ­ trusted experts and allies to help them anaanalyse information and navigate complex decisions, and to advocate for them.(page 21)

- People have access to the knowledge, skills and resources needed to care for themselves and their loved ones, making use of the full potential of information and communications technologies. Self-care and informal care are directly and explicitly linked to the formal service delivery sector through mechanisms that are effective and appropriate for the particular setting. (page 23)

- New technologies are critical for both demand- and supply-side efforts to improve health and well-being through stronger PHC. The rapid pace of change in information and communication technologies has opened up exciting possibilities for self-care and for the engagement of people and communities, developing resources that people can draw on as part of their self-care efforts. A number of efforts are under way to develop mHealth and eHealth platforms that expand the reach of health services and support self-care (e.g. by making information available when needed or by providing reminders for appointments or medications).(page 35)

2. The second document (the operational framework) is a much-needed piece of work on implementing the vision on but looks considerably less developed, certainly as far as some of the things that I think HIFA would want to see in it, so it is good, as your second post of 30th October noted , that WHO have put it out for consultation and I am sure HIFA colleagues will have valuable suggestions to make on what would help to operationalise the vision ( comments to

https://extranet.who.int/dataform/694626?lang=en , deadline 25 November).

Best regards


HIFA profile: Geoff Royston is an Independent Health Analyst and Researcher, former Head of Strategic Analysis and Operational Research in the Department of Health for England, and Past President of the UK Operational Research Society. His work has focused on informing the design, implementation and evaluation of policies and programmes in health and social care, and on fostering the capabilities of others to work in these areas. Associated activities have included modelling for understanding the performance of complex systems, analysis and communication of risk, and horizon scanning and futures thinking. He has also worked on information and communication technology in the health sector, notably in leading the design and national launch of the telephone and online health information and advice service NHS Direct. He has served on both scientific and medical UK Research Council panels, and as an impact assessor for the UK higher education Research Excellence Framework. He is a member of the editorial board for the journal Health Care Management Science and in 2012 was Guest Editor for its special issue on Global Health. He has been a consultant for the World Health Organisation, is a long standing member of the EURO Working Group on Operational Research Applied to Health Services, and is an expert adviser to the mHIFA (mobile Healthcare Information for All) programme. http://www.hifa.org/projects/mobile-hifa-mhifa He is also a member of the HIFA working group on Evaluating the Impact of Healthcare Information.



geoff.royston AT gmail.com