PHC EMRO Sameen Siddiqi

							 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
 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




Regional Office of the Eastern Mediterranean
         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.

Regional Office of the Eastern Mediterranean
      Community Based Initiatives in
      the Eastern Mediterranean




          BDN
          BDN 13
          Healthy Cities
          Healthycities           8
          Healthy Villages
          Healthyvillages  4
          Women in Health & Development        18
Regional Office of the Eastern Mediterranean
   22 June 2012                                     4
Tackling Social Determinants of Health and
Equity through Community Based Initiative




Regional Office of the Eastern Mediterranean
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


Regional Office of the Eastern Mediterranean
          Infant Mortality and Under 5 Mortality
                    Oman 1970-2006
          200
                181

          150



          100   118


           50
                                                                                   11.0
                                                                                   10.25
            0    // // // //
          DGHA - MOH                Infant Mortality Rate Under 5 Mortality Rate
Regional Office of the Eastern Mediterranean
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


Regional Office of the Eastern Mediterranean
 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?


Regional Office of the Eastern Mediterranean
   Globalization: Trade in health services

    Travel and Health Expenditure by
       Yemeni Patients on Foreign
           Treatment - 2000-03
                                 million US$
  82
  80
  78
  76
  74
  72
  70
  68
  66
         1        2          3          4
                      Year



Regional Office of the Eastern Mediterranean
                The challenge of
         Governance 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

Regional Office of the Eastern Mediterranean
  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



Regional Office of the Eastern Mediterranean
      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


Regional Office of the Eastern Mediterranean
Regional Office of the Eastern Mediterranean
   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
Regional Office of the Eastern Mediterranean
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


Regional Office of the Eastern Mediterranean
 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


Regional Office of the Eastern Mediterranean
Approaches to health system development
         Attributes          Primary Health Care       Health Sector
                               – as in Alma Ata          Reform
   Ideology promoted        Social egalitarian   Utilitarian

   Overall approach         Comprehensive        Selective – essential
                                                   package of services
                         Thank you for your
   Role of governments Greater public       Restricted role of
                        sector involvement    the government
   Focus on                  attention! Efficiency and
                           Equity and Social
                             justice               competition
   Champions                Socially driven      Economists
                             scientists
   Type of reforms          Programmatic         Structural

Regional Office of the Eastern Mediterranean