Речь на церемонии торжественного открытия Центра передового опыта ВОЗ в области первичной медико-санитарной помощи
Dr Zsuzsanna Jakab, WHO Regional Director for Europe
11 February 2015, Almaty, Kazakhstan
Your Excellency, honourable First Vice-Minister of Health and Social Development of the Republic of Kazakhstan, ambassadors and representatives of the United Nations system, other honourable officials of the Government of Kazakhstan, distinguished delegates from academe and partners, ladies and gentlemen, it is an honour to be here with you today, in celebration of the new WHO centre for excellence in primary health care that has been made possible through the great generosity of the Government of Kazakhstan.
Kazakhstan has been a long-time partner of WHO in strengthening health-service delivery.
The launch of the centre, almost four decades after the 1978 Declaration of Alma-Ata, marks Almaty as not only the birthplace of primary health care; but also its home.
Ladies and gentlemen, a great deal has changed since the Declaration of Alma-Ata. Nevertheless, last year, marked by the outbreak of Ebola virus disease, has served as an unfortunate reminder that the same principles that underpin the vision for a primary-health-care approach, continue to remain vital to global health and development.
There are many factors of culture, history and geography that have affected the countries hardest hit by the Ebola epidemic. Among these causes, the bottlenecks resulting from exceptionally weak health systems, following years of civil war and unrest, have been identified as the root of their inability to withstand the weight of this disease.
Now, a year from the start of the outbreak, rebuilding resilient health systems has looked to a primary-health-care approach, with the biggest and most obvious lessons learned comprising a call to realize these principles and bring about people-centred health-service delivery. What have we learned or relearned?
First, concerning the critical role of community engagement, communities know best what they need and are willing to accept. The disease has preyed on a deep-rooted cultural tradition of compassionate care for the ill, and ceremonial care of their bodies in death. Prevention and treatment measures at odds with these practices have reminded us that safe behaviour and life-saving supportive care cannot be promoted without the understanding and cooperation of individuals, their families and communities.
Second, good referral systems need to be in place, with measures for providing safer, more effective care. This means optimizing service delivery across levels and settings of care, for optimal provision along the care continuum, rather than as silos of excellence.
Third, management in service delivery needs critical attention. This has proved its importance to ensure the logistics needed for uninterrupted care, from as basic work as ensuring the regular support of electricity and running water, to the supply of essential medicines and commodities.
Fourth, looking to the broader health system, in its role to set the conditions for service delivery, there is an important need to work across core functions. Unreliable and often non-existent systems of vital health statistics, a meagre health workforce and a lack of competencies across health professionals and in laboratories, each affected the potential for timely detection of and response to infections.
Lastly, the social, environmental and economic determinants of health affect the type of response that health systems can provide to people’s needs. Intersectoral action, horizontal governance and a population-based approach to health are therefore confirmed to be the direction to overcome inequities within our societies.
Ladies and gentlemen, let us take from the tragedy that is this global health challenge, the opportunity to work harder to strengthen people-centred health systems as the foundation for health and development. Failure to invest in health systems leaves countries with no backbone to withstand the shocks that this century is delivering with unprecedented frequency.
In the WHO European Region, health systems have been challenged to continuously adapt to and evolve with the changing context. This includes the demographic transition, contributing to population ageing; an epidemiological transition, including increasing noncommunicable diseases coupled with persisting and (re-)emerging infectious threats, as well as sociobehavioural illness, multimorbidities and rates of chronicity; new, amplified and worsened environment-associated diseases and risk factors; and harmful societal trends including poor lifestyles and behavioural risk factors.
Adding urgency to reforms are the advances in research, technology, manufacturing and medicines that have dramatically changed how we prevent illness, alleviate pain, restore health and extend life; we have yet to take full stock of these. For example, service-delivery innovations, such as e-health and m-health, have made possible more personalized, affordable and effective services in ways previously unimaginable.
The use of these tools across and within countries varies considerably, signalling that systems do not naturally absorb innovations, at least not systematically. In this context, business as usual will not suffice. Considering the disease burden in the Region, a strong commitment to public health and its integration with health services delivery are especially needed.
That is, we need services that are proactive, rather than reactive, and continuous and comprehensive, rather than episodic and disease-specific; and services built on lasting patient–provider relationships, rather than incident- and provider-led care. With the consequences of the contextual changes taking clear shape – including increasing unmet need, longer waiting times, rising out-of-pocket payments and high rates of hospital readmission – the urgent need for service-delivery transformations with these changes in mind is made particularly clear.
Ladies and gentlemen, the Declaration of Alma-Ata was ahead of its time. Now, more than 35 years since its vision for health-service delivery was first put forward, both globally and in the WHO European Region, there is a renewed policy environment for health-service delivery founded on its same principles.
This continued commitment to strengthening health systems and transforming service delivery, promoting people-centred services through integrated delivery, has taken global focus as a priority programme of work and in the development of a WHO global strategy on service delivery.
In the WHO European Region, this has been conveyed in the development, adoption and now implementation of the European policy framework, Health 2020. Health 2020’s third priority area, strengthening people-centred health systems and public health capacity, is built on the principles of the Tallinn Charter: Health Systems for Health and Wealth: recognizing the unique responsibility of health systems to deliver services that improve, maintain or restore the health of individuals and their communities.
As part of the implementation of Health 2020, the development of a health systems-based, results-oriented approach for transforming services delivery was launched in 2013. Taking shape as the Framework for Action for Coordinated/Integrated Health Services Delivery, this work sets out to provide an action-oriented guide and operational resources to support service-delivery transformations in countries. The process of developing the Framework has been defined in a planning document with activities spanning from its official launch in 2013 to the meeting of the WHO Regional Committee for Europe in 2016, and its onward implementation to follow.
Ladies and gentlemen, good policies are not enough.
Putting people first is not a trivial principle and often requires significant, even if often simple, departures from business as usual. The conditions for achieving the Region’s greatest health potential, as set out in Health 2020, requires strong leadership to take on the complexities of systems and bring their parts into alignment, while managers face the equally difficult challenge of bringing about people-centred services in the day-to-day functioning of service provision.
Integrated health-service delivery is a vehicle for taking on these system-design challenges, providing the blueprint for the conditions needed to advance people-centred health-service delivery and giving direction to the process of transforming the provision of services.
This means operationalizing a revitalized commitment to a primary-health-care approach. More specifically, this means:
- recognizing that intersectoral action is vital: providing services throughout the life-course cannot be achieved by the health sector alone; there must be a joint effort to link with other sectors, including education and social services;
- establishing a competent workforce, targeting our systems of education and training, accreditation and certification, and continuous learning: only by doing so will we be able to raise the prestige of primary health care and its workforce and support providers with the skills needed for working together and closely with patients;
- financing primary care so funds for its function are available: looking here also to the appropriate use of incentives for quality and performance; and finally
- advancing innovations, including service and information and communication technologies to optimize the exchange of data and clinical information and to systematize the use of novel clinical innovations into the system for their benefits of scale.
The new centre for excellence in primary health care will ensure that the WHO Regional Office for Europe is equipped to support Member States in the task of revitalizing primary health care.
As an operational arm of the Regional Office and benefiting from its geographic position, the centre is expected to focus on activities for Member States. Key pillars of work have been anchored in synthesizing knowledge to expand the evidence base on service delivery; supporting countries by leveraging experience as technical know-how to assist in strengthening the delivery of services; advancing policy options, mechanisms and tools to further systematize priority actions for transformation; and building synergies with global health initiatives, fostering partnerships with leading academic institutions and think-tanks, and collaborating with development partners. These will enable the centre truly to position itself as a hub of excellence.
I close by reiterating my compliments to Kazakhstan for maintaining the global commitment to the primary-health-care approach and for walking the talk and pursuing reforms in Kazakhstan.
Recognizing the essential role of health-service delivery in working towards people-centred health systems, on behalf of the Member States, I thank the Government of Kazakhstan for this unique opportunity to advance health systems for health and development, as well as to defend our collective global health security.
Dear colleagues and friends, thank you for your kind attention.