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The History of Primary Health Care

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Introduction to the history of primary healthcare.

The history of primary healthcare.
From the small efforts of various groups to promote accessible and affordable health to all, the first significant step in the history of primary healthcare was the World Health Organization (WHO)’s “Health for all by the year 2000” initiative of 1977 which promoted UHC.
Although it was deemed impossible, atleast it led to the Alma Ata declaration in 1978 where various leaders established primary healthcare as the most practical and effective was of achieving the goal “Health for all by year 2000”.
30 years down the line, in 2008, the World Health Organisation launched the “Primary healthcare: now more than ever” report which highlighted several reforms necessary to make primary healthcare effective.
Then in 2018 was the Astana Declaration which traced the progress of primary healthcare since the Alma Ata declaration and established ways of strengthening primary healthcare to achieve universal health coverage.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Policy Framework for primary healthcare in Africa” which outline the goals to be met by Africa to achieve effective PHC for UHC in Africa.

Health for all by the year 2000

“Health for all by the year 2000” was a global health initiative launched by the World Health Organization (WHO) in 1977.
The initiative had three main objectives:
1. To achieve a level of health that would permit all individuals to lead a socially and economically productive life.
2. To reduce the gap in health status between developed and developing countries.
3. To provide essential health care to all individuals and families in the community.

Unfortunately, the goal of “Health for all by the year 2000” was not achieved but it did help in raising awareness of the need for accessible and affordable health for all, and this led to the establishment of primary healthcare in the 1978’s Alma Ata declaration.

The Alma Ata Declaration of 1978

The Alma-Ata Declaration is a health policy document that was adopted at the International Conference on Primary Health Care held in Alma-Ata, Kazakhstan in 1978.
The Declaration has had a profound impact on global health policy and practice. It has been a driving force behind the development of primary healthcare as a central component of health systems around the world.
It defined primary healthcare as “essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.”
And it also emphasized the importance of community participation, health promotion, and disease prevention in addition to curative services. It recognized the need for a comprehensive approach to healthcare that addressed not just physical health, but also mental, social, and spiritual well-being.

WHO’S “Primary Health Care: Now More Than Ever” Report of 2008

The report “Primary Health Care: Now More Than Ever” was published in 2008 by the World Health Organization (WHO). The report emphasized the importance of primary health care as the foundation of any effective health system and called for a renewed global commitment to primary health care as a means of achieving better health for all.
It highlighted four key reforms necessary to strengthen primary healthcare:
1. Strengthening health systems: The report called for a comprehensive approach to strengthening health systems, including investments in health infrastructure, health workforce education and training, and health information systems.
2. Improving access to primary health care: The report emphasized the need to improve access to primary health care services, particularly for underserved populations, through strategies such as expanding health coverage and reducing financial barriers to care.
3. Enhancing the quality of primary health care: The report called for efforts to improve the quality of primary health care services through initiatives such as strengthening health workforce capacity, promoting evidence-based practice, and implementing quality assurance systems.
4. Fostering community participation and empowerment: The report highlighted the importance of engaging communities in primary health care planning and decision-making to promote health equity and social justice.
Overall, the report called for a coordinated and sustained effort to strengthen primary health care systems worldwide, with a focus on addressing the health needs of the most vulnerable populations.

The Astana Declaration of 2018

The Astana Declaration is a global commitment to achieving universal health coverage (UHC) through primary health care (PHC). The declaration was adopted at the Global Conference on Primary Health Care in Astana, Kazakhstan in 2018, which marked the 40th anniversary of the historic Alma-Ata Declaration of 1978.
The Astana Declaration reaffirms the principles of the Alma-Ata Declaration, which recognized primary health care as the key to achieving health for all. The Astana Declaration goes further by emphasizing the need for a renewed commitment to primary health care as the foundation of health systems, and as a means of achieving universal health coverage.
The Astana Declaration calls for a series of actions to strengthen primary health care systems, including:
1. Investing in primary health care as the cornerstone of health systems
2. Strengthening health systems through increased funding and resources
3. Ensuring access to essential health services for all, including through community-based approaches
4. Empowering individuals and communities to participate in their own health and health care
5. Strengthening health workforce education and training to ensure a skilled and motivated health workforce
6. Strengthening health information systems to improve decision-making and accountability
7. Strengthening partnerships and cooperation between different sectors and actors to achieve shared health goals.

AfroPHC’s Policy Framework for PHC and UHC in Africa

This week we have been looking at the history of primary healthcare.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Building PHC Teams for UHC in Africa” which underscores the crucial role of the PHC workforce within a team based approach. It also outlines the key actions that need to be met by Africa to achieve effective PHC for UHC in Africa.
This policy framework was funded by Primary Health Care Performance Initiative (PHCPI) and echoes the voices of frontline primary healthcare workers and leaders across, Africa, collated through a series of virtual policy workshops and group discussions. The final workshop was held in October 2022 in Johannesburg, South Africa where a cohort of about 30 multicountry multiprofessional delegates met in person to finalise the policy framework.
In summary, the policy calls to Africa to pay heed to the call of its health professionals, to seize opportunities to overcome African challenges, to embrace the World Health Organisation’s Report of 2008 and Astana Declaration of 2018 by prioritizing integrated, resilient, person-centred and high quality PHC within UHC, re-organising UHC around PHC service delivery, integrating public health with primary care, and bringing private PHC providers into a regulated PHC system for UHC in Africa.

WHO policy brief on COVID-19 infodemic management

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The WHO policy brief on COVID-19 infodemic management outlines key actions for countries to consider when developing infodemic management policies, focusing on opportunities for strengthening and supporting such a network of actors.

The policy brief on infodemic management can be used by health authorities to support the development of a comprehensive infodemic management strategy, adapted to their country that leverages these activities efficiently. The brief highlights the importance of equipping health workers with skills to address health misinformation and the need for designated infodemic management teams to generate rapid actionable insights for health systems.

The policy brief is available in all official WHO languages.

The key points in the policy brief: 1. Train health workers, who are often the most trusted source of health information, to better identify and address health misinformation. 2. Tailor health, information and digital literacy initiatives to specific populations, and seek to debunk misinformation before it is widely disseminated through digital media and other channels. 3. Strive to develop high-quality, accessible health information in different digital formats designed for reuse, remixing and sharing and for rapid digital spread through social networks. 4. Establish an infodemic workforce for rapid infodemic insights generation and response, if necessary, by training staff to fulfil these functions; and ensure this function is clearly linked to and aligned with risk communications and community engagement efforts…more

Long covid—an update for primary care

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#LongCOVID (prolonged symptoms following covid-19 infection) is common.
The mainstay of management is supportive, holistic care, symptom control, and detection of treatable complications.
Many patients can be supported effectively in #primaryhealthcare by a GP with a special interest…more

WHO: More than half of child deaths are due to conditions that could be easily prevented or treated given access to health care and improvements to their quality of life

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Background Evidence has been accumulating that community health workers (CHWs) providing evidence–based interventions as part of community–based primary health care (CBPHC) can lead to reductions in maternal, neonatal and child mortality. However, investments to strengthen and scale–up CHW programs still remain modest.

Methods We used the Lives Saved Tool (LiST) to estimate the number of maternal, neonatal and child deaths and stillbirths that could be prevented if 73 countries effectively scaled up the population coverage of 30 evidence–based interventions that CHWs can deliver in these high–burden countries. We set population coverage targets at 50%, 70%, and 90% and summed the country–level results by region and by all high–burden countries combined. We also estimated which specific interventions would save the most lives.

Findings LiST estimates that a total of 3.0 (sensitivity bounds 1.8–4.0), 4.9 (3.1–6.3) and 6.9 (3.7–8.7) million deaths would be prevented between 2016 and 2020 if CBPHC is gradually scaled up during this period and if coverage of key interventions reaches 50%, 70%, and 90% respectively. There would be 14%, 23%, and 32% fewer deaths in the final year compared to a scenario assuming no intervention coverage scale up. The Africa Region would receive the most benefit by far: 58% of the lives saved at 90% coverage would be in this region. The interventions contributing the greatest impact are nutritional interventions during pregnancy, treatment of malaria with artemisinin compounds, oral rehydration solution for childhood diarrhea, hand washing with soap, and oral antibiotics for pneumonia.

Conclusions Scaling up CHW programming to increase population–level coverage of life–saving interventions represents a very promising strategy to achieve universal health coverage and end preventable maternal and child deaths by 2030. Numerous practical challenges must be overcome, but there is no better alternative at present. Expanding the coverage of key interventions for maternal nutrition and treatment of childhood illnesses, in particular, may produce the greatest gains. Recognizing the millions of lives of mothers and their young offspring that could

be achieved by expanding coverage of evidence–based interventions provided by CHWs and strengthening the CBPHC systems that support them underscores the pressing need for commitment from governments and donors over the next 15 years to prioritize funding, so that robust CHW platforms can be refined, strengthened, and expanded... more

WHO makes new recommendations for Ebola treatments, calls for improved access

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The World Health Organization (WHO) has published its first guideline for Ebola virus disease therapeutics, with new strong recommendations for the use of two monoclonal antibodies. WHO calls on the global community to increase access to these lifesaving medicines.

Ebola is a severe and too often fatal illness caused by the Ebola virus. Previous Ebola outbreaks and responses have shown that early diagnosis and treatment with optimized supportive care —with fluid and electrolyte repletion and treatment of symptoms—significantly improve survival. Now, following a systematic review and meta-analysis of randomized clinical trials of therapeutics for the disease, WHO has made strong recommendations for two monoclonal antibody treatments: mAb114 (Ansuvimab; Ebanga) and REGN-EB3 (Inmazeb)…

The new guidance complements clinical care guidance that outlines the optimized supportive care Ebola patients should receive, from the relevant tests to administer, to managing pain, nutrition and co-infections, and other approaches that put the patient on the best path to recovery.

Dr Richard Kojan, co-chair of the Guideline Development Group… “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.”…

There is also a recommendation on therapeutics that should not be used to treat patients: these include ZMapp and remdesivir...more

Besrour Year In Review

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It is our pleasure to send you our Year in Review Report for the year 2021. The idea of the Besrour Centre for Global Family Medicine was born out of the tragedies of the humanitarian crisis in Darfur Sudan that began in 2003, the Banda Aceh tsunami in Indonesia in 2004 and the Haitian earthquake of 2010.

Since the official opening of the Besrour Centre in 2015, we have matured both as a discipline and as a centre. Today, not only do we advocate for family medicine and its role in improving patient care, but also for the models of care throughout the health system that are based on family medicine principles. Over the last six years, our focus has shifted from building family medicine capacity in low- and middle-income countries to studying and promoting family medicine-led models around the world.

The global COVID-19 pandemic has reinforced the importance of our work. It continues to highlight that global problems require global solutions—it is not just an urgent moral issue, it’s a global public health issue. The pandemic also highlighted gaps in and between health systems around the world. Capacity has been stretched everywhere, revealing areas where access remains problematic, and where integration at the system level is still lacking. At the same time, it revealed incredible innovation and perseverance.

As the pandemic continues to vacillate between infectious and chronic impacts, improved integration and the adaptability of family medicine will be key in all health system contexts, including Canada. All of Besrour Centre’s initiatives are exploring or demonstrating how family doctors are leading at this time. Our collective journey highlights that capacity building takes time and determination. To continue this work, we need your ongoing engagement, partnership, and help. We are deeply appreciative of the funding provided by the Foundation for Advancing Family Medicine (FAFM) and all our partners that helps fuel our work. As always, we are indebted to Dr. Sadok Besrour for his vision and perennial support to build the Centre.

Together, we are a vibrant network of community-based leaders and partners that continue to learn from one another. Our collective effortsare strengthening family medicine-led models that are at the heart of health systems around the world and, in turn, improve equitable access to care.

Warm regards,

David Ponka, MD CM, CCFP(EM), FCFP, MSc
Director | Directeur
The Besrour Centre for Global Family Medicine | Le Centre Besrour pour la médecine familiale mondiale
The College of Family Physicians of Canada |
Le Collège des médecins de famille du Canada
1(905) 629-0900 ext | poste 398
dponka@cfpc.ca https://www.cfpc.ca/The_Besrour_Centre/

Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control.

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PURPOSE: Although the global burden of cancer falls increasingly on low- and middle-income countries (LMICs), much of the evidence for cancer prevention and control comes from high-income countries and may not be directly applicable to LMIC settings. In this paper, we focus on the following question: When the majority of the evidence supporting an evidence-based intervention or implementation strategy comes from high-income countries, what local, contextual evidence is needed when transferring and adapting an intervention or strategy to a specific LMIC setting?

METHODS: We draw on an existing framework (the Population, Intervention, Environment, Transfer-T process model) for assessing transferability of interventions between distinct settings and apply the model to two case studies as learning examples involving implementation of tobacco use treatment guidelines and self sampling for human papillomavirus DNA in cervical cancer screening.

RESULTS: These two case studies illustrate how researchers, policymakers, practitioners, and consumers may approach the need for local evidence from different perspectives and with different priorities. As uses and expectations around local evidence may be different for different groups, aligning these priorities through multistakeholder engagement in which all parties participate in defining the questions and cocreating the solutions is critical, along with promoting standardized reporting of contextual factors.

CONCLUSION: Local, contextual evidence can be important for both researchers and practitioners, and its absence may hinder translation of research and implementation efforts across different settings. However, it is essential for researchers, practitioners, and other stakeholders to be able to clearly articulate the type of data needed and why it is important. In particular, where resources are limited, evidence generation should be prioritized to address real needs and gaps in knowledge…more

Mooki Newsletter Volume 2 Issue 2

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We are sharing the second issue of Mooki newsletter of the Lesotho Nurses Association. For the success of our newsletter, please feel free to share your stories, articles, events, interviews, and any developments in Lesotho Nursing and Midwifery with the editor (contacts provided in this issue). The editorial team will highly appreciate feedback on how to improve the Newsletter…!!!

PLEASE FEEL FREE TO SHARE THE NEWSLETTER ON YOUR NETWORKS.

Mooki Newletter Vol 2 Iss 2Download

ReLAB-HS August 2022 Newsletter

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Learning, Acting and Building for Rehabilitation in Health Systems (ReLAB-HS) is continuing its efforts to strengthen health systems that are responsive to the growing needs for rehabilitation across the lifespan by targeting its efforts in Burma, Pakistan, Uganda and Ukraine – and in this newsletter you can read of how ReLAB-HS is making a difference in those countries.

Read about ReLAB-HS’s official launch in Pakistan, its advocacy work at the World Health Assembly, and connect with several learning resources created by the consortium. This newsletter also contains information on how to register for an upcoming Massive Online Open Course, “Understanding the Rehabilitation Needs of Displaced Persons.” And be sure to save the date (Sept. 26, 9 a.m. EDT) for a ReLAB-HS webinar “Leadership for Rehabilitation: Addressing the needs in fragile and conflict-affected settings.” …more

UpToDate – Monkeypox Content Available for FREE

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Wolters Kluwer are providing FREE access to the latest evidence-based content in UpToDate and Ovid relating to the Monkeypox outbreak to all clinicians and organisations, including those that do not currently subscribe to UpToDate. As with all UpToDate clinical topics, the content is being constantly reviewed by our team of clinical experts, clinical researchers and editors and is updated as new information becomes available.

Get FREE access to the related clinical topics as well as FREE access the information below here: http://gag.gl/rQQeJj

– European and UK Society guidelines including the British HIV association and UK Health Security Agency.

– Patient education informmation relating to risk, symptoms and treatments in a printable, understandable format.

– Understanding the neurollogical effects of the monkeypox virus on patients.

– A primer on Monkeypox foor obstetricians and gynaecologists.

– Additional Monkeypox ressources.

WHO publishes new guidelines on HIV, hepatitis and STIs

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The guidelines outline a public health response to HIV, viral hepatitis and sexually transmitted infections (STIs) for 5 key populations (men who have sex with men, trans and gender diverse people, sex workers, people who inject drugs and people in prisons and other closed settings)…

“The new data from UNAIDS show that around 70% of new HIV infections occur among key populations and their partners…” said Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes…

These guidelines also acknowledge that behavioural interventions aimed at changing behaviours – which tend to be prioritized in many settings – have no impact on incidence of HIV, viral hepatitis and STIs or on behaviour change…more

AfroPHC Newsletter August 2022

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It has been an arduous task to prepare the next draft of the AfroPHC Policy Framework, after extensive discussions at the AfroPHC e-Conference 17-18th May. Sorry that we did not share anything in June and July! We have now fashioned a “Health care worker call for Africa to build effective PHC teams for PHC and UHC in Africa” It is now available for public comment after the Executive and Advisory Boards have engaged with it.

This second draft of the AfroPHC policy framework is still an argument from healthcare workers for policymakers to prioritise PHC teamwork for holistic care of empanelled populations in decentralised units of community practice. We see the definition of PHC services and modelling of teams in the light of country resources, emerging blended capitation payment systems in UHC reforms across Africa, the inclusion of private providers and the use of complexity theory in bottom-up organisation of PHC in Africa as critical supports that are needed to build PHC teams for UHC in Africa. See the document here and please feel free to comment on it [https://afrophc.org/2022/08/07/afrophc-draft-policy-framework-released-for-stakeholder-comment/].

We have been fortunate in winning a PHC Performance Initiative Micro-Grant of $40 000 to take the policy framework further. It was an incredibly strong pool of 200 applicants and our proposal rose to the top. The goal in our grant-seeking project is to deepen the draft AfroPHC Policy Framework on “Building PHC teams for UHC in Africa” by focusing on EFFECTIVENESS. The target participants and audiences will be AfroPHC members, PHC team members and other stakeholders as well as young health professionals and students at regional and country levels. Activities will be mostly online across African countries, with hybrid Final Workshop of the AfroPHC Executive and Advisory Board in Johannesburg, South Africa 25th-26th October 2022 and a virtual Launch Event on 12th December 2022. See more about the overall grant activities here [https://afrophc.org/2022/08/07/phc-performance-initiative-micro-grant/].

Our process starts in earnest as we have until end October to use the funds. We have a list of regions and stakeholder groups we would like to engage: Central, Southern, Western, Eastern, Arabic and Portuguese Africa. See the detailed list of countries and key stakeholders with dates of consultations and join the WhatsApp group for these regions. See more here [https://afrophc.org/chapters/]. We are very keen that as many local stakeholders participate. These include professional associations, ministries of health, accreditation / certification bodies, academics, patient advocacy groups etc. Please feel free to share this email to any key stakeholders you think should be there and ask them to join us to discuss AfroPHC and the Policy Framework.

We keen to collect cases on ““Building effective multidisciplinary primary health care teams for universal health coverage in Africa” and have set aside prizes worth $1000 for this purpose. We are looking for short, real-life stories about an initiative, project or advocacy campaign that highlight interdisciplinary and interprofessional teamwork being implemented within the African context, demonstrating person and family centered care and helping communities and societies transition to healthy populations. Sharing experiences of less successful case studies and lessons learned is also welcome. The deadline for submitting the case studies is 11th September. Winners will be announced by 31st October. The case studies can be submitted in text format (1200 words max), following the guiding questions, by email to info@afrophc.org. Complementing the case studies with visual materials, such as photos from the field, would be most welcome. See details here https://afrophc.org/2022/08/07/call-for-submissions-of-short-cases/

The AfroPHC Annual General Meeting (AGM) on Thursday 19th May agreed to some few changes. A key change is that we will have associate membership having full access to all the current benefits of AfroPHC. We have created full membership at a fee of $20 for individual members and $40 for institutional members with the additional benefit of having vote/s at the Annual General Meeting and being able to stand for election to the Executive Board (EB). We will begin this process from November 2022. Speaking of elections we welcome our three new EB members: Dr Umar Ibrahim (CHEW, Nurse with PhD from Nigeria) (https://afrophc.org/conference-agm/agm-2022/umar-ibrahim-2/), Mr Innocent Somboi (Clinical Officer from Tanzania) (https://afrophc.org/about/innocent-somboi/) and Dr Mercy Wanjala (Family Physician from Kenya) (https://afrophc.org/conference-agm/agm-2022/mercy-wanjala-2/) [who has since resigned to become the Deputy Executive Coordinator].

We always have wonderful AfroPHC Policy Workshops. Mercy has organised several: “Point of Care Testing in African PHC” 21st June [https://afrophc.org/2022/06/20/afrophc-workshop-21st-june-labs-poct-in-african-phc/], “Onehealth n African PHC” July [https://afrophc.org/2022/07/18/afrophc-workshop-19-july-onehealth-in-african-phc/], and now plans one on “Workers Health in African PHC” 16th August [https://afrophc.org/2022/08/07/afrophc-workshop-16-aug-workers-health-in-african-phc/]. Do join us at the next one.

AfroPHC also provides great value for members at no cost: management course, research support, CPD and the development of a family medicine postgraduate diploma for doctors, nurse clinicians and clinical officers.

See this article on a South African model for community practice https://www.timeslive.co.za/sunday-times-daily/news/2022-03-07-this-is-how-nhi-can-shine-doctor-behind-soweto-clinic-that-broke-the-mould/

A useful article on “African primary healthcare as a complex adaptive system” has been published and is available in pre-publication form on a webpage here. It is an important support to the AfroPHC Policy Framework. See here https://profmoosa.com/article-african-primary-healthcare-as-a-complex-adaptive-system/

See below a sample of useful posts on the AfroPHC blog and keep tabs on it.

Blood Exposure Accidents among Health Care Personnel
Are Africa’s health resources overly focused on HIV/AIDS?
WHO publication “Implication of the COVID-19 Pandemic for Patient Safety: A Rapid Review”, Tuesday, 09 August 2022
Monkeypox declared global health emergency by WHO as cases surge
LeBoHA’s June Newsletter
Don’t forget to engage with us on Facebook, Twitter and YouTube and keep in touch!

New global alliance launched to end AIDS in children by 2030

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Globally, only half of children living with HIV are on life-saving treatment. UNAIDS, UNICEF, and WHO have brought together a new alliance to fix one of the most glaring disparities in the AIDS response…more

WHO launches appeal to respond to urgent health needs in the greater Horn of Africa

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The health and lives of people in the greater Horn of Africa are threatened as the region faces an unprecedented food crisis. In order to carry out urgent, life-saving work, WHO is launching a funding appeal for US$ 123.7 million…more

Are Africa’s health resources overly focused on HIV/AIDS?

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… Africa’s double burden of infectious and chronic disease is at the center of this debate on whether Africa is overspending health resources on … For starters, according to the World Health Organization, Africa has the highest incidence of HIV…more

General practitioners’ communication skills in Nairobi, Kenya: A descriptive observational study

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Abstract

Background High quality primary care is associated with person-centeredness and effective communication that also supports continuity and coordination of care. In Kenya, there is little knowledge about the quality of communication in consultations by general practitioners (GPs).

Aim To evaluate the quality of communication by GPs.

Design & setting Descriptive, observational study of 23 GPs consultations in 13 private sector primary care facilities in Nairobi, Kenya.

Method One consultation with a randomly selected adult patient was recorded per GP, and 16 communication skills evaluated with the Stellenbosch University Observation Tool. A total percentage score was calculated per consultation, and compared with the GPs’ demographics, consultations’ complexity and duration using the Statistical Package for Social Sciences.

Results The GPs’ median age was 30.0 years (IQR: 29–32) and median consultation time was 7.0 minutes (IQR =3–9). Median overall score was 64.3% (IQR: 48.4–75.7). They demonstrated skills in gathering information, making and explaining the diagnosis and suggesting appropriate management. They did not make an appropriate introduction, explore the context or patient’s perspective, allow shared decision making or provide adequate safety netting. There was a positive correlation between the scores and duration of the consultations (r=0.680, P=0.001). The score was higher in consultations of moderate complexity (78.1; IQR =57.1–86.7) versus low complexity (52.2; IQR =45.1–66.6) (P=0.012).

Conclusion Consultations were brief and biomedical by young and inexperienced GPs. GPs needed further training in communication skills, particularly with regard to person-centredness. Deploying family physicians to the primary care setting would also improve the overall quality of service delivery.

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