Primary Health Care - Now More Than Ever

Primary Health Care - Now More Than Ever

(Parte 1 de 16)

Primary Health Care



Than Ever

The World Health Report 2008

Primary Health Care



Than Ever

The World Health Report 2008

WHO Library Cataloguing-in-Publication Data The world health report 2008 : primary health care now more than ever.

1.World health – trends. 2.Primary health care – trends. 3.Delivery of health care. 4.Health policy. I.World Health Organization.

© World Health Organization 2008

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Design: Reda Sadki Layout: Steve Ewart and Reda Sadki Figures: Christophe Grangier Printing Coordination: Pascale Broisin and Frédérique Robin-Wahlin

Printed in Switzerland

The World Health Report 2008 was produced under the overall direction of Tim Evans (Assistant Director-General) and Wim Van Lerberghe (editor-in-chief). The principal writing team consisted of Wim Van Lerberghe, Tim Evans, Kumanan Rasanathan and Abdelhay Mechbal. Other main contributors to the drafting of the report were: Anne Andermann, David Evans, Benedicte Galichet, Alec Irwin, Mary Kay Kindhauser, Remo Meloni, Thierry Mertens, Charles Mock, Hernan Montenegro, Denis Porignon and Dheepa Rajan. Organizational supervision of the report was provided by Ramesh Shademani.

Contributions in the form of boxes, fi gures and data analysis came from: Alayne Adams, Jonathan Abrahams, Fiifi Amoako Johnson, Giovanni Ancona, Chris Bailey, Robert Beaglehole, Henk Bekedam, Andre Biscaia, Paul Bossyns, Eric Buch, Andrew Cassels, Somnath Chatterji, Mario Dal Poz, Pim De Graaf, Jan De Maeseneer, Nick Drager, Varatharajan Durairaj, Joan Dzenowagis, Dominique Egger, Ricardo Fabregas, Paulo Ferrinho, Daniel Ferrante, Christopher Fitzpatrick, Gauden Galea, Claudia Garcia Moreno, André Griekspoor, Lieve Goeman, Miriam Hirschfeld, Ahmadreza Hosseinpoor, Justine Hsu, Chandika Indikadahena, Mie Inoue, Lori Irwin, Andre Isakov, Michel Jancloes, Miloud Kaddar, Hyppolite Kalambaye, Guy Kegels, Meleckidzedeck Khayesi, Ilona Kickbush, Yohannes Kinfu, Tord Kjellstrom, Rüdiger Krech, Mohamed Laaziri, Colin Mathers, Zoe Matthews, Maureen Mackintosh, Di McIntyre, David Meddings, Pierre Mercenier, Pat Neuwelt, Paolo Piva, Annie Portela, Yongyut Ponsupap, Amit Prasad, Rob Ridley, Ritu Sadana, David Sanders, Salif Samake, Gerard Schmets, Iqbal Shah, Shaoguang Wang, Anand Sivasankara Kurup, Kenji Shibuya, Michel Thieren, Nicole Valentine, Nathalie Van de Maele, Jeanette Vega, Jeremy Veillard and Bob Woollard.

Valuable inputs in the form of contributions, peer reviews, suggestions and criticisms were received from the Regional Directors and their staff, from the Deputy Director-General, Anarfi Asamoah Bah, and from the Assistant Directors-General.

The draft report was peer reviewed at a meeting in Montreux, Switzerland, with the following participants: Azrul Azwar, Tim Evans, Ricardo Fabrega, Sheila Campbell-Forrester, Antonio Duran, Alec Irwin, Mohamed Ali Jaffer, Safurah Jaafar, Pongpisut Jongudomsuk, Joseph Kasonde, Kamran Lankarini, Abdelhay Mechbal, John Martin, Donald Matheson, Jan De Maeseneer, Ravi Narayan, Sydney Saul Ndeki, Adrian Ong, Pongsadhorn Pokpermdee, Thomson Prentice, Kumanan Rasanathan, Salman Rawaf, Bijan Sadrizadeh, Hugo Sanchez, Ramesh Shademani, Barbara Starfi eld, Than Tun Sein, Wim Van Lerberghe, Olga Zeus and Maria Hamlin Zuniga.

The report benefi ted greatly from the inputs of the following participants in a one-week workshop in Bellagio, Italy: Ahmed Abdullatif, Chris Bailey, Douglas Bettcher, John Bryant, Tim Evans, Marie Therese Feuerstein, Abdelhay Mechbal, Thierry Mertens, Hernan Montenegro, Ronald Labonte, Socrates Litsios, Thelma Narayan, Thomson Prentice, Kumanan Rasanathan, Myat Htoo Razak, Ramesh Shademani, Viroj Tangcharoensathien, Wim Van Lerberghe, Jeanette Vega and Jeremy Veillard.

WHO working groups provided the initial inputs into the report. These working groups, of both HQ and Regional staff included: Shelly Abdool, Ahmed Abdullatif, Shambhu Acharya, Chris Bailey, James Bartram, Douglas Bettcher, Eric Blas, Ties Boerma, Robert Bos, Marie-Charlotte Boueseau, Gui Carrin, Venkatraman Chandra-Mouli, Yves Chartier, Alessandro Colombo, Carlos Corvalan, Bernadette Daelmans, Denis Daumerie, Tarun Dua, Joan Dzenowagis, David Evans, Tim Evans, Bob Fryatt, Michelle Funk, Chad Gardner, Giuliano Gargioni, Gulin Gedik, Sandy Gove, Kersten Gutschmidt, Alex Kalache, Alim Khan, Ilona Kickbusch, Yunkap Kwankam, Richard Laing, Ornella Lincetto, Daniel Lopez-Acuna, Viviana Mangiaterra, Colin Mathers, Michael Mbizvo, Abdelhay Mechbal, Kamini Mendis, Shanthi Mendis, Susan Mercado, Charles Mock, Hernan Montenegro, Catherine Mulholland, Peju Olukoya, Annie Portela, Thomson Prentice, Annette Pruss-Ustun, Kumanan Rasanathan, Myat Htoo Razak, Lina Tucker Reinders, Elil Renganathan, Gojka Roglic, Michael Ryan, Shekhar Saxena, Robert Scherpbier, Ramesh Shademani, Kenji Shibuya, Sameen Siddiqi, Orielle Solar, Francisco Songane, Claudia Stein, Kwok-Cho Tang, Andreas Ullrich, Mukund Uplekar, Wim Van Lerberghe, Jeanette Vega, Jeremy Veillard, Eugenio Villar, Diana Weil and Juliana Yartey.

The editorial production team was led by Thomson Prentice, managing editor. The report was edited by Diana Hopkins, assisted by Barbara Campanini. Gaël Kernen assisted on graphics and produced the web site version and other electronic media. Lina Tucker Reinders provided editorial advice. The index was prepared by June Morrison.

Administrative support in the preparation of the report was provided by Saba Amdeselassie, Maryse Coutty, Melodie Fadriquela, Evelyne Omukubi and Christine Perry.

Photo credits: Director-General’s photograph: WHO (p. viii); introduction and overview: WHO/Marco Kokic (p. x); chapters 1–6: Alayne Adams (p. 1); WHO/Christopher Black (p. 23); WHO/Karen Robinson (p. 41); International Federation of Red Cross and Red Crescent Societies/John Haskew (p. 63); Alayne Adams (p. 81); WHO/Thomas Moran (p. 9).

Contents i

The World Health Report 2008Primary Health Care – Now More Than Ever

Message from the Director-Generalviii

Introduction and Overviewxi

Responding to the challenges of a changing worldxii Growing expectations for better performancexiii From the packages of the past to the reforms of the futurexiv Four sets of PHC reformsxvi Seizing opportunities xviii

Chapter 1. The challenges of a changing world1

Unequal growth, unequal outcomes2 Longer lives and better health, but not everywhere2

Growth and stagnation4

Adapting to new health challenges7

A globalized, urbanized and ageing world7 Little anticipation and slow reactions9

Trends that undermine the health systems’ response11

Hospital-centrism: health systems built around hospitals and specialists11 Fragmentation: health systems built around priority programmes12 Health systems left to drift towards unregulated commercialization13

Changing values and rising expectations14

Health equity 15 Care that puts people fi rst16 Securing the health of communities16 Reliable, responsive health authorities17 Participation 18

PHC reforms: driven by demand18

Chapter 2. Advancing and sustaining universal coverage23

The central place of health equity in PHC24 Moving towards universal coverage25

Challenges in moving towards universal coverage27

Roling out primary-care networks to fi l the availability gap28 Overcoming the isolation of dispersed populations30 Providing alternatives to unregulated commercial services31

(Parte 1 de 16)