Presentation by Dr.Hans Kluge e.a., director of Health Systems, WHO-Euro at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

1. Primary health care: Objectives,
principles and policy directions
Dr Hans Kluge
Mrs Christine Beerepoot
Mr Rokho Kim
WHO Regional Office for Europe
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

2. Healthy ageing and the importance of
Primary Health Care
Fauja Singh,
UK, oldest
person ever
to run a
marathon.
Toronto
16 Oct 2011
aged 100
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

3. What do we talk about when talking about
primary health care? An outline
• NCD burden
• Definitions
• Policy documents
• PHC Reforms
• Partnership Dutch
Government/WHO
• Conclusions
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

4. Total deaths by broad cause group, by WHO Region,
World Bank income group and by sex, 2008
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

5. Prevalence of multiple chronic conditions
increases steeply with age: Netherlands
Source: van Baal et al, 2011,
Co-occurrence of diabetes,
myocardial infarction, stroke,
and cancer: quantifying age
patterns in the Dutch
population using health survey
data, Population Health Metrics
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

6. Public health and health systems
Public
Health
Health Systems
Education
Essential Public Health
Operations
Transport
Population-based health services
Other sectoral actors (beyond health Health Care Services:
systems) with health generating activities Primary, secondary, tertiary
Environment
Prevention, protection,
promotion Curative
Individual health services
Agriculture
Tourism
* Link to Health 2020, its governance, the whole-of-government
and the whole-of-society approach
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

7. Operational approach to support Member States in
health system strengthening (WHO EURO)
Expected Core Removal of health
results services system bottlenecks
Maternal and
Population and individual
Population level
child health
Resource generation
level service delivery
(Human resources and
Individual level
outcomes
Health financing
Governance
technology)
Cardiovascular
Population level
health Individual level
outcomes
Population level
Tuberculosis Individual level
Population level
Etc. Individual level
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

8. Primary Health Care
a health reform movement launched at Alma Ata in 1978 to move towards health for all.
2008: a set of policy orientations and reforms needed to move towards health for all: moving towards
universal coverage; shifting service delivery to people-centred primary care; ensuring health in all
policies; promoting inclusive leadership and governance. (See Primary Health Care reforms)
1978: 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. It forms an integral part of both the
country’s health system, of which it is the central function and the main focus and of the overall social and economic development of the
community.
1980s: The set of activities outlined in the Declaration of Alma-Ata: education concerning prevailing health problems and the methods of
preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal
and child health care, including family planning; immunization against the major infectious diseases; prevention and control of
locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs.
1990s: a level of care, that is the point of entry to the health services system (see: primary care).
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

9. Alma-Ata Declaration. World Health Report
2008 “Now more than ever”
• Universal coverage reforms to
improve health equity
• Service delivery reforms to
make health systems people-
centred
• Leadership reforms to make
health authorities more reliable
• Public policy reforms to promote
and protect the health of
communities
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

10. Efficiency gains are imperative
• Many effective policy instruments
to mitigate impact of crisis focusing
on cost reduction and efficiency
gains
◦ Hospital reconfiguration
◦ Increased focus on primary
health care
◦ Shift from inpatient to
outpatient care
◦ Rational use of medicines
◦ Reduced prices of medical
goods
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

11. I. Universal coverage reforms to improve health
equity.
Ensure availability
Eliminate barriers to access
Organize social protection
• But that is not enough:
– mobilize beyond the
health sector
– give visibility to
inequalities
– reach the unreached
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

12. Moldova: expansion of coverage towards
universality
• Expanded PHC to all
Insured pay less out-of-pocket
citizens regardless of
insurance status 100
90.7
• Expanded coverage of
90 76
80 69.4 65.5 63.7
70
health insurance program 60
50
46.8 45.6
to the poor 40
30
24.4
20
• Coverage funded by 10
0
Employees insured Non-working insured Self-insured Uninsured
pooled general tax and Any kind of medical services Inpatient care
payroll tax in mandatory
health insurance scheme
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

13. MOH/ WHO Mobile Health Team, Myanmar (2008)
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

14. II. Leadership reforms – Inclusive leadership and
effective government
• Recognition of the key role &
responsibilities of government
• Inclusive leadership and policy
dialogue: from command-and-
control to steer-and-negotiate
• Matching growth in health
expenditure with massive
reinvestment in capacity for
leading and governing the health
sector
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

15. The Tallinn Charter 2008:
Health Systems for Health and Wealth
The Tallinn Charter has:
• inspired countries to act on
their values to improve health
and wealth;
• affirmed a value-based
approach to health system
strengthening; and
• empowered health ministries to
lead change for health
improvement.
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

16. III. Service delivery reforms
• Putting people first: four features of good care
• Person-centeredness
• Comprehensiveness and integration
• Continuity of care
• A personal relationship with well-identified, regular and
trusted providers
• Organizing primary care networks accordingly
• Shifting the entry point: bringing care closer to the people
• Shifting accountability: responsibility for a well-identified
population
• Shifting power: the primary care team as the hub of
coordination
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

17. PHC as a hub of coordination between
hospitals and community care
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

18. Partnership Ministry of Health the Netherlands and WHO
Regional Office for Europe on Primary Health Care
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

19. The benefits of Primary Health Care
• Improved health outcomes at the population
level
• Improved equity in health outcomes and
access to health services
• Better efficiency of the health system as a
whole, less costs
• More satisfaction of users with health services
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

20. Modernize PHC within the healthsystem
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

21. Integrated Care : Simultaneously Managing
Crisis & Transformative Change
Primary Early Acute Rehabilitation
Prevention Management & secondary
Management
prevention
1 2
Short term strategy & Long term strategy
Crisis management
Drugs: Brand to Generic Reforming Delivery
Human Resources: Salaries Chronic Diseases Agenda
Tecnologies: Desinvestment… Integrated Care
SUSTAINIBILITY?
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

22. Tools for Integration Help to move
towards a “System” Perspective
risk stratification…
case nurses…
routine clinical reminders…
continuum of care…
activated patient…
Regular telemonitoring …
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

23. IV. Public policy reforms to promote and protect the health
of communities: national health policies and strategies
System-wide analysis and frameworks are more important than ever
Resources are scarce, improved efficiency is needed
Support Member States
1. Defining priorities informed by high-quality analysis and evidence
2. Convening many actors of the health system
3. Facilitating cross-country sharing and learning
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

24. Coverage of OHS in 21 countries
100
95
90
90 86
80 80 OHS can be provided to
80
70 70
Under-served population
70
through PHC system
60
60
50 50 50 50
48
50
39
40 34
30
28
30
15
20
10
10 5 4
Connecting Health and Labour,
0 Role of Occupational Health in PHC
NET FIN SVN BEL FRA SWE JAP HUN DEN NOR POR ITA TUR POL UNK BUL GRE EST CHI
The KEN SVK
Hague 2011

25. WHO position: universal coverage of OHS
• WHO Constitution: Health as a fundamental human
right
• Alma Ata Declaration (1978): Health care closer to the
places where people live and work
• Global Strategy on Occupational Health for All (1996),
and Global Plan of Action on Workers’ Health (2007):
– Occupational health services should be provided for all
workers including migrant workers, workers in small industries
and in the informal sector, and other occupational groups at
high risks and with special needs, including child workers and
farmers.
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

26. A stepwise strategy
for occupational Stage IV
Comprehensive
health services Service
Stage III •In-company or
International external
special OHS units
Standard Service
•Comprehensive
Objective for all!
content:
prevention,
Stage II
curative and
Basic Service promotion &
•OHS Infrastructure development
services
•ILO No. 161, 155
Stage I •PHC Infrastructure
•Multidisciplinary
Starting level content
•Basic OHS content
•Advice in OH •Prevention plus
•Accidents and ODs•Toolboxes curative services
•Acute ill-health
•PHC
Field nurse Physician and nurseMultidisciplinary
Multidisciplinary
Safety agent with short special team with
special training specialists' team
training
Starting point for Connecting Health and Labour,
Big industries and
SMEs,SSEs,SEs,IFSSMEs,SSEs,SEs,IFS
Big industries and Big OHS Centres
Role of Occupational Health in PHC
well organised The Hague 2011
SMEs

27. Conclusion
• Commitment of member states for the need for change
towards integrated health care with PHC at the heart
• Redefine the role of hospitals
• Involvement of community care and patient empowerment
• Transformative education, role of nurses and paramedics
• Increase efficiency and reduce costs protecting the
vulnerable
• Exchange best practices
• ONE SIZE DOES NOT FIT ALL
• WALK THE TALK: TAKE CARE OF OURSELVES !
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011

28. -From Values
to Action -
Division of Health Systems
Thank You and Public Health
Connecting Health and Labour,
Role of Occupational Health in PHC
The Hague 2011