Walking the Talk

WALKING THE TALK

Table 4.1 Reimagining a PHC fit-for-purpose: Outcomes and priority reforms “HOW?”: PRIORITY REFORMS Multidisciplinary Team-Based Organization Multidisciplinary teams align clinical services to meet the full range of local health needs. Clinical

1. From dysfunctional gatekeeping to quality comprehensive care for all

services address acute illnesses and injuries and manage chronic conditions, including mental health needs. Teams expand community health education, health and nutrition promotion, and disease prevention.

“WHAT?”: OUTCOMES

Multidisciplinary teams build long-term trust

2. From fragmentation to peoplecentered integration

with empaneled communities, collaborate and communicate internally, and coordinate patients’ movement through the health system and back to the community.

Empanelment creates accountability for health outcomes. Financing and other mechanisms

3. From inequities to fairness and accountability

reinforce accountability. Team composition reflects local health and health care needs and socio-economic determinants. Both patient and health outcomes are embedded in the accountability framework.

PHC teams include public health surveillance and outreach capacity. Team structure helps buffer

4. From fragility to resilience

provider absences. Service-delivery organization and leadership ensure team capacity to manage the unexpected.

(Continued)

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Walking the Talk

Published on Jul 25, 2022Medicine

World Bank Publications

"Almost half a century ago, policy leaders issued the Declaration of Alma Ata and embraced the promise of health for all through primary health care (PHC). That vision has inspired generations. Countries throughout the world—rich and poor—have struggled to build health systems anchored in strong PHC where they were needed most. The world has waited long enough for high-performing PHC to become more than an aspiration; it is now time to deliver. The COVID-19 (Coronavirus) pandemic has facilitated the reckoning for that shared failure—but it has also created a once-in-a-generation opportunity for transformational health system changes. The pandemic has shown policy makers and ordinary citizens why health systems matter and what happens when they fail. Bold reforms now can prepare health systems for future crises and bring goals such as universal health coverage within reach. PHC holds the key to these transformations. To fulfill that promise, however, the walk has to finally match the talk. Walking the Talk:

Walking the Talk

Articles inside

What will the World Bank do?

Recommendations for donors and the international health community

References

Recommendations for countries

human capital

Conclusions

Notes

Building skills for multisectoral action among PHC practitioners

Financing multisectoral engagement

From fragility to resilience

A partnership to support primary health care

From inequities to fairness and accountability

mechanisms and team-based care models

From fragmentation to people-centered integration

resource allocation

revenue?

From dysfunctional gatekeeping to quality, comprehensive care for all

Priority Reform 3: Fit-for-purpose financing for public-health-enabled primary care

Social and practical support for a resilient health workforce

From inequities to fairness and accountability

From fragility to resilience

practice

From fragmentation to people-centered integration

Priority Reform 2: The fit-for-purpose multiprofessional health workforce

From dysfunctional gatekeeping to quality, comprehensive care for all

From fragility to resilience

From inequities to fairness and accountability

4.1 Why team-based care?

From fragmentation to people-centered integration

sharing in primary health care

and priority reforms

3.8 What has to change: Sectoral silos inhibit collaboration

References

Foundations for change: Enabling multisectoral action in PHC

Shift 4: From fragility to resilience

3.4 What has to change: Discontinuous delivery

health care inequities

Shift 3: From inequities to fairness and accountability

Shift 2: From fragmentation to people-centered integration

Shift 1: From dysfunctional gatekeeping to quality comprehensive care for all

Implications for primary health care

by income group and geographic location, 1950–2100

Policy recommendations

1 Key recommendations for fit-for-purpose primary

quality gaps

1.1 Defining primary health care

What the World Bank and its partners will do