Walking the Talk

WALKING THE TALK

From inequities to fairness and accountability When well designed and sufficiently resourced, PHC financing mechanisms play an essential role in promoting and reinforcing values of fairness, equity, and accountability within the overall healthcare system. Value-based payment mechanisms, for example, reinforce provider accountability for population-wide health outcomes, including for poor and vulnerable people. Sufficient pooled resource mobilization plays a redistributive role, leveraging social resources for equitable service coverage. Likewise, fair, inclusive, and transparent design of explicit health benefits packages creates an equitable entitlement across the entire population; providers and the government, in turn, can be held accountable for ensuring this package is, in fact, delivered. In this section, we consider four elements of PHC financing for fairness and accountability that this report has not previously discussed: ++

Financing to break down demand-side access barriers

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Pro-equity and accountability in intergovernmental transfers

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Transparency and accountability in planning and budgeting

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Community engagement in resource allocation.

Financing to break down demand-side access barriers For truly equitable access and utilization, all PHC services must be free at the point of service. There is broad consensus that financial barriers to PHC services in LMICs (such as user fees) should be removed (WHO 2016). Nevertheless, financing reforms that are not backed by mobilization of additional resources and careful planning to compensate for simultaneous revenue loss and costs associated with increased utilization can cause their own problems, for example, a shift to informal payments, patients’ forgoing services altogether, or ad hoc or implicit rationing (McPake et al. 2011). This further highlights the importance of defining an explicit benefits package, as well as a fair and inclusive priority-setting process appropriate for the local context.

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Even when PHC is free at the point of service, some populations may still face financial or nonfinancial barriers to access services. These barriers could include migrants or refugees who fall between the cracks of empanelment strategies; marginalized populations who are socially stigmatized or fear

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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