CHAPTER 5: POLICY RECOMMENDATIONS
Recommendations for countries Management of the reform process 1. Create an inclusive leadership group to drive PHC reforms. This group will be responsible for delivering PHC reform on the path to UHC. It will work through dialogue and seek consensus, while recognizing the imperative for bold decisions and timely action. In most instances, the leadership group will include high-level representation from ministries of finance, health, and planning, among others; members of parliamentary health, finance, and budget committees; and representatives of professional associations, civil society organizations, and other stakeholder groups. Typically, the leadership group will be mandated to set up additional committees, commission reports, conduct public hearings, and initiate other activities to gather data and work toward consensus for decision-making.
Team-based care organization and delivery models 1. Assess health workforce strengths and gaps, and plan the transition to team-based delivery. Although all countries should aspire to build multidisciplinary care teams to deliver PHC, the specifics of team composition and empanelment strategies should be tailored to the local context. Contextual factors to consider include national and local epidemiologic profiles and socioeconomic determinants of health (Borgès Da Silva et al. 2013). To start, each country—supported by technical partners and donors, as appropriate—can undertake a situation assessment encompassing the following: (1) the current structure and composition of the health workforce; (2) how well the workforce matches health and health care needs; (3) people’s care-seeking patterns across different provider types and levels of care; and (4) payment/financing mechanisms. Building on the situation assessment, countries can develop a transition plan to organize existing health worker cohorts into teams; establish managerial relationships and reporting chains; and empanel populations to care teams. Empanelment approaches should be responsive to local contexts and engage the private sector, depending upon the level of their engagement in PHC that is often socially stratified in low- and middle-income countries (LMICs). These countries often have private and deregulated low-technology clinics and pharmacies for the poor and the rural areas, as well as higher-cost and often insurance-driven private care facilities complementing and competing with the public health sector on quality, amenities, and more personalized care (Private Sector Health Alliance of Nigeria n.d.). Transition planning may consider short-, medium-, and longterm workforce and financing reforms to expand the comprehensiveness of care, extend the PHC teams’ outreach into the community, and support integrated service delivery within care teams and across levels of care.
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