Walking the Talk

WALKING THE TALK

Policy recommendations Each country will have its own road map for PHC reform that reflects national starting conditions, health and development priorities, and political economies. However, some policy priorities will apply across settings. This report formulates broad policy recommendations for governments and proposes actions for the global health community, including the World Bank.

Team-based care organization 1. Assess health workforce strengths and gaps and plan the transition to team-based delivery. Countries can jump-start their PHC team composition and empanelment strategies through a situation assessment and team-based care transition plan. 2. Leverage information technology on the PHC frontlines. Digital tools can foster transparency and accountability in PHC. Countries can score efficiency gains by upskilling data analysis capabilities within local care teams.

Multidisciplinary health workforce development 1. Launch multidisciplinary medical education reforms. Medical education strategies will build the skills for community-focused, team-based care. 2. Reform provider compensation to promote rural practice and generalist care. Countries can use evidence-based options to tackle compensation imbalances and redistribute the health workforce. 3. Expand tiered accreditation systems tied to reimbursement policy. Governments can engage with the private sector to leverage its workforce and infrastructure for PHC delivery, while improving care quality and affordability. Reimbursement and strategic purchasing policies can incentivize private sector participation in a tiered accreditation system.

Financing and resource mobilization 1. Finance PHC through general government expenditure, without user fees. Countries get the best results when they finance PHC through general government revenue. PHC services should be free at the point of care.

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2. Implement pro-health taxes. Countries can often boost tax revenue by implementing or increasing pro-health taxes on harmful products, especially tobacco, alcohol, and sugar.

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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