primary health care and the social determinants of health ... · in yuty, caazapa, paraguay,...
TRANSCRIPT
Primary Health Care and the Social
Determinants of Health: the common quest for
equity
Mirta Roses Periago
PAHO/WHO
Presentation to the WHO Commission on the Social Determinants of Health
Vancouver, Canada
9 June 2007
The Americas
remain being the most
unequal region of the
World:
220 million people 220 million people
living in povertyliving in poverty
The Region shows a demographic transition with still high population growth and ageing, fast unplanned urbanization.
Research has revealed the complex relationships between social, economic, environmental, political and culture conditions–so called the social determinants of health–and their impact on the health profile of people and communities.
The Social Determinants of Health
in the Americas
New focus on the SDH and human development recognizes that health has become central to the development agenda because:
– It is a basic human need– It is indispensable for the existence and persistence of democratic societies
– It is a fundamental human right
Any attempt to improve health must be linked to the broader economic, social and political context, and needs to ensure the inclusion of multiple actors
and sectors
The sisterhood between the Social Determinants
of Health (SDH) and Primary Health Care
(PHC)
Milestones that feed into the evolution of
PHC in the Americas include:
For the past 30 years, PHC has been struggling to be
recognized as a key component
of effective health systems.
WHO Commission on Macroeconomics and Health; focus on equity; MDGs with health at the core
2000
People at the center of development; health sector reforms and structural adjustments; decentralization of the State and elimination of polio in the Americas.
1990
“Health for All;” expansion of PHC and vertical programs in selected countries; SILOS; rebirth of community participation as countries came out of dictatorial ruling
1980
Lalonde Report establishing the concept of the “non-medical” determinants of health.
1970
Primary Health Care in the
Region of the Americas
– Need to overcome the tremendous exclusion (40%) in health
– Need to broaden social protection as a key element in health sector reforms and as a public policy
– Need to implement new strategic and programmatic orientations to accelerate the improvement of health outcomes
– Need to integrate and synergize the Millennium Development Goals (MDG)
There are still unacceptable, avoidable and
unfair disparities to overcome within and among the
countries of the Americas
The Social Determinants of Health and
Primary Health Care
PHC is a useful approach for equitable health and human developmentequitable health and human developmentsince it calls for more attention to the operational and structural needs of
health systemshealth systems(access, sustainable increased resources, political commitment, quality of care, social empowerment and citizen satisfaction)
Right to the highestRight to the highest
attainable level ofattainable level of
healthhealth
EquityEquity
SolidaritySolidarity
Responsiveness toResponsiveness to
peoplespeoples’’ healthhealth
needsneeds Quality
Quality--oriented
oriented
Government
Government
accountability
accountability
Socia
l justice
Socia
l justice
Sustainability
Sustainability
Partic
ipation
Partic
ipation
Intersectoriality
Intersectoriality
First Contact
First Contact Comprehensive,
Comprehensive,
integrated and
integrated and
continuing care
continuing care
Family a
nd
Family a
nd
community
community
based
based
Emphasis on
Emphasis on
promotion and
promotion and
prevention
prevention
Appropriate
Appropriate
care
care
ActiveActive
participat
ion
participat
ion
mecha
nisms
mecha
nisms
Sound policy,Sound policy,legal & institutionallegal & institutional
frameworkframework
ProPro--equity
equitypolicies
policies& programs
& programs
Optim
al
Optim
al
organiza
tion
organiza
tion
& management
& management
Appropriate
Appropriate
human
human
resources
resources
Adequate and
Adequate and
Sustainable
Sustainable
resources
resources
Intersectorial
Intersectorial
actions
actions
Universal Universal
coveragecoverage
and accessand access
Core Values, Principles and Elements in a PHC-Based Health System
PAHO understands PHC as an integral part and the axis for the development of
health systems and considers the building of health systems based on PHC as the most appropriate path to produce
equitable and sustainable improvement in the health of the people of the Americas
PAHO conceptual framework for
PHC
1.1. Responsiveness to peopleResponsiveness to people’’s health s health needsneeds
2.2. Accountable and transparent Accountable and transparent GovernanceGovernance
3.3. Results and Quality orientationResults and Quality orientation
4.4. Social justice and ethicsSocial justice and ethics
Main Principles of PHC-based Health Systems
5.5. Sustainability and continuitySustainability and continuity
6.6. Intersectoriality to work upstreamIntersectoriality to work upstream
7.7. Social and individual engagement Social and individual engagement
Main Principles of PHC-based Health Systems
In the past few years, the Region has faced considerable changes:
• Rapid and unplanned urbanization
• Structural changes in health systems
• Climate changes• Demographic transitions• Increased inequity and poverty
In the Americas, the principles of PHC have been adopted and adapted
by each country according to its own reality and needs.
Social and Environmental Aspects
of Primary Health Care
The emphasis on the environmental aspects of PHC has been highlighted with the definition of “primary environmental care” (Borrini, 1990) which includes a focus on community-based development to achieve sustainable livelihood with 3 elements:
• Fulfill basic human needs
• Empower peoples and communities
• Optimal and sustainable use and management of community resources
Social and Environmental Aspects
of Primary Health Care
One of the most effective approaches is to consider PHC in its wider concept,
embracing health promotion and prevention, care and rehabilitation,
active and conscious citizenship and community engagement to produce and sustain
better health for all ages
Social and Environmental Aspects
of Primary Health Care
The initiative analyzes local realities, develops critical
interventions, and provides targeted technical assistance with the
support of PAHO/WHO technical units and other UN system
agencies.
Communities are chosen by national Ministers of Health in
collaboration with PAHO/WHO Representatives (PWRs).
Selection is based on their extreme conditions of vulnerability
and poverty. To date there are in 26 communities in 13 countries
participating.
Is designed to foster a citizenry that exercises its capacity for
change through their collective and individual power.
It is a catalyst for change, that coordinates actions to allow
political leaders, the leaders and inhabitants of the communities,
NGOs, IOs, and the international cooperation community work
together at the local level.
Reviews the experiences of work done since Alma Ata and re-
energizes them through local work with a concrete objective;
advancing towards the MDGs.
This initiative’s contribution to the Region is to shift from the
analysis of MDG indicators to participatory, action-oriented
research that fosters local empowerment.
Puts the emphasis on improving conditions of peoples and their
territories through the community self-management model.
Empowers individuals and the community via a horizontal
exchange partnership between local communities and providers
of technical assistance.
Faces, Voices, and Places of the MDGs is a regional
initiative that targets the poorest and most
vulnerable communities in Latin America and the
Caribbean to help them achieve the MDGs from
the perspective of health.
Active
Selected
Movement
Community
"Our greatest concern must always rest with
disadvantaged and vulnerable groups. These
groups are often hidden, live in remote rural
areas or shantytowns and have little political
voice."
Dr Margaret Chan
WHO Director-General
WHO Commission on Social Determinants
of Health / Knowledge Networks and Faces,
Voices and Places
Social Exclusion
The initiative is aimed at addressing the most vulnerable, neglected and
economically deprived communities. In Ventanilla, Peru, through
participatory action research methodology exercises the community and
its citizens are being empowered to reduced social exclusion.
Measurement and Evidence
The initiative’s initial diagnosis includes a thorough study of available data
on the community, setting of baselines and targeting and monitoring of
advances. Through the PAHO - ECLAC-CELADE Agreement, census
data from 19 LAC countries was analyzed and sub-national poverty maps
were created to facilitate targeting of the most vulnerable communities.
Women and Gender Equity
In the Chiquimula and El Estor regions of Guatemala multi-cultural and
gender perspectives have driven the work. This will lead to the
development of healthy mechanisms, processes and actions to be taken at
the local level to reduce gender-based inequities in health.
Priority Public Health Conditions
In Santa Fe de Veraguas in Panama, malaria control has been
approached with a focus on socially and economically disadvantaged
groups. Interventions and actions to improve the situation will address the
social determinants causing inequities in health outcomes, barriers and will
facilitate access to health care.
Urban Settings
In four communities in the Greater San Salvador area in El Salvador work
is underway to address the most vulnerable and marginalized communities.
The strategy employs an intersectorial, multi-programmatic, approach to
influence health determinants through participatory activities centered on
situation analysis.
Early Child Development
In Yuty, Caazapa, Paraguay, efforts involving the community component of
the IMCI strategy are underway through participatory planning exercises with
local leaders. These have led to disease prevention and health promotion
activities under MDGs 1, 4 and 5. These provide opportunities to young
children and their mothers in shaping sound lifelong health and development
status.