scholarly journals The origins of Ethiopia's primary health care expansion: The politics of state building and health system strengthening

2020 ◽  
Author(s):  
Kevin Croke
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Developmental State ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
World Health ◽  
Director General ◽  
Central Feature ◽  
Primary Health ◽  
Health Programmes

Abstract Ethiopia’s expansion of primary health care over the past 15 years has been hailed as a model in sub-Saharan Africa. A leader closely associated with the programme, Tedros Adhanom Gebreyesus, is now Director-General of the World Health Organization, and the global movement for expansion of primary health care often cites Ethiopia as a model. Starting in 2004, over 30 000 Health Extension Workers were trained and deployed in Ethiopia and over 2500 health centres and 15 000 village-level health posts were constructed. Ethiopia’s reforms are widely attributed to strong leadership and ‘political will’, but underlying factors that enabled adoption of these policies and implementation at scale are rarely analysed. This article uses a political economy lens to identify factors that enabled Ethiopia to surmount the challenges that have caused the failure of similar primary health programmes in other developing countries. The decision to focus on primary health care was rooted in the ruling party’s political strategy of prioritizing rural interests, which had enabled them to govern territory successfully as an insurgency. This wartime rural governance strategy included a primary healthcare programme, providing a model for the later national programme. After taking power, the ruling party created a centralized coalition of regional parties and prioritized extending state and party structures into rural areas. After a party split in 2001, Prime Minister Meles Zenawi consolidated power and implemented a ‘developmental state’ strategy. In the health sector, this included appointment of a series of dynamic Ministers of Health and the mobilization of significant resources for primary health care from donors. The ruling party’s ideology also emphasized mass participation in development activities, which became a central feature of health programmes. Attempts to translate this model to different circumstances should consider the distinctive features of the Ethiopian case, including both the benefits and costs of these strategies.

On the World Health Organization’s Neglect of the Role of Medical Doctors in Its Conception and Practice of Primary Health Care

2019 ◽  
Vol 49 (3) ◽  
pp. 642-657
Author(s):  
Socrates Litsios
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Soviet Union ◽  
World Health ◽  
Director General ◽  
Medical Doctors ◽  
Primary Health ◽  
The Soviet Union ◽  
Year 2000

Primary health care (PHC) emerged in the early 1970s as WHO’s response to the failure of its basic health services approach. The Soviet Union succeeded in getting WHO’s governing bodies to agree to hold an international conference on PHC, a conference that was held in Alma-Ata, the capital of the Soviet Republic of Kazakhstan, in September 1978. In 1975, Dr. Halfdan Mahler, WHO’s charismatic director-general, introduced the goal of “health for all” (HFA) by the year 2000. Alma-Ata declared PHC as the key for achieving HFA. Although WHO had promoted the involvement of medical schools in community health, Mahler’s antimedical establishment rhetoric contributed to WHO ignoring the potential role that medical doctors could play in PHC and HFA.

Nursing Profession’s Contribution to Person- and People-Centered Primary Health Care

2015 ◽  
Vol 5 (4) ◽  
pp. 197-203
Author(s):  
Yukiko Kusano ◽  
Erica Ehrhardt
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Policy Development ◽  
Workforce Planning ◽  
Policy Decision ◽  
Well Being ◽  
World Health ◽  
Integration Of Care ◽  
Primary Health ◽  
Strategic Role

Background: Equity and access to primary health care (PHC) services, particularly nursing services, are key to improving the health and well-being of all people. Nurses, as the largest group of healthcare professionals delivering services wherever people are, have a unique opportunity to put people at the centre of care, making services more effective, efficient and equitable.Objectives: To assess contributions of nurses to person and people-centered PHC. Methods: Analysis of nursing contributions under each of the four sets of the PHC reforms set by the World Health Organization.Results: Evidence and examples of nursing contributions are found in all of the four PHC reform areas. These include: expanding access;addressing problems through prevention; coordination and integration of care; and supporting the development of appropriate, effective and healthy public policies; and linking field-based innovations and policy development to inform evidence-based policy decision making.Conclusions:Nurses have significant contributions in each of the four PHC reform areas. The focus of nursing care on people-centeredness, continuity of care, comprehensiveness and integration of services, which are fundamental to holistic care, is an essential contribution of nurses to people-centered PHC. Nurses’ contributions can be optimised through positive practice environments, appropriate workforce planning and implementation andadequate education and quality control though strong regulatory principles and frameworks. People-centered approaches need to be considered both in health and non-health sectors as part of people-centered society. A strategic role of nurses as partners in services planning and decision-making is one of the key elements to achieve people-centered PHC.

scholarly journals Effects of The Leadership, Management And Governance Intervention On Maternal And Child Health Service Performances In Ethiopia: A Propensity Score Matched Analysis

2021 ◽  
Author(s):  
Mesele Damte Argaw ◽  
Binyam Fekadu Desta ◽  
Sualiha Abdlkader Muktar ◽  
Wondwosen Shiferaw Abera ◽  
Ismael Ali Beshir ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Child Health ◽  
Maternal And Child Health ◽  
Work Climate ◽  
Exposed Group ◽  
Health System Strengthening ◽  
Primary Health ◽  
New Challenges ◽  
And Child Health

Abstract Background: The maternal, neonatal and child mortality rates in Ethiopia are among the reported highest in Africa. Despite the reported alarming mortality rates, there are proven public health interventions in place to avoid preventable maternal and child deaths. Leadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing the work climate, and creating responsive health systems. Hence, the Ethiopian Ministry of Health with the support of the USAID Transform: Primary Health Care Activity has been implementing LMG interventions to improve performance of primary health care entities. The LMG interventions include a six-day classroom training with an additional six to nine months of leadership project implementation, supplemented with three to four onsite coaching sessions. The purpose of this evaluation was to measure the effects of LMG interventions on maternal and child health service performances and on the overall health system strengthening measurement results of primary health care entities. Methods: The study used a cross-sectional study design with propensity matched score analysis and was conducted from August 28, 2017, to September 30, 2018, in Amhara, Oromia, Tigray, and Southern Nations, Nationalities, and Peoples’ (SNNP) regions. Data collection took place through interviewer and self-administered questionnaires among 227 LMG intervention exposed and 227 non-exposed health workers. Propensity score matched analysis was used to estimate the average treatment effects of LMG interventions on contraceptive acceptance rates, antenatal care, skilled birth attendance, postnatal care, full immunization services, growth monitoring services, management system, work climate and capacity to respond to new challenges. Results: The mean overall maternal and child health key performance indicator score with standard deviation (SD) for the LMG intervention exposed group was 63.86 ± 13.16 (SD) and 57.02 ± 13.71 (SD) for the non-exposed group. The overall health system strengthening score for the LMG intervention exposed group (mean rank =269.31) and non-exposed group (mean rank = 158.69) had statistically significant differences (U=10.145, z= -11.175, p=0.001). The average treatment effects of 3.54, 3.51, 2.64, 3.00, 1.073.34 percentage-points were observed for contraceptive acceptance rate, antenatal care, skilled birth attendance, postnatal care, full immunization, and growth monitoring services, respectively. In addition, with regards to health system strengthening measurements, we found an average treatment effect (ATE) of 12.46, 4.79 and 4.88 percentage points for strengthening management system, enhancing work climate and capacity to respond to new challenges, respectively. Conclusion: We found positive evidence of effects of the LMG intervention on increased maternal and child health services performances at primary healthcare entities. Moreover, health facilities with LMG intervention exposed health workers had a higher and statistically significant difference in management systems, work climate and readiness to face new challenges. Therefore, this study generates evidence for integrating LMG interventions to improve the performance of primary healthcare entities and maternal and child service uptake of community members, which contributes to the reduction maternal and child deaths.

scholarly journals The COVID-19 Pandemic and Non-communicable Diseases—A Wake-up Call for Primary Health Care System Strengthening in Sub-Saharan Africa

2020 ◽  
Vol 11 ◽  
pp. 215013272094694
Author(s):  
Christian Kraef ◽  
Pamela Juma ◽  
Per Kallestrup ◽  
Joseph Mucumbitsi ◽  
Kaushik Ramaiya ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Systems ◽  
Health Spending ◽  
Communicable Diseases ◽  
Sub Saharan Africa ◽  
Primary Health Care System ◽  
Health Coverage ◽  
Non Communicable Diseases ◽  
Primary Health

Strengthening Primary Health Care Systems is the most effective policy response in low-and middle-income countries to protect against health emergencies, achieve universal health coverage, and promote health and wellbeing. Despite the Astana declaration on primary health care, respective investment is still insufficient in Sub-Sahara Africa. The SARS-CoV-2019 pandemic is a reminder that non-communicable diseases (NCDs), which are increasingly prevalent in Sub-Sahara Africa, are closely interlinked to the burden of communicable diseases, exacerbating morbidity and mortality. Governments and donors should use the momentum created by the pandemic in a sustainable and effective way by pivoting health spending towards primary health care.

scholarly journals Integrated people-centred primary health care in Greece: unravelling Ariadne’s thread

2019 ◽  
Vol 20 ◽  
Author(s):  
Christos Lionis ◽  
Emmanouil K. Symvoulakis ◽  
Adelais Markaki ◽  
Elena Petelos ◽  
Sophia Papadakis ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Reform ◽  
Lessons Learned ◽  
World Health ◽  
Policy Recommendations ◽  
Effective Implementation ◽  
Primary Health ◽  
Information And Communication ◽  
Health Organization

Abstract The 40th anniversary of the World Health Organization Alma-Ata Declaration in Astana offered the impetus to discuss the extent to which integrated primary health care (PHC) has been successfully implemented and its impact on research and practice. This paper focuses on the experiences from Greece in implementing primary health care reform and lessons learned from the conduct of evidence-based research. It critically examines what appears to be impeding the effective implementation of integrated PHC in a country affected by the financial and refugee crisis. The key challenges for establishing integrated people-centred primary care include availability of family physicians, information and communication technology, the prevention and management of chronic disease and migrant and refugees’ health. Policy recommendations are formulated to guide the primary health care reform in Greece, while attempting to inform efforts in other countries with similar conditions.

Health for All and Primary Health Care, 1978–2018: A Historical Perspective on Policies and Programs Over 40 Years

2018 ◽  
Author(s):  
Susan B. Rifkin
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
United Nations ◽  
Good Health ◽  
World Health ◽  
Primary Health ◽  
The World ◽  
Definition Of Health ◽  
Definition Of ◽  
Health Organization

In 1978, at an international conference in Kazakhstan, the World Health Organization (WHO) and the United Nations Children’s Fund put forward a policy proposal entitled “Primary Health Care” (PHC). Adopted by all the World Health Organization member states, the proposal catalyzed ideas and experiences by which governments and people began to change their views about how good health was obtained and sustained. The Declaration of Alma-Ata (as it is known, after the city in which the conference was held) committed member states to take action to achieve the WHO definition of health as “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Arguing that good health was not merely the result of biomedical advances, health-services provision, and professional care, the declaration stated that health was a human right, that the inequality of health status among the world’s populations was unacceptable, and that people had a right and duty to become involved in the planning and implementation of their own healthcare. It proposed that this policy be supported through collaboration with other government sectors to ensure that health was recognized as a key to development planning. Under the banner call “Health for All by the Year 2000,” WHO and the United Nations Children’s Fund set out to turn their vision for improving health into practice. They confronted a number of critical challenges. These included defining PHC and translating PHC into practice, developing frameworks to translate equity into action, experiencing both the potential and the limitations of community participation in helping to achieve the WHO definition of health, and seeking the necessary financing to support the transformation of health systems. These challenges were taken up by global, national, and nongovernmental organization programs in efforts to balance the PHC vision with the realities of health-service delivery. The implementation of these programs had varying degrees of success and failure. In the future, PHC will need to address to critical concerns, the first of which is how to address the pressing health issues of the early 21st century, including climate change, control of noncommunicable diseases, global health emergencies, and the cost and effectiveness of humanitarian aid in the light of increasing violent disturbances and issues around global governance. The second is how PHC will influence policies emerging from the increasing understanding that health interventions should be implemented in the context of complexity rather than as linear, predictable solutions.

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