WHO checks the pulse of world, finds primary healthcare lacking

Despite measures taken by governments to improve public healthcare facilities, the World Health Report 2008 has found striking inequalities within as well as between countries in healthcare access, costs and outcomes. To fix these symptoms, the report has called upon countries to build up political will and re-orient their focus on primary health care (PHC), a holistic approach to health care formally launched 30 years ago.

In fact, as an example of ambitious PHC-focussed reforms, the report released by the World Health Organisation (WHO) on Tuesday, has cited India ?s case. ?The country?s health missions introduced in rural and urban areas have also been accompanied by a doubling of public expenditure on the health sector,? it points out.

?When countries at the same level of economic development are compared, those where health care is organised around the tenets of PHC produce a higher level of heath for the same investment. Such lessons take on critical importance at a time of global financial crisis,? the report states.

In 1978, about two thirds of the world?s population lived in countries that went on to experience increases in life expectancy at birth and considerable economic growth. The most impressive relative gains were in a number of low-income countries in Asia, including India , Latin America and northern Africa . These countries, whose population has gone up from 1.1 billion in 1978 to nearly 2 billion today, have seen life expectancy at birth increase by 12 years while GDP per capita has increased 2.6 times.

But differences in life expectancy between the richest and poorest countries now exceed about 40 years. Life expectancy at birth was less than 60 years towards the end of 1970s which has now surpassed 74 years. Of the estimated 136 million women who will give birth this year, around 58 million are not going to receive any medical help during childbirth and the postpartum period, endangering their lives and that of their infants.

Globally, annual government expenditure on health varies from as little as 20 dollars per person to anything over 6000 dollar. For 5.6 billion people in low?and middle-income countries, more than half of all health care expenditure is through out-of-pocket payments. With costs of health care rising and systems for financial protection in disarray, personal expenditures on health now push more than 100 million people below the poverty line each year.

Vast differences in health occur within countries and sometimes within individual cities. In Nairobi , for example, the under-five mortality rate is below 15 per 1000 in the high-income area. In a slum in the same city, the rate is 254 per 1000.

?High maternal, infant, and under-five mortality often indicates lack of access to basic services such as clean water and sanitation, immunizations and proper nutrition. Primary health care, including integrated services at the community level, can help improve health and save lives,? Ann M Veneman, Unicef executive director said.

?The World Health Report sets out a way to tackle inequities and inefficiencies in health care, and its recommendations need to be heeded. A world that is greatly out of balance in matters of health is neither stable nor secure,? WHO director General Margaret Chan said at the launch of the report.

To carry on with reforms that would also help governments in its political outcomes, they would have to respond to rising demand as well as to the health challenges and constraints the country faces. The report says a mere ?technical programme? won?t do and it?s vital to remain rooted in concerns relevant to society. Governments must specify the expected health, social and political returns, as well as the relevant costs to tackle the obstacles to PHC.

?Creating the political alignment and commitment to reform, however, is only a first step. Insufficient preparation of its implementation is often the weak point,? the report has said. The report highlights the fact that many health systems have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet the needs and expectations of people, especially among impoverished and marginalised groups. These conditions of ?inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability.?

WHO has argued that the values, principles and approaches of PHC are more relevant now than ever before. ?Viewed against current trends, primary health care looks more and more like a smart way to get health development back on track,? said Dr Chan.

In far too many cases, people who are well-off and generally healthier have the best access to the best care, while the poor are left to fend for themselves. Health care is often delivered according to a model that concentrates on diseases, high technology, and specialist care, with health viewed as a product of biomedical interventions and the power of prevention largely ignored.