World health report 2008: primary health care now more than ever
Amy McKay, PHC RIS
 Seeing the demand for a renewal of primary health care (PHC) thirty years after the Declaration of Alma-Ata, the World Health Organization (WHO) has released the Primary health care now more than ever report. Looking to ‘narrow the intolerable gaps between aspiration and implementation' the report puts forth four sets of reforms that constitute the agenda for the renewal of PHC:
- Universal coverage reforms – ensure universal access to health services and universal social health protection.
- Service delivery reforms – reorganise health services around people's needs and expectations.
- Public policy reforms – integrate public health policies with primary care.
- Leadership reforms – need for inclusive, participatory, negotiation-based leadership.
The report highlights that universal coverage needs to be the foundation for health equality coupled with action against social detriments that affect the value of ‘health for all'. With statistics proving that 100 million people are pushed into poverty each year by catastrophic health expenditure the report pushes the need for pre-payment instead of an out-of-pocket payment at the time of service as a pressing reform.
Putting people first is at the core of service delivery reforms with the report highlighting the case of a medical centre in Alaska which decided to adopt the principle of establishing a direct relationship between staff members and patients. This new venture reduced waiting times significantly, emergency room visits were cut by 50% and referrals to specialty care by 30%.
The report states that public policy reforms will be needed to complement universal coverage and service delivery reforms as well as leadership reforms to make sure that strong and decisive leadership is taken to pursue the preceding reforms.
Finally the report addresses the way forward, noting that individual countries will need to address specific conditions and contexts that affect them and draw on the best available evidence to advance these reforms. Essentially, to pursue these reforms, countries will need to have a clear vision on the future of primary health care.
The report is available for download at:<www.who.int/whr/2008/en/index.html>
Reference
World Health Organization. (2008). The world health report 2008: primary health care now more than ever. WHO Press, Switzerland
Global Health Watch 2: An alternative world health report
Libby Kalucy, PHC RIS
 Global Health Watch 2: An Alternative World Health Report was launched by Professor Fran Baum at Flinders University on 4 December 2008, adding Australia to 20 other countries in which this important report has been launched.
The report covers many topics, such as access to medicines, mental health, water and sanitation, nutrition, and war and conflict. It draws attention to the politics of global health and the policies and actions of key actors. The report is not only an educational resource for health professionals and activists, but also makes clear the need for global health advocates to engage in lobbying key actors to do better and to do more, whilst resisting those that do harm.
What can we do in the face of overwhelming problems described in this report? Fortunately, there are stories of local successes such as academics and activists working to lower the price of essential medicines. A small victory against the global arms industry was scored in the UK when a civil society campaign, including the editorial staff of the Lancet, persuaded the multinational company which owns the Lancet and many other academic journals to sell off its interests in international armaments fairs.
Elizabeth Harris from the Centre for Health Equity Training Research and Evaluation spoke about her long term research work on unemployment in Fairfield in Sydney's west, where more than one quarter of GPs have now been trained in working with the unemployed, and 250 people have gained jobs in the area health service. I'm aware that many Australian primary health care academics and health workers are inconspicuously engaged in addressing inequalities. Speakers called on the audience to advocate through RACGP, Public Health Association of Australasia and civil society, to take part in local action, and to monitor levels of Australian aid.
Read the report at <www.ghwatch.org/ghw2/ghw2_report.php>
Reference
People's Health Movement, Medact and Global Equity Gauge Alliance. (2008). Global Health Watch 2: An Alternative World Health Report. Zed Books Ltd, London
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