Reinventing primary health care: the need for systems integration
Author(s)/Editor(s): Frenk J
Publisher/Organizer: The Lancet
Publication date: 2009; 374 (9684)
Number of pages: 3
The world has come a long way since the Alma Ata Declaration 30 years ago. However, achievements have fallen short of expectations. This is therefore the time to launch a renewed effort to strengthen health systems as the fundamental strategy for integrating primary health care.
“In particular, the developments in telecommunications such as mobile phones are mobilising cutting-edge innovations that are now available even in the poorest communities. Appropriate technology should no longer be identified with primitive methods. Nowadays a patient can be diagnosed and treated in the first level of care in a rural community by a provider working in a high-specialty urban hospital.
Therefore, we should be able to launch a fundamental shift from the rigid pyramidal structures that have prevailed in the health sector to adaptable networks that improve access to all levels of care. A related transformation means moving beyond health centres, which by definition concentrate human and technological resources, into health spaces, which extend the reach of comprehensive care into schools, workplaces, recreational areas, and the homes of those who live with a chronic condition.
The present interest by major global health actors in strengthening health systems offers a unique opportunity. We have to take advantage of this opportunity to reinvent primary health care for the 21st century. We should leave behind the ideological debates of the past and focus instead on developing primary care networks that are seamlessly integrated into the rest of the health system.
The vision is thus to assure that high-quality services are provided on the basis of a defined population, through proactive strategies, favouring continuity of care, guaranteeing an explicit set of entitlements, and assuring universal social protection in health. Therein may lie the key to finally unlocking the full potential of Alma Ata.”