Service delivery and safety

Innovations from BRICS countries on people-centred health reforms at 70th World Health Assembly

MAY 2017 | GENEVA -- On 24 May at the 70th World Health Assembly, a group of large emerging economies referred to as the “BRICS countries” – which includes Brazil, the Russian Federation, India, China and South Africa – convened at a side event sponsored by China. The aim: to share experiences and innovations on people-centred reforms as a cornerstone to making progress towards universal health coverage, using the WHO Framework on integrated people-centred health services as a basis for discussion.

The countries have made progress towards universal health coverage over the years, improving access to quality health services while also lifting hundreds of millions of people out of poverty. With this, they have amassed a wealth of experience on service delivery reforms from which other countries can draw valuable lessons.

Clockwise from top left: BRICS speakers, Dr Liang Wannian, Mr Ricardo Barros, Dr Veronika Skvortsova, Mr Sanjeev Kumar, Dr Aaron Motsoaledi

The Executive Deputy Director, Office of State Council Healthcare Reform Leading Group in China, Dr Liang Wannian, who was the first to speak in a series of presentations made by Ministers of Health and high-level ministry of health officials, highlighted the importance the Chinese government has placed on providing improved primary health service, by transforming the primary service model and enhancing division and cooperation as well as other supporting mechanisms, thus building an integrated health service system. He emphasized that “to build an integrated service delivery system, we need the collective effort of government, people and institutions at all levels”. This is supported by strong change management for integrated care such as active communications and pilot projects, as well as ensuring that evaluation and monitoring mechanisms are in place.

For Brazil, Mr Ricardo Barros, Minister of Health shared the aspiration that “what we want is to have 80% of problems resolved in primary-level care so that people don’t need to go to the hospital”, he noted that “(delivering) primary-level care is the great challenge that we have” and that although “we have resources available for health, we don’t use them very wisely, so we are trying to improve that.”

Dr Veronika Skvortsova, Minister of Health of the Russian Federation also highlighted the important role of designing a patient-focused system for health care based on accessibility and quality. Specifically, she identified the goal of ensuring the “accessibility of all types of medical care, from primary care to high tech forms of care”. She also touched on the country’s efforts in mobilizing intersectoral action by prioritizing national strategies to fight tobacco, alcohol abuse, healthy eating, and exercise programmes for youth.

For India, Mr Sanjeev Kumar, Additional Secretary, Ministry of Health and Family Welfare highlighted that the country had adopted a new national policy linked to universal health coverage in March 2017, which is “our (India’s) roadmap for national health financing and articulates our vision for achieving universal health coverage. It is based on the principles of equity, universality, accountability, affordability and patient care”. The role of primary care centres as a first point of contact, and the integration of reproductive care in these centres was also noted as an important part of health service reforms.

Dr Aaron Motsoaledi, Minister of Health of South Africa, concluded the series of country presentations by returning the conversation to the importance of reorienting the model of care to focus on primary care. Specifically, he underscored that, “in order for UHC to survive and be sustainable, its heartbeat must be primary health care. In other words, we need to move deliberately from the present curative system which is hospital-based to a primary health care system”. He shared South Africa’s “ideal clinic” innovation, which encourages the development of more attractive primary care clinics to draw patients away from tertiary care centres.

Clockwise from top left: Dr Ilona Kickbusch and Dr Margaret Chan, Dr Letsie Nyane, Dr Arlindo do Rosario, Dr Meng Qingyue, Dr Timothy Evans, and Dr Amanda Howe

The presentations by BRICS countries were followed by a panel discussion moderated by Dr Ilona Kickbusch of The Graduate Institute of International and Development Studies. Representatives including academic institutions (Dr Meng Qingyue, Dean, Peking University), professional associations (Dr Amanda Howe, President, Global Family Doctor/WONCA), financial institutions (Dr Timothy Evans, Senior Director, World Bank Group), and other countries were invited to share their perspectives and remarks on the importance of people-centred reforms in their respective organizations and settings. They also had an opportunity to briefly discuss their experiences in managing and enabling change across multiple stakeholders, grounded by a people-centred approach that engages with people and communities to understand their preferences, needs and values in designing health programmes.

"(We) failed to reach the Millennium Development Goals because health services were not people-centred... we need to not just plan for people, but also with people."

Dr Letsie Nyane, Director-General Health Services, Lesotho

The important role of BRICS countries in supporting development cooperation was highlighted by Dr Arlindo do Rosario, Minister of Health Cabo Verde, who commented on the bilateral support they have received over the years for health and personnel training, as well as for infrastructure.

The need for a people-centred approach was also expressed by Dr Letsie Nyane, Director-General Health Services of Lesotho, who candidly shared with the audience that Lesotho, “failed to reach the Millennium Development Goals because health services were not people-centred – people were not part of planning and implementation and the government was consequently not held accountable.” She identified an impetus for change that involves, “not just planning for people, but also with people”.

The position of the BRICS countries in exerting significant influence through their leadership on integrated service delivery reforms, centred around the needs of people was one of the key messages arising from this over-subscribed World Health Assembly side event. Many of the ministers spoke about the need for greater focus on primary health care as part of a people-centered approach. World Bank Group Senior Director Timothy Evans added that financing must support primary health care and that “there is no universal health coverage without primary health care.”

The role and cooperation of these countries in supporting the exchange of knowledge, learning and innovations on the path towards universal health coverage and the health-related SDGs will be particularly important as other countries begin to transform their health services to better serve the needs of their populations. This point was underscored by WHO Director-General Margaret Chan who reminded the audience to "make sure no one is left behind on the road to UHC and to keep people and their communities at the center - no matter where they are” – which was further reinforced by Dr Edward Kelley, Director, WHO Service Delivery and Safety Department.

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