The world health report

Chapter 7: Health Systems: principled integrated care


Building systems based on principles: WHO cooperation with countries

The health goals described in this report will not be met without significant strengthening of health systems in low-income and middle-income countries. This applies to achieving the MDGs, scaling up HIV/AIDS prevention and treatment, managing the double burden, and the other key health objectives.

There are numerous ways in which health systems strengthening could be undertaken and systems development priorities set. This chapter has proposed that countries' efforts to build up their health systems in the coming years should be guided by the values of primary health care. It has argued that, despite sweeping changes in the global health policy environment over the past quarter-century, the core principles of primary health care remain valid.

Even greater challenges lie in the future for health systems. In the years ahead, environmental change will affect population health in ways not yet understood. Health systems are already grappling with the effects of economic globalization, including migration and the impact of trade patterns and practices on population health. As issues such as intellectual property rights and trade in services continue to be debated in international forums, health systems will face new pressures. In this context, resolute commitment to the primary health care values of equity, universal access to care, community involvement and intersectoral action will be more important than ever.

This chapter has begun to investigate how a health systems effort based on primary health care might confront key challenges in workforce development and retention, information management, health financing, and pro-equity stewardship. Clearly, however, this investigation must be carried further. Much remains to be understood about how health systems function, why they fail or respond slowly to some crises, and about how primary health care principles can be translated into practical policies that will yield health improvements for communities. Intensified research and information sharing on health systems must be high on the agenda of the global health community.

Promoting health systems research is an element of WHO's programme for more effective cooperative work with countries. WHO will also work closely with countries to exploit fully current health systems knowledge and the results of ongoing research. The priorities for this work include:

  • strengthening the quality of policy research and improving international access to current evidence about the effectiveness of primary health care models and interventions;
  • building new networks to facilitate the sharing of best practices and experience;
  • developing a coherent "programme of work" for primary health care that effectively integrates all levels of WHO;
  • improving communication and collaboration with other international agencies to avoid sending contradictory messages on health systems development;
  • developing an evaluative framework and a review process that will help Member States to review existing primary health care policies and plan any necessary changes (2).

Above all, WHO's commitment with respect to health care systems based on primary health care is to move the Organization's focus as rapidly as possible from advocating principles to supporting practical application through technical cooperation with Member States. Current global consultations on primary health care will provide opportunities for sharing evidence and comparing country experiences. The urgency of global health challenges demands that this knowledge be turned speedily into action for health systems improvement based on primary health care.

The commitment to cooperation with countries on health systems development is part of a broader change in WHO's way of working. At a time when new challenges need to be met with new responses, WHO is altering its approach and redirecting its resources. The Organization is reinforcing its technical collaboration and support for people in governments, the private sector and civil society who are engaged in health work. This support will come from all levels of WHO and will be displayed in specific country cooperation strategies. Strengthening WHO's presence in countries and intensifying country-level collaboration is the best way for the Organization to accelerate progress towards the goals that unite the global health community: measurable health improvements for all, and vigorous strides to close equity gaps.

This report began by describing the contrasts that characterize global health. An approach based on primary health care recognizes the need to attack the roots of health disparities intersectorally. Hence the importance of the MDGs, and the global compact on which the goals are founded. The health sector can make the most effective contribution to the attainment of the MDGs, HIV/AIDS treatment targets and other objectives by strengthening health care systems. Working together to build effective, responsive, pro-equity health care systems, WHO, Member States and their partners will shape a more just, more secure and healthier future for all.