CHWs (42) BMJ: Primary healthcare is cornerstone of universal health coverage (1) PACK (Practical Approach to Care Kit) (4)

10 June, 2019

Dear HIFA colleagues,

'Global collaboration is also essential, including efforts by WHO and other leading global health organisations to develop standardised, evidence based tools and resources that support the implementation of effective, safe, and patient centred primary healthcare.'

Below are extracts from a new BMJ editorial by Agnes Binagwaho & WHO Director-General Tedros Adhanom Ghebreyesus, and a comment from me.

CITATION: Primary healthcare is cornerstone of universal health coverage

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2391 (Published 03 June 2019)

BMJ 2019;365:l2391

Correspondence to: A Bingawaho abinagwaho@ughe.org

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'We must invest more in primary healthcare — and invest more wisely...

'We have already seen, in our own countries, how placing primary healthcare at the heart of all efforts to achieve universal health coverage has transformed population health. In Rwanda, 45 000 community health workers serve as the first point of contact for people needing healthcare; they are the functional link between communities and health facilities, such as hospitals. In Ethiopia, tens of thousands of health extension workers bring healthcare to villages and put communities in control of their health. In both countries, primary healthcare has been successfully tailored to local health priorities, as the World Health Organization recommends...

'Global collaboration is also essential, including efforts by WHO and other leading global health organisations to develop standardised, evidence based tools and resources that support the implementation of effective, safe, and patient centred primary healthcare...'

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COMMENT: The authors highlight the importance of community health workers in the provision of primary health care and the achievement of universal health coverage. For me, this underlines the critical nature of WHO's CHW Guideline and how the international community interprets, considers and integrates (where appropriate) its recommendations. It is also vital that challenges such as national policy development and implementation are discussed sooner (including here on HIFA) rather than later, as well as questions around issues such as the parallel strengthening of the existing health workforce.

Perhaps it is helpful to keep our focus on understanding and progressively addressing the basic SEISMIC needs of *all* health professionals and paraprofessionals to maximise their ability to deliver the care for which they are trained. There can be nothing more demoralising and disempowering than to set high expectations and then expect these to be achieved with minimal support (http://www.hifa.org/about-hifa/hifa-universal-health-coverage-and-human-...). As I have suggested before on HIFA, health systems need to be health-worker-centred as well as people-centred.

Specifically the call 'to develop standardised, evidence based tools and resources that support the implementation of effective, safe, and patient centred primary healthcare' represents a direct call for increased investment in evidence-based tools such as PACK (Practical Approach to Care Kit), as described by HIFA members Joseph Ana, Tracy Eastman and others.

When we started HIFA in 2006 we set our sights on 'Health information for all by 2015'. We've since learned that this is a marathon, not a sprint. That said, we continue to move slowly but surely towards a world where every health worker will have access to the reliable information they need, in the language and format they need, to help inform better clinical decisions and better health outcomes.

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

http://www.hifa.org/projects/community-health-workers

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org