Series: Alma-Ata: Rebirth and Revision
Supporting the delivery of cost-eff ective interventions in primary health-care systems in low-income and
middle-income countries: an overview of systematic reviews
Simon Lewin, John N Lavis, Andrew D Oxman, Gabriel Bastías, Mickey Chopra, Agustín Ciapponi, Signe Flottorp, Sebastian García Martí,
Tomas Pantoja, Gabriel Rada, Nathan Souza, Shaun Treweek, Charles S Wiysonge, Andy Haines
The Lancet.- Vol 372 September 13, 2008
Available online: http://www.thelancet.com/journals/lancet/article/PIIS0140673608614038/abstract
[Free subscription required]
“….Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries.
This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades….’
Affiliations
a. Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
b. Health Systems Research Unit, Medical Research Council of South Africa, South Africa
c. Department of Clinical Epidemiology and Biostatistics, Department of Political Science, and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
d. Norwegian Knowledge Centre for the Health Services, Oslo, Norway
e. Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
f. Health Systems Research Unit, Medical Research Council of South Africa, South Africa
g. Institute for Clinical Effectiveness and Health Policy (IECS) and Iberoamerican Cochrane Network, Buenos Aires, Argentina
h. Norwegian Knowledge Centre for the Health Services, Oslo, Norway
i. Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
j. Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
k. Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
l. Department of Clinical Epidemiology and Biostatistics and Health Research Methodology PhD Programme, McMaster University, Hamilton, Canada
m. Division of Health Sciences Research and Education, University of Dundee, Dundee, United Kingdom
n. Norwegian Knowledge Centre for the Health Services, Oslo, Norway
o. South African Cochrane Centre, Medical Research Council of South Africa, Cape Town, South Africa
p. Director's Office, London School of Hygiene and Tropical Medicine, UK
| Series: Alma-Ata: Rebirth and Revision
Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise
Summary: In this paper, we revisit the revolutionary principles—equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action—raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for a.....
Summary | Full Text
Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews
Summary: Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although .....
Summary | Full Text Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care
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Summary: We assessed progress for primary health care in countries since Alma-Ata. First we analysed life expectancy relative to national income and HIV prevalence to identify overachieving and underachieving countries. Then we focused on the 30 low-income and middle-income countries with the highest average yearly reduction of mortality among children less than 5 years of age, describing coverage and equity of primary health care as well as non-health sector actions. These 30 countries have scaled up selective primary health care (eg, immunisation, family planning), and 14 have progresse.....
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Community participation: lessons for maternal, newborn, and child health
Summary: Primary health care was ratified as the health policy of WHO member states in 1978. Participation in health care was a key principle in the Alma-Ata Declaration. In developing countries, antenatal, delivery, and postnatal experiences for women usually take place in communities rather than health facilities. Strategies to improve maternal and child health should therefore involve the community as a complement to any facility-based component. The fourth article of the Declaration stated that, “people have the right and duty to participate individually and collectively in the planni.....
Summary | Full Text Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?
Summary: Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delive.....
Summary | Full Text Integrating health interventions for women, newborn babies, and children: a framework for action
Summary: For women and children, especially those who are poor and disadvantaged, to benefit from primary health care, they need to access and use cost-effective interventions for maternal, newborn, and child health. The challenge facing weak health systems is how to deliver such packages. Experiences from countries such as Iran, Malaysia, Sri Lanka, and China, and from projects in countries like Tanzania and India, show that outcomes in maternal, newborn, and child health can be improved through integrated packages of cost-effective health-care interventions that are implemented incremen.....
Summary | Full Text Making Alma-Ata a reality, now and going forward
The last paper in the Alma-Ata series issues a call for action by The Lancet Alma-Ata Working Group. They say "The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then". 'Health for All' by the year 2000 was not achieved and the Millennium Development Goals for 2015 will not be met in most low-income countries......
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