‘Health is a right of the peo­ple and a re­spon­si­bil­ity of gov­ern­ment,’ says PAHO Di­rec­tor

The Star (St. Lucia) - - LOCAL -

Health is a hu­man right, and it is gov­ern­ments’ re­spon­si­bil­ity to en­sure that right, said the Di­rec­tor of the Pan Amer­i­can Health Or­ga­ni­za­tion (PAHO), Dr. Carissa F. Eti­enne, on Oc­to­ber 26, dur­ing the clos­ing ses­sion of the Global Con­fer­ence on Pri­mary Health Care in As­tana, Kaza­khstan.

“Health is not a priv­i­lege, nor a com­mod­ity. It is a fun­da­men­tal hu­man right,” said Eti­enne, adding that “na­tional gov­ern­ments must lead and own na­tional pro­cesses to­wards uni­ver­sal health, in co­or­di­na­tion with part­ners”.

The Global Con­fer­ence on Pri­mary Health Care, held Oc­to­ber 25-26, was or­gan­ised by the World Health Or­ga­ni­za­tion (WHO), UNICEF and the Gov­ern­ment of Kaza­khstan and was at­tended by rep­re­sen­ta­tives of gov­ern­ments, non­govern­men­tal or­gan­i­sa­tions, in­ter­na­tional agen­cies, aca­demic in­sti­tu­tions and youth or­gan­i­sa­tions.

“We know what works and what we need to do,” said Eti­enne, re­fer­ring to what is known as the Pri­mary Health Care (PHC) strat­egy. Based on the prin­ci­ples of eq­uity and sol­i­dar­ity in health, the PHC strat­egy was first en­dorsed by global health lead­ers 40 years ago in the 1978 Dec­la­ra­tion of Alma-Ata, signed in the city that served as Kaza­khstan’s cap­i­tal un­til 1997.

Dur­ing the As­tana meet­ing, del­e­gates from more than 120 coun­tries—in­clud­ing many from the Amer­i­cas—reaf­firmed their coun­tries’ com­mit­ments to PHC and signed the Dec­la­ra­tion of As­tana, in which sig­na­tory coun­tries pledge to strengthen their pri­mary health care sys­tems as an es­sen­tial step to­ward achiev­ing health for ev­ery­one, ev­ery­where. Uni­ver­sal health is also called for in the United Na­tions’ Sus­tain­able De­vel­op­ment Goals (SDGs).

PHC is a strat­egy for hu­man health and well-be­ing and so­cial de­vel­op­ment that is cen­tred on peo­ple, their fam­i­lies and com­mu­ni­ties. “It is not merely the first level of care, nor it is the pro­vi­sion of a lim­ited pack­age of ser­vices for the poor,” said PAHO Di­rec­tor Eti­enne, who also serves as WHO’s Re­gional Di­rec­tor for the Amer­i­cas.

Pri­mary Health Care en­vi­sions uni­ver­sal ac­cess to com­pre­hen­sive and qual­ity health care ser­vices that fo­cus not just on cur­ing dis­eases but also on pre­ven­tion, re­ha­bil­i­ta­tion, and treat­ment. The strat­egy also calls for ad­dress­ing so­cial de­ter­mi­nants of health such as poverty, ed­u­ca­tion and hous­ing.

Eti­enne noted that PHC also re­quires break­ing down bar­ri­ers to ac­cess to health, in­clud­ing fi­nan­cial, geo­graphic, and cul­tural and gen­der bar­ri­ers. It also seeks to over­come the frag­men­ta­tion and seg­men­ta­tion of health sys­tems and ser­vices.

All this “re­quires State ac­tion” said Eti­enne. “With­out State ac­tion, there is no right to health, es­pe­cially for those liv­ing in sit­u­a­tions of vul­ner­a­bil­ity.” She urged gov­ern­ments to lis­ten to the voices of those who have lacked eq­ui­table ac­cess to health, to bet­ter un­der­stand their needs and to strengthen their par­tic­i­pa­tion and com­mit­ment to be able to de­velop a model of care cen­tred on peo­ple and com­mu­ni­ties.

PHC should be cen­tral to coun­tries’ ef­forts to trans­form their health sys­tems in or­der to ad­vance to­wards uni­ver­sal ac­cess to health and uni­ver­sal health cov­er­age. As a key step to­ward uni­ver­sal health, said Eti­enne, “we need a rev­o­lu­tion­ary first level of care” that of­fers com­pre­hen­sive health ser­vices lo­cated where peo­ple live and work.

That first level of care should make ra­tio­nal and ef­fi­cient use of tech­nol­ogy and or­gan­i­sa­tional in­no­va­tion, in­clud­ing in­ter­dis­ci­pli­nary health teams with a new cadre of per­son­nel and skills mix. It should be sup­ported by an in­te­grated health ser­vices de­liv­ery net­work, in­clud­ing hospi­tals and spe­cial­ized ser­vices, and should be able to re­spond to risk fac­tors, vi­o­lence, men­tal health is­sues, sex­ual and re­pro­duc­tive health, chronic non­com­mu­ni­ca­ble dis­eases, and dis­as­ters, among oth­ers, said Eti­enne.

Ev­ery­one has a role to play in ad­vanc­ing uni­ver­sal health, said Eti­enne, in­clud­ing gov­ern­ments, young peo­ple, women, the pri­vate sec­tor, academia, de­vel­op­ment part­ners, com­mu­nity lead­ers and peo­ple ev­ery­where. She urged all these ac­tors to ac­cel­er­ate their ef­forts go­ing for­ward.

Eti­enne said gov­ern­ments should take the lead by adopt­ing co­her­ent poli­cies and reg­u­la­tions and by in­vest­ing in health. “Please do not re­duce health to min­i­mum sets of pack­ages of es­sen­tial ser­vices, when your peo­ples de­serve so much more!” she told gov­ern­ment rep­re­sen­ta­tives, adding, “In­vest in your peo­ple and your sys­tems; in­vest in health, not war.”

PAHO’s Di­rec­tor chal­lenged young peo­ple to be­come more in­volved in health, say­ing, “You are our fu­ture, the en­ergy that will drive change.” She called on women to urge lead­ers to en­sure that gen­der is cen­tral to de­ci­sion-mak­ing in health. And she chal­lenged aca­demi­cians to in­vest in op­er­a­tional re­search that is con­text spe­cific and fo­cused on the needs of coun­tries and the health sys­tems, to pro­vide ev­i­dence that will guide and sup­port pol­i­cy­mak­ers to take the right de­ci­sions.

Eti­enne also rec­og­nized the role of the pri­vate sec­tor as health care providers and their im­por­tance in in­no­va­tion and tech­no­log­i­cal de­vel­op­ment. Em­pha­siz­ing the prin­ci­ple of so­cial re­spon­si­bil­ity, how­ever, she urged that the pri­vate sec­tor “in­no­vate, but based on health needs”.

Ad­dress­ing de­vel­op­ment part­ners, Eti­enne said that the Dec­la­ra­tion of As­tana and the SDGs of­fer a “golden mo­ment” that must be seized. “We can­not leave here and re­peat the mis­takes of the past” by re­duc­ing pri­mary health care to min­i­mum sets of poor ser­vices for the poor.

“There is no other way” than PHC to achieve health for ev­ery­one, ev­ery­where, said Eti­enne. “Pri­mary Health Care is smart. Pri­mary Health Care is right.”

Dr Eti­enne, PAHO Di­rec­tor, Global Con­fer­ence on Pri­mary Health Care.

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