Annual Health Forum 2007 Reorientation of the Health Workforce for future challengers Primary Health...

Annual Health Forum 2007

Reorientation of the Health Workforce Reorientation of the Health Workforce for future challengers for future challengers

Primary Health Care Workforce

Dr Abhaya Tissera


Primary Health CarePrimary Health Care

• ‘essential health care …..made universally

accessible to individuals and families in

the community…..it forms an integral part

both of the country’s health system, of

which it is the central function and main

focus, and of the overall social and

economic development of the community.(WHO International Conference on PHC , Alma Ata 1978)


Primary health care workforcePrimary health care workforce

• Medical Officer of Health and the team

• First point of peoples contact with the

Health Service,

• Bring health care as close as possible to

where people live and work.


Challengers Challengers

• Changing concept of health

• Developing new technology

• Epidemiological transitions

• Demographic transitions

• Changing health care priorities

• The way health system doing its

business

• Changing social and cultural values


Changing concept of health and health careChanging concept of health and health care

Period Ideology of health Competencies

19th century

Biomedical model legislations and sanitary reforms

Early 1970s Health Field – life style

Health education

Late 1970s Social model of health PHC concept

Community participation Empowerment

1986 onward

Ottawa Charter for HPBangkok Charter for HP

Advocacy Partnership building


Epidemiological and demographic transitionsEpidemiological and demographic transitions

Demographic transition

• Increasing aging population, and youths and adolescents

• healthy aging,

• youth counseling,

• community based disability management

Epidemiological transition

• Changing disease pattern from CD to NCDs

• community based interventions

• management of NCDs at PHC level


Changing health care priorities: new areas…Changing health care priorities: new areas…

• Health care for aging population

• Youths and adolescents health

• Prevention and management of major

non communicable disease,

• New emerging diseases

• Health care in natural disasters


Changing health care priorities: more funds..Changing health care priorities: more funds..

• Country Cooperate Strategy - WHO

• Component of HSDP project - World Bank

• Component of EBM study – JICA


The new approaches for health careThe new approaches for health care

Integrated Non-Communicable Disease Prevention • community interventions

– The active participation of families and communities,

– pooling and sharing resources to ensure integrated preventions.

– The identification of leaders, organized groups and institutions.

– The development of strategic coalitions and alliances

( PHA Canada, 2007)


Changing social and cultural valuesChanging social and cultural values

• people’s choice for place of delivery has been

changed from ‘home’ to ‘institution’

• more and more mothers are now seeking services

of GPs/institutions for immunization of their

children

• Home Visits by FHWs vs Home Care by private

health agency


Competency profiles Competency profiles

Technical competenciesNon technical competencies

– Community participation– Advocacy– Communication – Developing partnership – Facilitating group dynamics – Change management– Organizing community groups


Response to challengers Response to challengers

1.District Health System DHO system

2.Increasing numbers but preserving existing job categories

• allocating less number of populations per FHW and

assigning new tasks

• ??assigning new tasks will dilute the present core functions

3. Adding new disciplines , job categories


What can we do in the future ?What can we do in the future ?

1.In response to the challengers, adding new areas of

work and new approaches at the PHC level is inevitable

2.That mean, adding new sets of competencies ,both

technical and non technical , at the PHC level .

3.Executing non-technical competencies need more time

and energy.

4.Therefore ‘packing’ all competencies required to face

the challenges into one ‘box’ may be impossible.


What can we do in the future ?What can we do in the future ?

• Adding new disciplines or new categories of workers

• Change the way of doing business such as – networking, – partnership building and – out sourcing

– ???Accountability– ??? Quality of work


National Occupational StandardsNational Occupational Standards

• ‘evidence of the quality of the human resources, that is competencies of the PHC worker, assessed against a set of agreed criteria for the best practice (Liz Rolls, 1999).

Example • the National Occupational Standards for Health

Promotion and Care• what is happening now, • what is considered good practice, • what is not happening now- but should be happening

and • what can be anticipated in future (Care Sector Consortium, 1997, p7).

Annual Health Forum 2007 Reorientation of the Health Workforce for future challengers Primary Health...

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