Category Archives: About AfroPHC

“Building effective PHC teams for UHC in Africa” Launch

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As a beacon for frontline health workers devoted to Primary Health Care (PHC) service delivery and the realization of Universal Health Coverage (UHC) in Africa, we are excited to announce the launch of the AfroPHC Policy Framework titled “Building the PHC Team for UHC in Africa.”

Event Details:

Why Attend?

  1. Deep Dive into the AfroPHC Policy Framework: Gain insights into our comprehensive guideline crafted to build a resilient PHC team pivotal for driving UHC in Africa.
  2. Engage in Rich Discussions: Partake in an interactive webinar, group deliberations, and a Q&A session to exchange experiences, perspectives, and best practices.
  3. Drive Recommendations: Be part of a collective voice shaping the future of PHC teams, financing models, and effective PHC policy implementations.
  4. Collaborate: Join stakeholders, policymakers, healthcare professionals, and communities in a unified mission to bolster PHC for UHC in Africa.

Event Structure:

  • Welcome (10 mins): Introduction to the AfroPHC Policy Framework.
  • Keynote (10 mins): Emphasizing the role of a robust PHC workforce for UHC.
  • Thematic Presentations (80 mins): Covering topics like multidisciplinary teams, community health workers, PHC financing models, and  PHC Implementation Country successes and lessons.
  • Q&A Session (20 mins): Address audience queries.
  • Group Discussions (45 mins): Theme-based dialogues to drive actionable insights.
  • Plenary (60 mins): A summary of group findings and a moderated cross-theme exploration.

RSVP: register in advance for the webinar. Post registration, you will receive a confirmation email with further joining details. Please share this within your networks nad with your members.

In a world where patients and health workers often get lost in bureaucracy, our vision stands clear: an empowered, people-centric PHC team aptly equipped for Africa’s unique needs. We count on your invaluable participation to bring this vision closer to reality.

Meet Our Speakers

Dr. Jeff Markuns is a practicing family doctor and faculty member at Boston University, and currently the President for the North America Region of the World Organization of Family Doctors (WONCA). Most recently, Jeff was the Executive Director of the Primary Health Care Performance Initiative (PHCPI), a partnership between the Bill & Melinda Gates Foundation, the World Bank Group, UNICEF, the Global Fund and the World Health Organization with Ariadne Labs and Results for Development (R4D) as technical partners, all focused on better primary health care measurement for improvement in low and middle income countries. Jeff has particular expertise in education as the current and founding Director of the Masters program in Health Professions Education at Boston University. Jeff’s earlier clinical work has included both outpatient and inpatient services, including 20 years of labor and delivery, his teaching experience included his work as an Assistant Program Director for BU’s residency in Family Medicine, and his operational experience included leading one of BU’s primary Family Medicine clinical units in an affiliated community health center. As the Executive Director of the Global Health Collaborative in the Department of Family Medicine, Jeff’s deep experience with frontline primary health care and the human resource capacity-building necessary to support its success has led to successful long-term vertically and horizontally-integrated development efforts to promote primary health care system strengthening and workforce development, supporting programs throughout southeast Asia and in Lesotho in southern Africa.

Dr. Viviana Martinez-Bianchi is a family doctor, a fellow of the American Academy of Family Physicians, an Associate Professor, and the Director for Health Equity at Duke University’s Department of Family Medicine and Community Health, in North Carolina, USA.  She served as Executive Member-at-Large of the World Organization of Family Doctors (WONCA) and WONCA liaison to the World Health Organization from 2016-2021, she is a member of the WONCA Rural Council, and has chaired WONCA’s Organizational Equity committee. She has been a member of the AfroPHC Advisory since its inception.  She serves in multiple organizations, boards, taskforces and advisories addressing care for marginalized populations. 

 

Dr. Faraz Khalid is currently a Research and Innovation Officer at Special Program for Primary Health Care at WHO Headquarters, and before this role, he was responsible for coordination for Universal Health Coverage reforms at the WHO’s Eastern Mediterranean Regional Office.

He has taken on multiple roles in the low- and middle-income countries health systems in the last seventeen years. He started his career as a medical doctor, transitioned to a program manager of an award winning innovative mhealth enabled social health protection program in Pakistan, has worked as health systems and financing consultant with World Health Organization, UNICEF, Asian Development Bank, and USAID.

Following his medical training, he completed his PhD in Global Health Policy and Management from Tulane School of Public Health and Tropical Medicine, USA and did Master’s in public health from London School of Hygiene and Tropical Medicine.

Dr. Salim Ali Hussein is a Public Health Practitioner in the Ministry of Health,  heading Primary Health Care, in the Ministry of Health, Kenya since July 2019. Passionate in Health System strengthening.

Previously held positions; head of Department of Health Promotion, Division of Community Health and has been a District Medical Officer In Charge of Marsabit District and Makindu Sub District. He holds an MSc Public Health System Management and Application from Kenyatta University and MB ChB from University of Nairobi. I have been trained on Social Innovation and system Change at University of Cape Town, leading high performing healthcare organizations (LeHHO) at Strathmore University, Strategic Leadership Development Programme at Kenya School of Government, in Information, Education & Communication in Health at Okinawa International Centre, Japan, and in Executive Hospital Management at  United State International University, Nairobi.

Dr Kalangwa Kalangwa is a Zambian medical doctor working for the Ministry of Health Headquarters as Assistant Director Health Promotion and Community Health in the department of Public Health and Research. He is also the spokesperson for the Ministry of Health. He has a special interest in solving health challenges using a public health approach. He has over 8 years experience in clinical medicine and public health. He holds a bachelor of science in Human Biology, a bachelor of Science in Medicine and Surgery and a masters degree in Epidemiology and Biostatistics, all obtained from the University of Zambia. He is currently perusing an MBA in Healthcare Management at UNICAF

The Virtual Workshops

The policy was constructed by over 500 members from over 20 African countries through virtual workshops since 2020. The workshops occurred on every third Tuesday of every month, 1-4 pm Central African Time, and the aim was to help build a shared perspective amongst PHC team members across Africa. All workshops were in the format of a moderated discussion with panellists and then group discussion and feedback. These workshops were accredited for continuing medical education (CME)/continuing professional development (CPD) across many African countries. They also had English/French/Portuguese translators available. 

Final Policy Framework Workshop in Johannesburg, South Africa

In October 2022, AfroPHC was able to host an in-person meeting in Johannesburg, South Africa. The purpose of this meeting was to finalise the policy paper, and the call to action for PHC across the African continent. About 35 members of the AfroPHC Executive and Advisory Board convened, together with other key stakeholders and experts, as the first in-person meeting of AfroPHC.

The Executive Summary

As the largest grassroots African institution specifically dedicated to advocating for frontline health workers who are committed to PHC service delivery and universal health coverage (UHC), we call on all stakeholders across Africa to build and empower effective PHC teams to achieve high quality PHC and UHC in Africa.

Our experience of primary health care (PHC) is of patients who are treated as numbers in a queue, with poor comprehensiveness, continuity, and coordination. Health workers are also treated like numbers in a bureaucracy that fragments and undermines training and service for integrated care around patient and population needs.

Our vision for PHC and UHC is a PHC team with skills mix appropriate to Africa, including family doctors, family nurse practitioners, clinical officers, community health workers and others that are empowered to take care of an empaneled population in high-quality people centred PHC.

Africa, please heed to the call of your health professionals.

Currently, the PHC system in Africa faces many new challenges AND opportunities. To date, human resources for health in PHC are grossly insufficient in number, often inefficiently and inequitably distributed, lacking adequate training for delivering fully responsive and comprehensive frontline care, and are treated inequitably within the health system. Projections for the African health workforce suggest this will worsen over the next five years. There has been a lack of solidarity among key role players in healthcare to create adequate PHC funding in Africa. Resources do not appropriately or adequately reach the frontline PHC service platform due to outdated service delivery and payment models. However, there are opportunities that leaders can capitalize on: global PHC milestones, increasing political will for investment in PHC, and proven mechanisms for achieving a stronger workforce such as the professionalization and scaling up of community health workers, clinical role-sharing, and the integration of family doctors, advanced practice nurse practitioners and allied health professionals into PHC.

We call on African leaders and global stakeholders to develop and implement a regional forward-looking plan to:

1)Build robust PHC SYSTEMS.

This must be based on a high quality bio-psycho-social-spiritual approach for PHC that is comprehensive, coordinated and integrated person- family- and community-centred. It must integrate PHC priorities and Health in All Policies. It must be based on empanelling of defined populations to a specific PHC team using community oriented primary care. It must be supported by interoperable e-Health and a strong District Health System to coordinate public and private providers.

2)Educate, recruit and maintain a sufficient frontline PHC WORKFORCE.

This must include a complete workforce of locally trained family doctors, nurses, advanced practitioners, pharmacists, professionalized community health workers and others sufficient to deliver high quality PHC. This workforce must involve role-sharing with supportive supervision; distributed leadership; clinical governance by accountable clinicians; and an integrated human resources development and management plan suitable to PHC.

3)Support PHC with FINANCES.

There must be political and sustained funding action that considers PHC as an investment; a fight for global solidarity action on PHC funding pools; and better management of PHC across Africa with strategic purchasing and payment reforms using blended capitation.

This can all come together easily in a simple nationally-defined PHC contract using risk-adjusted blended capitation payment to decentralised PHC teams empanelled to enrolled populations, coordinated by the district health services to provide services to the full population, and easily administered at national or sub-national level for empowered public and private providers.

As the African Forum for Primary Health Care, we call on Africa to commit to making this plan a reality and building effective PHC teams for UHC in Africa. We commit to mobilising PHC workers across Africa to create PHC teams around empanelled populations as sentinel sites across Africa to share best practice and to show evidence of how effective we can be at both practice and population level if we are empowered to deliver quality PHC as a team.

The AfroPHC Call to Africa: Join AfroPHC and build effective primary health care teams for universal health coverage in Africa

In opening we call on Africa

  • To pay heed to the call of its health professionals for PHC and UHC in Africa.
  • To seize opportunities to overcome African challenges for PHC and UHC in Africa.
  • To embrace the World Health Report of 2008 and Astana Declaration of 2018 by prioritizing integrated, resilient, person-centred and high quality PHC within UHC, re-organising UHC around PHC service delivery, integrating public health with primary care, and bringing private PHC providers into a regulated PHC system for UHC in Africa.

In terms of PHC Systems we call on Africa

  • To embrace the disciplines of family medicine and generalist PHC, with its bio-psycho-social-spiritual approach to care, to achieve PHC and UHC in Africa by 2023 that is personalised, comprehensive, continuous, and coordinated, in line with global standards.
  • To embrace primary care, defined by WHO as an essential level of care, that needs to be responsive, person- family- and community-centred and covers the full spectrum of care within the paradigm of OneHealth for PHC and UHC in Africa by 2023.
  • To integrate priority programmes (communicable diseases, non-communicable diseases, mother-woman-child health, violence-trauma, mental health etc.) into PHC in a diagonal manner that both supports these vertical priorities as well as supporting horizontal integration by PHC teams around patient and population for UHC in Africa by 2033.
  • To strengthen rehabilitation and palliation in PHC by 2033 with decentralised and well-funded community rehabilitation and palliation services, where teams with an appropriate mix of skills and professional supervision are linked to multiple community practices for accountable care.
  • To integrate oral health into PHC by 2033 with team-based service delivery models that includes appropriate role- and task-sharing with a range of oral health care practitioners and dentist support and supervision and that are linked to multiple community practices for accountable care.
  • To strengthen access to medicines and investigations with greater embrace of pharmacy professionals and point-of care technology at PHC level to achieve PHC for UHC in Africa by 2033.
  • To strengthen coordination of PHC referrals to hospitals with the placement of postgraduate-trained family doctors in PHC teams by 2033 to achieve UHC in Africa.
  • To prioritise PHC as the foundation for UHC: making “Health in All Policies” an integrating and develop­mental public health approach to decentralised government, and strengthening PHC teams with local linkages to other sectors affecting social determinants of health by 2023 to deliver PHC and UHC in Africa.
  • To strengthen the district health service to coordinate decentralised and empowered providers by 2033 and to ensure they deliver on agreed-upon results as they implement PHC and UHC in Africa.
  • To embrace the strategy of empanelment of a defined population and linking them to a defined, fully staffed, and equipped PHC team and medical home by 2023 as a foundational step to achieving PHC and UHC in Africa.
  • To embrace community-oriented primary care in community practices of 30 000 by 2033 and aspire to community practices of 10 000 for achieving PHC and UHC in Africa by 2043.
  • To embrace the Blueprint for Rural Health and rural proof all health policies by 2023 to support rural and marginalised urban primary health care comprehensively, especially creating stepladder entry requirements for educational institutions and rural/marginalised urban student immersion for the full PHC team, to achieve PHC and UHC in Africa.
  • To recognise the unique challenges of women in PHC and to explore innovative and sustainable interventions to overcome these for PHC and UHC in Africa
  • To recognise the unique opportunities of youth in PHC and to explore innovative and sustainable interventions to address these for PHC and UHC in Africa.
  • To embrace the variety of eHealth solutions for PHC by ensuring that sustainable national e-health strategies are supported by accessible infrastructure, interoperability and user-friendly designs that enable the PHC team and patients/populations to enhance quality and support new models of care in PHC and UHC in Africa.
  • To engage communities and ensure social participation in advancing team-based PHC across Africa.
  • To embrace the culture of quality and patient safety with strong teamwork, and to measure and monitor performance to achieve quality PHC and UHC in Africa.
  • To develop and support practice and population research sites focussed on PHC across Africa and to expand the range of indicators that will assess the effectiveness of PHC teams empanelled to populations as a key service delivery reform

In terms of PHC Workforce we call on Africa

  • To build a larger, better trained PHC workforce (integrating public and private providers) with more opportunities (educational, financial, and clinical) and greater resources (starting with structurally defining PHC services) to enable PHC and UHC.
  • To acknowledge the burden on all cadres in PHC and to embrace trans professional collaboration with a mix of all health professionals using respectful, collaborative role sharing and supportive supervision for achieving PHC and UHC in Africa.
  • To embrace distributed leadership practices, and education for it, among all PHC workers and managers to achieve PHC and UHC in Africa.
  • To embrace the important role of medical, dental, nursing and other professions with post-graduate training for decentralised primary care settings to support clinical governance, coordinated care and efficient referrals to achieve PHC and UHC in Africa.
  • To standardise, professionalise and decently remunerate community healthcare workers that are strongly integrated with the PHC team, and furthermore to aspire to a target of one CHW per thousand persons by 2043 to achieve PHC and UHC in Africa.
  • To clarify and harmonise PHC workforce nomenclature for the different categories and disciplines in PHC, and to then embark on labour market analyses in PHC (including public and private) and specific PHC human resource for health (HRH) policies and strategic plans to scale up the PHC health workforce by 2033 to achieve PHC and UHC in Africa.
  • To implement a robust educational and credentialing systems for developing a competent workforce dedicated to delivering comprehensive PHC services necessary to achieve UHC in Africa.
  • To protect all PHC workers as a precious and vulnerable resource and to empower them to build quality and resilience as a team that works closely with communities to achieve PHC and UHC for Africa.

In terms of PHC Finances we call on Africa

  • To regard health as an investment and to leverage political goodwill for action on PHC/UHC by defining PHC in budget terms, ringfencing the financing of PHC and committing to at least 2% of their GDP on PHC for UHC in Africa.
  • To re-examine global social solidarity on PHC and strengthen contributions to PHC for UHC in Africa as a priority, starting with High-Income Countries increasing ‘donor aid’ to 2% of their health spend and ‘donor aid’ funds allocating 30% to an African Union funding pool for integrated PHC and UHC in Africa by 2033.
  • To work towards better funded single pools for UHC funding, prioritising strategic purchasing for PHC with standard and transparent contracting of both public and private providers in empowered decentralised units of PHC for UHC in Africa by 2043.
  • To embrace PHC teams paid by blended capitation models (including capitation, fee-for-service and performance payments) to achieve holistic and responsive PHC and UHC in Africa by 2043.
  • To embark on simple nationally-defined PHC contracting to community practices for accountable care from both public and private service providers.

In closing,

We call on Africa to empower and build an effective PHC team to achieve PHC and UHC in Africa. We, as the African Forum for Primary Health Care (AfroPHC), commit to educating and empowering providers and their communities at the frontline to support this goal in any way we can, including

building AfroPHC Chapters at country level as a forum

for PHC and UHC in Africa.

The History of Primary Health Care

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Introduction to the history of primary healthcare.

The history of primary healthcare.
From the small efforts of various groups to promote accessible and affordable health to all, the first significant step in the history of primary healthcare was the World Health Organization (WHO)’s “Health for all by the year 2000” initiative of 1977 which promoted UHC.
Although it was deemed impossible, atleast it led to the Alma Ata declaration in 1978 where various leaders established primary healthcare as the most practical and effective was of achieving the goal “Health for all by year 2000”.
30 years down the line, in 2008, the World Health Organisation launched the “Primary healthcare: now more than ever” report which highlighted several reforms necessary to make primary healthcare effective.
Then in 2018 was the Astana Declaration which traced the progress of primary healthcare since the Alma Ata declaration and established ways of strengthening primary healthcare to achieve universal health coverage.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Policy Framework for primary healthcare in Africa” which outline the goals to be met by Africa to achieve effective PHC for UHC in Africa.

Health for all by the year 2000

“Health for all by the year 2000” was a global health initiative launched by the World Health Organization (WHO) in 1977.
The initiative had three main objectives:
1. To achieve a level of health that would permit all individuals to lead a socially and economically productive life.
2. To reduce the gap in health status between developed and developing countries.
3. To provide essential health care to all individuals and families in the community.

Unfortunately, the goal of “Health for all by the year 2000” was not achieved but it did help in raising awareness of the need for accessible and affordable health for all, and this led to the establishment of primary healthcare in the 1978’s Alma Ata declaration.

The Alma Ata Declaration of 1978

The Alma-Ata Declaration is a health policy document that was adopted at the International Conference on Primary Health Care held in Alma-Ata, Kazakhstan in 1978.
The Declaration has had a profound impact on global health policy and practice. It has been a driving force behind the development of primary healthcare as a central component of health systems around the world.
It defined primary healthcare as “essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.”
And it also emphasized the importance of community participation, health promotion, and disease prevention in addition to curative services. It recognized the need for a comprehensive approach to healthcare that addressed not just physical health, but also mental, social, and spiritual well-being.

WHO’S “Primary Health Care: Now More Than Ever” Report of 2008

The report “Primary Health Care: Now More Than Ever” was published in 2008 by the World Health Organization (WHO). The report emphasized the importance of primary health care as the foundation of any effective health system and called for a renewed global commitment to primary health care as a means of achieving better health for all.
It highlighted four key reforms necessary to strengthen primary healthcare:
1. Strengthening health systems: The report called for a comprehensive approach to strengthening health systems, including investments in health infrastructure, health workforce education and training, and health information systems.
2. Improving access to primary health care: The report emphasized the need to improve access to primary health care services, particularly for underserved populations, through strategies such as expanding health coverage and reducing financial barriers to care.
3. Enhancing the quality of primary health care: The report called for efforts to improve the quality of primary health care services through initiatives such as strengthening health workforce capacity, promoting evidence-based practice, and implementing quality assurance systems.
4. Fostering community participation and empowerment: The report highlighted the importance of engaging communities in primary health care planning and decision-making to promote health equity and social justice.
Overall, the report called for a coordinated and sustained effort to strengthen primary health care systems worldwide, with a focus on addressing the health needs of the most vulnerable populations.

The Astana Declaration of 2018

The Astana Declaration is a global commitment to achieving universal health coverage (UHC) through primary health care (PHC). The declaration was adopted at the Global Conference on Primary Health Care in Astana, Kazakhstan in 2018, which marked the 40th anniversary of the historic Alma-Ata Declaration of 1978.
The Astana Declaration reaffirms the principles of the Alma-Ata Declaration, which recognized primary health care as the key to achieving health for all. The Astana Declaration goes further by emphasizing the need for a renewed commitment to primary health care as the foundation of health systems, and as a means of achieving universal health coverage.
The Astana Declaration calls for a series of actions to strengthen primary health care systems, including:
1. Investing in primary health care as the cornerstone of health systems
2. Strengthening health systems through increased funding and resources
3. Ensuring access to essential health services for all, including through community-based approaches
4. Empowering individuals and communities to participate in their own health and health care
5. Strengthening health workforce education and training to ensure a skilled and motivated health workforce
6. Strengthening health information systems to improve decision-making and accountability
7. Strengthening partnerships and cooperation between different sectors and actors to achieve shared health goals.

AfroPHC’s Policy Framework for PHC and UHC in Africa

This week we have been looking at the history of primary healthcare.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Building PHC Teams for UHC in Africa” which underscores the crucial role of the PHC workforce within a team based approach. It also outlines the key actions that need to be met by Africa to achieve effective PHC for UHC in Africa.
This policy framework was funded by Primary Health Care Performance Initiative (PHCPI) and echoes the voices of frontline primary healthcare workers and leaders across, Africa, collated through a series of virtual policy workshops and group discussions. The final workshop was held in October 2022 in Johannesburg, South Africa where a cohort of about 30 multicountry multiprofessional delegates met in person to finalise the policy framework.
In summary, the policy calls to Africa to pay heed to the call of its health professionals, to seize opportunities to overcome African challenges, to embrace the World Health Organisation’s Report of 2008 and Astana Declaration of 2018 by prioritizing integrated, resilient, person-centred and high quality PHC within UHC, re-organising UHC around PHC service delivery, integrating public health with primary care, and bringing private PHC providers into a regulated PHC system for UHC in Africa.

Chiawelo Community Practice

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Chiawelo Community Practice is an experiment in developing community-oriented primary care (COPC) more strongly in South Africa, as a model for GP-led teams contracted to the National Health Insurance (NHI). It is part of the Chiawelo Community Health Centre in Soweto, a facility owned by the public health service in South Africa. It also functions as part of the Wits University teaching and research platform. It is led by a family physician (Prof. Shabir Moosa). The team includes a family physician, an occasionally rotating 1st-year family medicine registrar, one clinical associate, three medical interns rotating weekly, one professional nurse, three enrolled nurses (team leaders), and 30-42 CHWs. They are caring for 30 000+ residents from the community of Ward 11, 12, 15, 16, & 19 in strong teamwork. Local stakeholders are engaged strongly, supporting a growing targeted health promotion programme. This has resulted in low utilisation rates (less than one visit per person per year), easy access aligned to need, high satisfaction and high clinical quality. This has been despite the challenge of a reductionist PHC system, poor management support and poor public service culture. The results could be more impressive if panels were limited to 10 000, if there was a better team structure with a single doctor leading a team of 3–4 nurse/clinical associates and 10–12 CHWs and PHC provider units that are truly empowered to manage resources locally.