Closing speech - Primary Health Care towards Universal Health Coverage and Sustainable Development Goal 3, Global Conference on Primary Health Care

26 October 2018, Astana, Kazakhstan

Honourable ministers, distinguished delegates and colleagues, what full and productive days these have been.

What has been achieved

I am honoured and proud to have been part of these important discussions on this landmark anniversary.

The Declaration of Alma-Ata was very much ahead of its time. We have now embraced and reiterated its fundamental tenets and its visionary recommendations, while adapting them to the realities of our time.

We have confronted these realities: our ageing populations coupled with the burden posed by noncommunicable diseases and chronic care needs; the increased demands for mental health services; and the urgent need to halt epidemics of high-impact communicable diseases, to name just a few.
We have looked at effective ways to involve our citizens, both as communities who want to have a say about the shape of primary care services, and as individual patients who now expect to play an active role (and rightly so!) as codecision-makers with health professionals in the process and type of care they receive.
We have discussed key strategic directions of our response, from the responsible use of antibiotics to the preparedness of our systems for emergencies. We have learned from best practices for integrating service delivery across the different levels of care, including public health interventions, as well as social and community services. We have seen how effective primary health care provides the appropriate organizational platform and mix of skills and types of competencies required to achieve this integration and continuum of care.
We have also debated the role of technology and its potential to increase the progress and effectiveness of primary health care. E-health records, for instance, will not only empower patients to take decisions on their own care, but will enable a more cost-effective delivery and integration of services. However, we must also evaluate the impact of these new technologies very rigorously and remind ourselves that technology will never be able to replace our health workforce, our valuable human capital in primary health care.

Time to step up implementation and increase the pace of reforms

From these discussions, a few things remain clear:

We know what we need to do.
We have strong and often sufficient evidence about what works and what doesn’t and in different contexts.
It is now, more than ever, high time to step up our implementation efforts and increase the pace of primary health care reforms.

To be successful, in addition to solid evidence, we need strong values emanating from the Declaration of Alma-Ata, now further developed in the Declaration of Astana. We also need to be better at the “know how” to transform primary health care by introducing innovation and managing change effectively.

I will devote the remains of this speech to briefly outlining these two aspects of implementation.

Value-based primary health care

Primary health care cannot be separated from its vision and its commitment to social justice. This was the political battle of Mahler and we need to engage in it, if we are to move forward, more than ever today, when facing challenging political contexts.
Primary health care cannot be divorced from society and communities. It must be part of the democratization of health. It is also a social catalyser to build trust if supported by health literacy.
Primary health care was the linchpin in the introduction of multisectorality. That must be part of the narrative even more in this era of the Sustainable Development Goals, in which cities and local communities have a central role to play.

Transformation know how

Our ability to transform primary health care will depend on a range of factors, some intrinsic to the health system; some contextual, such as economic and social developments, political stability or institutional capacity.

While some may be out of our reach, many others can be addressed through effective transformation programmes under strong leadership and whose time horizon goes beyond political cycles.

During the conference, country delegates described a range of mechanisms to set up implementation, including a better understanding of political economy factors, use of intersectoral agreements, ensuring accountability for outcomes and activating communities.

There is enormous transformation potential (also called leap frogging) in introducing a series of policy accelerators and disruptive innovations.

Briefly and to name just a few:

New skills, competencies and health professions in primary health care, backed by new and innovative training programmes. The model of the physician and nurse working in isolation is not fit for purpose. We need multidisciplinary primary care teams in which, for instance, some tasks initially performed by specialists are now adopted by general practitioners; nurses and community health workers take a predominant role in managing chronic conditions; and new professions are included, such as case managers.
Empowered populations and patients that express their preferences and choices, demand accountability for outcomes, participate in clinical decisions and take responsibility for their own health.
Incentives (financial and otherwise) applied to all members of primary health care teams to strengthen their response and effectiveness to deal with chronic conditions and to integrate public health interventions, but also to respond to acute care.
E-health technologies, many now affordable in all income settings, to enable access to health information, improve communication and transparency; and which flatten traditional hierarchical relationships between patients and professionals.

Moving towards the future

Now is the time to accelerate. The Declaration of Astana is a call to step up action, which should empower us to make primary health care a reality in all our countries. Our shared goal to pursue universal health care depends on our commitment and ability to put this declaration into practice.

Working together, I am confident of our success. It will require a full and comprehensive commitment to action from all of us in this room. We, the participants of this 40th anniversary conference represent our societies: the policy-makers, the professional associations, the youth (bringing an ambitious and fresh voice to these discussions); the patients, carers, academics, donors, community-based organizations, faith-based organizations and the funding agencies. All and each one of us have a role to play in writing this next chapter on the future of primary health care.

Allow me to close with a moment of thanks to our hosts, the Government of Kazakhstan, for another act of generosity and professionalism. These past days, you recreated the platform that was first built in Kazakhstan 40 years ago for a global discussion on primary health care. I thank you on behalf of the Region for your foresight then and this enduring commitment now.

I wish us all continued success on our return home.

Our work begins now.

Thank you very much.