First Read Case Study 2 Primary Care Workforce Around the World from Chapter 4

Then Read Case Study 2 Primary Care Around the World from Chapter 7

CASE STUDY 2 PRIMARY CARE AROUND THE WORLD In 1978, the International Conference on Primary Health Care created the Declaration of Alma- Ata, which underscored not only the necessity of a robust primary healthcare system to sustain a comprehensive national health system but also the importance of establishing healthcare as an essential human right (WHO 1978). Globalization has continued to put pressure on health systems that are under strain to provide services that are high quality, universally accessible, and affordable. There is clear evidence that primary healthcare leads to better health for all and better-functioning healthcare systems. While global health has improved on aggregate, a number of political, demographic, and epidemiological transitions have increased inequalities in progress within and between countries. These transitions have put a strain on existing healthcare systems, and a focus on primary care as an essential part of healthcare reform is necessary. The World Health Organi- zation (WHO) considers universal healthcare a critical aspect of a move toward reform based on primary care. Since the adoption of the Sustainable Development Goals (SDGs), WHO has framed its advocacy for universal healthcare around Target 3.8 of SDG 3, which focuses on service coverage and financial protection (WHO 2018d, 2018e). With rising healthcare costs and disorganized systems for financial protection, personal health expenditures now force more than 100 million people into poverty each year. Vast dif- ferences in health occur between and within countries and even within individual cities. In reemphasizing primary healthcare, WHO argues that its core principles and approaches are more relevant than ever, a conclusion which several findings support (Van Lerberghe 2008). Using existing preventive measures more efficiently may reduce the global burden of disease by as much as 70 percent (Van Lerberghe 2008). Tasks performed by specialists mayto visit the Japanese HC alliance in China. The success of the HC the public sector, the private sector, and the community (Hu and CASE STUDY 2 PRIMARY CARE WORKFORCE AROUND THE WORLD A robust primary care workforce is critical in a diverse global community that faces the chal tenges of aging populations and epidemiologic transitions. There is a worldwide shortage of primary care physicians and an increased demand for primary care services. In response, the primary care workforce has been diversifying to include a wider range of health professionals such as nurse practitioners, registered nurses, and clinical staff members. Although primary care systems globally face challenges associated with a shrinking workforce and increasing care needs, there are differences in skill mix and organizational structures within and across Storey Banidmay Into ins high-income and low-to-middle-income countries. A skill mix is defined as the combination of posts, grades, or occupations in an organi- zation, or the combination of activities and skills needed for a particular job within an orga- nization. Skill mixes differ by countries, sectors, and health systems. Factors such as resource availability, culture, and demographic makeup may determine the appropriate skill mix (Buchan and Dal Poz 2002). In high-income countries such as the United Kingdom, the United States, and Canada, primary and community care services face the major challenges of increasing workloads, aging populations, and increasingly complex medical problems (Checkland and Spooner 2015). The numbers and working hours of primary care physicians are decreasing for reasons including, but not limited to, an increase in the proportion of female physicians electing to work fewer hours or part-time and an increase in the number of patients as well as their care demands. In response, most countries have diversified their primary care teams to include nonphysician providers such as nurse practitioners and physician assistants. While nurse practitioners and physician assistants are able to complete at least 60 percent of office-based primary care, owing to low remuneration and high training requirements, the numbers of nurse practitioners and physician assistants working in primary care are still low in many countries (Ginsburg, Taylor, and Barr 2009). It has been suggested that workplace innovations such as shifting tasks from physicians to nonphysician health professionals are necessary to resolve the current chal- lenges of primary care. However, such task shifting necessitates a willingness of physicians to give up tasks and the ability and capacity of nonphysician providers to execute these tasks. In countries with emerging economies such as Brazil and India, workplace innovations such as task shifting have been more easily adopted, partly due to fewer established expectations of professional roles (Freund et al. 2015).Chapter 7: International Health Policy Issues 205 be better managed by general practitioners, family doctors, or nurses. Specialist-oriented care contributes to inefficiency, restricted access to care, and deficiencies in comprehensive care. When healthcare is skewed toward specialist care, a range of protective and preventive care interventions may be lost (WHO 2006). Unequal access to care and disparities in health outcomes are usually worst when health is regarded as a commodity and care is profit driven. Workforce shortages in primary care also pose a significant challenge (as described in Case study 2, "Primary Care Workforce Around the World," in chapter 4). An effective primary healthcare approach protects against many of these problems, emphasizing a holistic view of health in which prevention is as important as cure in a care continuum that extends over the human life span. The primary healthcare approach targets key health determinants in multiple nonhealth sectors, in effect launching an "upstream attack" on threats to health (Van Lerberghe 2008). The main strategy for addressing disparities in healthcare is to shift toward universal health coverage with an emphasis on the values of equity, social justice, and solidarity and the overarching goals of fairness and efficiency in service delivery