PCIC

Aceso Global CTO Contributes to WHO’s Vision on the Transformative Role of Hospitals in PHC

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The WHO recently released a brief on “The Transformative Role of Hospitals in the Future of Primary Health Care” as part of its Technical Series on Primary Healthcare. It builds on two documents, “People-Centred Hospitals towards Universal Health Coverage: a WHO Position Paper” and “A Global Vision for Person- and Community Centered Hospitals in a PHC-based Health System,” both of which are in press. Aceso Global CTO Gerard La Forgia participated as a technical expert to and contributing author of these foundational documents. 

The release of this brief is timely, reflecting a growing consensus in the global health community about the fundamental role of primary care in achieving person-centered universal health coverage (UHC), and the need to rethink traditional functions of hospitals to support this agenda.

Historically, hospital and primary care systems have operated in siloes, with hospitals isolated and primarily focused on what happens within their walls, and largely absent from preventive and promotive care. The resulting care model has been fragmented, inefficient, and curative in focus, often with an outsized share of services delivered by hospitals, due in part to the lack of integration across the health system. In low- and middle-income countries (LMICs), this has contributed to distorted costs and poor quality; these systems do not serve NCDs adequately, and recent health gains and longer lifespans are being jeopardized by their failures.

The WHO Expert Group brief envisions a future of primary healthcare in which hospitals break out of their walls and actively contribute to the development of comprehensive primary care, in partnership with primary care providers and communities. New roles for hospitals will be coupled with improved hospital organization and management to raise performance, supported by an enabling institutional and policy environment that facilitates needed change. The brief outlines this vision, and touches upon pathways to transformation. The forthcoming WHO position paper provides more specifics and will serve as a resource for policymakers and planners in LMICs.

Since its founding, Aceso Global has been at the forefront of this global movement calling for renewed thinking on the roles of hospitals in people-centered healthcare systems. CEO Maureen Lewis and CTO Gerard La Forgia were founding members of and led the Center for Global Development Hospitals for Health Working Group, and have been consistent voices highlighting the key role of hospitals in reaching UHC. Aceso Global has worked in numerous countries to strengthen hospital management, raise performance, and integrate inpatient and primary care. Most notably, we provided options for a hospital PPP in St. Lucia, led the production of a Vertical Integration/Network Diagnostic and Readiness Tool for the Joint Learning Network and advised a number of countries on hospital reform, among other efforts.

This WHO brief highlights the nexus in the hospital, primary care and UHC agendas, and represents an important step forward in the global movement toward better integrated, more responsive healthcare systems.

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Aceso Global CTO Authors World Bank Call to Action for Chinese Health Care System

A new World Bank report, issued in collaboration with the Government of China and the World Health Organization, urges adopting “People Centered Integrated Care” in China as a way to reduce costs and place primary care at the heart of the country’s health system. Aceso Global CTO Gerard La Forgia led the study from its inception and joined Aceso Global just prior to the conclusion of the report. The World Bank released the report’s 200-page Policy Summary on July 22, 2016.

 
 
 

Over the past three decades, China has made significant improvements in health, including in child and maternal mortality. Also, Chinese citizens theoretically enjoy Universal Health Coverage. Yet, in the years ahead rising costs could limit further improvements in the Chinese health system. An aging population and a shift in the disease burden to non-communicable diseases such as cancer, cardiovascular disease and diabetes will place new strains on an already costly system. Current healthcare costs are growing unsustainably, and are projected to reach 9.1 percent of GDP by 2035. The People Centered Integrated Care model suggested in the report provides a potential means to making the system more effective while also containing cost escalation.

The existing Chinese system over invests in expensive hospitals and specialty care, while increasingly neglecting primary care service. Rising patient dissatisfaction with the quality of primary care has driven many Chinese to visit hospitals at the first sign of illness. Not only is this an inefficient use of expensive hospital resources, but it has also led to a decline in the number of health professionals seeking work in the primary care sector. This vicious cycle only further weakens the quality of the primary care system. In response to these challenges, the report recommends placing primary care at the core of an integrated health system to reduce costs and free up hospitals for more complex care needs, while simultaneously altering incentive systems so that hospitals and clinics are rewarded for quality of care rather than the volume of services provided. Finally, the report encourages greater private sector involvement to harness private sector efficiency for public healthcare. 

The challenges faced by China—from rising health costs, to an aging population, to a shifting disease burden away from communicable diseases—are not unique. OECD countries are already facing these issues, and Emerging Market countries will experience similar trends over the next decade and will be confronted with the need to rein in costs while expanding service equity and quality. Policymakers can consult the report for lessons as a step to solving these challenges. 

 

Find the report, Healthy China: Deepening Health Reform in China: Building High-Quality and Value-Based Service Delivery, here.

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