Department of Family Medicine, Menoufia University, Menoufia, Egypt.
Algerian Society of General Medicine, Alger, Algeria.
Eur J Gen Pract. 2020 Dec;26(1):1-6. doi: 10.1080/13814788.2019.1640210. Epub 2019 Aug 1.
Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. This paper describes and analyses the health systems of Algeria, Kuwait, Morocco, Saudi Arabia, Jordan and Iraq to PHC. Data were collected during a workshop at the Wonca East Mediterranean Regional Conference in 2018. Academic family physicians (FP) presented their country; using the Wonca framework of 11 PowerPoint slides, with queries of the country demographics, main health challenges, and the position of PHC in the health system. The six countries had achieved a significant improvement in populations' health but currently face challenges of health financing, a small number of certified FPs, difficulties in accessing services and bureaucratic procedures. Primary concerns were the absence of a family practice model, brain drain and immigration of FPs. Countries differed in building a coherent policy. Priorities should be focused on: developing PHC model in Eastern Mediterranean region with advocacy for community-based PHC to policymakers; capacity building for strengthening PHC-oriented health systems with FP specialty training and restrict practising to fully trained FPs; engage communities to improve understanding of PHC; adopt quality and accreditation policies for better services; validation of the referral and follow-up process; and, develop public-private partnership mechanisms to enhance PHC for UHC.
初级卫生保健（PHC）对于公平获得和具有成本效益的医疗保健至关重要。这使得 PHC 成为全球全民健康覆盖战略的关键因素。实施 PHC 需要了解当前卫生系统的情况，但对于大多数国家来说，没有可用的数据。本文描述和分析了阿尔及利亚、科威特、摩洛哥、沙特阿拉伯、约旦和伊拉克的卫生系统，以了解其对 PHC 的实施情况。数据是在 2018 年世界家庭医生组织东地中海区域会议的一次研讨会上收集的。学术家庭医生（FP）介绍了他们的国家；使用世界家庭医生组织的 11 张幻灯片框架，提出了国家人口统计数据、主要健康挑战以及 PHC 在卫生系统中的地位等问题。这六个国家的人口健康状况有了显著改善，但目前面临着卫生融资、合格的 FP 数量较少、获取服务和官僚程序困难等挑战。主要关注点是缺乏家庭实践模式、人才流失和 FP 的移民。各国在制定连贯政策方面存在差异。重点应放在以下方面：在东地中海地区发展 PHC 模式，倡导以社区为基础的 PHC，以争取政策制定者的支持；通过 FP 专业培训和限制仅对完全培训的 FP 进行实践来加强以 PHC 为导向的卫生系统的能力建设；让社区参与进来，提高对 PHC 的理解；采用质量和认证政策，以提供更好的服务；验证转诊和随访过程；发展公私伙伴关系机制，以加强全民健康覆盖的 PHC。
