Moosa Shabir
African Forum for Primary Health Care, Johannesburg, South Africa.
Department of Family Medicine and Primary Care, University of Witwatersrand, Johannesburg, South Africa.
Risk Manag Healthc Policy. 2023 Sep 27;16:1999-2017. doi: 10.2147/RMHP.S392454. eCollection 2023.
The primary health care (PHC) system in Africa faces many 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. 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 Resources do not appropriately or adequately reach the frontline PHC service platform due to outdated service delivery and payment models. Patients experience PHC 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. However, opportunities abound with global PHC milestones, increasing political will for investment in PHC, and proven mechanisms for achieving a stronger workforce such as community health workers, clinical task-sharing, and the integration of family doctors into PHC. The African Forum for PHC (AfroPHC) has a vision for PHC and UHC that is team-based 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. AfroPHC is making a call on stakeholders to develop and implement a regional forward-looking plan to 1) build robust PHC systems, 2) train, recruit and maintain a sufficient frontline PHC workforce, and 3) support PHC with appropriate financing. This can all come together easily in a nationally defined PHC contract using risk-adjusted blended capitation payment to decentralised PHC teams empanelled to enrolled populations, coordinated by district health services and easily administered at national or sub-national level for empowered public and private providers.
非洲的初级卫生保健（PHC）系统面临诸多挑战与机遇。迄今为止，初级卫生保健领域的卫生人力资源数量严重不足，分布往往低效且不均衡，缺乏提供全面响应式一线护理的充分培训，并且在卫生系统内受到不公平对待。医疗保健领域的关键角色之间缺乏团结协作，无法在非洲创造足够的初级卫生保健资金。由于服务提供和支付模式过时，资源无法适当地或充分地到达初级卫生保健一线服务平台。患者体验到的初级卫生保健是排队等待，缺乏全面性、连续性和协调性。卫生工作者在官僚体系中也被当作数字对待，这种体系割裂并破坏了围绕患者和人群需求的综合护理培训与服务。然而，随着全球初级卫生保健里程碑的出现、对初级卫生保健投资的政治意愿增强，以及实现更强大劳动力队伍的已证实机制，如社区卫生工作者、临床任务分担以及将家庭医生纳入初级卫生保健，机遇也大量涌现。非洲初级卫生保健论坛（AfroPHC）对初级卫生保健和全民健康覆盖有着基于团队的愿景，其技能组合适合非洲，包括家庭医生、家庭执业护士、临床干事、社区卫生工作者以及其他有能力在高质量的以患者为中心的初级卫生保健中照顾参保人群的人员。非洲初级卫生保健论坛呼吁利益相关者制定并实施一项区域前瞻性计划，以1）建立强大的初级卫生保健系统，2）培训、招募和维持足够的初级卫生保健一线劳动力，以及3）通过适当的融资支持初级卫生保健。这一切可以通过一份国家定义的初级卫生保健合同轻松实现，该合同采用风险调整后的混合按人头付费方式，支付给为参保人群服务的分散式初级卫生保健团队，由地区卫生服务协调，并在国家或国家以下层面易于管理，以赋予公共和私立提供者权力。
