“ensuring Coverage: Strategies For Health Insurance Approval And Claims In Australia” – The Covid-19 pandemic has highlighted the importance of resilient health systems, rooted in the delivery of primary care at the community level, for the detection and response of epidemics. Some countries that prioritized the delivery of primary health care (PHC) – by involving the community in the design of health programmes; ensuring high-quality training and professional development for health workers; and collecting data to analyze trends and improve services prior to the pandemic – have made it possible to focus on maintaining services for essential health programs during a prolonged period of crisis. At the same time, countries that had previously prioritized the delivery of PHC have also been able to turn to providing additional services that allow populations to meet pandemic-related health needs, both in the diagnosis and treatment of Covid-19 infections and in the delivery of Covid-19 – vaccine.
Elements of strong PHC that have served populations well during the pandemic include routine immunization programs for children; a focus on collecting and analyzing data to improve service quality at the local level; a role for community health workers in educating about, monitoring and reporting outbreaks; and an emphasis on equitable access to affordable and high-quality health services. The rapid scale-up of Covid-19 vaccination programs for adults, together with new efforts to collect, track and integrate data on respiratory infections into existing health data platforms, now offers an opportunity to reach older patients regarding PHC and improve surveillance of services to ensure quality of care.
“ensuring Coverage: Strategies For Health Insurance Approval And Claims In Australia”
Above all, experts increasingly recognize that high-quality PHC helps build the population’s trust in the health sector and contributes to the resilience of the overall health system. Given the important role PHC has played in shaping countries’ responses to Covid-19, taking steps now to support countries in prioritizing PHC can help ensure continuity of health services and a more effective, community-centred outbreak response in future health crises and pandemics.
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According to the World Health Organization and UNICEF, primary healthcare is a whole society approach to health which aims to ensure the highest possible level of health and well-being.
PHC is related to primary care but differs in a few important ways. PHC services are rooted in a commitment to equity and include everything from health promotion and disease prevention to treatment, rehabilitation and palliative care, while primary care typically refers to medical management of disease or health conditions. PHC and primary care are both distinguished from secondary care, which refers to specialized health care, and differently from tertiary care, which refers to the provision of more advanced health services in a hospital.
The PHC concept gained traction in the 1970s at a global conference in the former Soviet Union, where national delegations adopted the Declaration of Alma-Ata. At that session, participants defined PHC as “the first level of contact of individuals, the family and the community with the national health system that brings health care as close as possible to where people live and work” and marked it as a means to achieve the goal of providing “health for all.”
Forty years later, the world community reconvened in Kazakhstan to assess progress in achieving the vision of accessible, equitable and affordable healthcare. The 2018 Astana Declaration both affirmed the importance of PHC in the quest to secure “health for all” and recognized the critical role PHC can play in promoting health security by strengthening communities’ capabilities to detect disease outbreaks and to respond.
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PHC is closely linked to the goal of universal health coverage (UHC), which the WHO defines as a situation in which “all people have access to the health services they need . . . without the risk of financial difficulties in paying for them for them.” UHC is a key focus of the Sustainable Development Goals, in which goal 3.8 emphasizes the importance of “protection from financial risk, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” When global health advocates, national leaders and health officials gathered for the 2019 UN high-level meeting on universal health coverage, they issued a policy statement that pointed to PHC as the key means of to ensure a population’s access to a set of basic services while reducing the risk of catastrophic health expenditure by the target date of 2030.
The UHC framework defines essential services as those related to child health, reproductive health, malaria, tuberculosis, HIV, and non-communicable diseases, such as mental health. It prioritizes preventive services, such as immunizations and regular check-ups, and the provision of high-quality care by well-trained staff. While a country’s approach to UHC depends on available resources, national priorities and existing programs, there is always an element of public funding for health services through payroll or general taxes and an emphasis on insurance or pooled spending schemes to cover the cost of care to cover The WHO and the World Bank track countries’ progress towards UHC through the Service Coverage Index, which uses household and other survey data to measure people’s ability to access a set of 16 essential services, which include PHC .
Recent analyzes have shown that the delivery of preventive care and treatment services through the PHC framework can be both cost-effective and health-promoting. PHC includes health services such as nutrition; the provision of water, sanitation and hygiene (WASH); public education regarding health; community involvement in the design and monitoring of health services; maternal and child health; routine immunizations; control of infectious diseases; and the management of chronic, non-communicable diseases.
How to measure countries’ financial and political commitments to PHC, as well as their success in reaching people with PHC services, is a question that has attracted global attention and generated much debate in recent years. Not all countries track public spending on PHC in the same way, and there are chronological gaps in country reporting on some of the most recognized indicators, making it difficult to compare countries’ progress over time. Organizations such as the Primary Health Care Performance Initiative, the Joint Learning Network for Universal Health Coverage, and Ariadne Labs, among others, work closely with countries to support their efforts to finance, govern, and evaluate progress in ensuring access from people to PHC.
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Countries have taken several different approaches to ensure that their populations have access to the benefits that the PHC framework has to offer:
In the 1990s, recognizing that more than two-thirds of the national population lived a significant distance from a health facility, Ghana began implementing the Community Health Planning and Strategy (CHPS) program, placing health posts throughout the country. Staffed by a nurse and trained volunteers, each CHPS compound serves 4,500-5,000 people and provides the population in its catchment area with access to family planning supplies, oral rehydration services, and immunizations, among other services. Thanks to a slow rollout of the program and careful analysis of local level data on health attitudes, the Ghana Health Service, which oversees the CHPS program, has prioritized the active involvement of people who using the health system to ensure alignment of health services. with social needs and values. It places a high value on educating users about health and the health system, as well as seeking community input regarding program design to improve health outcomes.
To help finance services provided by the CHPS compounds, Ghana created the National Health Insurance Scheme (NHIS) (NHIS) in 2003, which is funded by the proceeds of a 2.5 percent levy on luxury goods such as payroll taxes and premiums paid by people working in the informal sector. Health services for young children, pregnant women, the elderly and the needy are provided free of charge, and these populations are exempt from paying such premiums. Roughly half of the more than 30 million people living in Ghana are enrolled in the insurance scheme. The NHIS benefits package covers the most common health conditions seen at health facilities, and patients can search for services at a number of different sites, including CHPS posts.
Regardless of where patients ultimately receive care, however, they must first visit a primary provider before being referred to a higher-level clinic. Careful collection of data from clinics, community education and user feedback has enabled Ghana to identify ongoing challenges, including low service coverage, despite the fact that nearly three-quarters of health funding is channeled to PHC services.
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In the early stages of the pandemic, Ghana prioritized protecting health workers and developing back-up teams, in case health workers fell ill or were exposed to Covid-19, to ensure continuity of services. By working to improve the CHPS and NHIS models and protect those providing health care, Ghana has maintained high child immunization rates and maternal and child health maintenance services during Covid-19. Health workers also contribute to the delivery of Covid-19 vaccines. By the end of March 2022, more than 9 million adults in Ghana have received at least one dose of vaccine. Compared to other lower-middle-income countries, Ghana has experienced a lower rate of Covid-19 cases and deaths per million since the pandemic began.
Investment in the recruitment, training and continued career development of a cadre of community-based health workers has been a key element in the transformation of Vietnam’s health profile over the past several decades. While all health care was provided free of charge in the 1970s, in the mid-1980s, when Vietnam’s economy underwent a period of
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