Integrated Primary Health Care
Coordinating healthcare is a major challenge for health systems around the world; but in regions with large equity gaps in social service coverage such as Latin America and the Caribbean, the challenge can seem insurmountable. Integrated primary health care is the most promising solution for overcoming this challenge and optimizing healthcare coordination, even among the most vulnerable households. Integrated primary health care services are highly effective in closing equity gaps that may exist in areas such as maternal and child health and nutrition services, infectious disease control, and chronic disease prevention and management. Over the past decade, concerns over an unfinished agenda in both maternal and child health care and infectious disease prevention and treatment- including neglected tropical diseases or NTDs - have been aggravated by the onset of a rapidly-growing epidemic of chronic noncommunicable diseases (NCDs). This has spawned renewed interest in the primary health care agenda.
Integrated primary health care programs offer patients community-oriented services, continuity of care and appropriate mechanisms for referrals and counter-referrals to higher levels of care, as needed. Within a community-oriented model, health professionals have a greater awareness and understanding of the risk factors affecting their patients, which enables them to make more accurate diagnoses, and to address the broader causes of ill-health when treating a disease. Serving as the first point of contact in an integrated system allows primary health care professionals to provide continuous service over time, reducing unnecessary procedures while improving prospects for successful treatment and management over the long term. While effective primary care may resolve most cases, primary health care services must be appropriately integrated into a network of specialized clinics and hospitals, to which patients are referred and from which they are counter-referred back to their local primary care providers.
Integrated primary health care is appropriately equipped to address specific needs throughout the life cycle, from pregnancy and birth through infancy, childhood and adolescence, into adulthood and the reproductive years; and later on, in the senior years. Thus, a child who is brought to a local clinic for growth monitoring should have her vaccination status confirmed. Likewise, a pre-diabetic patient who visits a health post for a prescription should also be screened for hypertension and referred to nutrition counseling.
Several initiatives that aim to expand primary health care services within a family-oriented framework are already in place. Early detection and treatment at the first level of care prevent deterioration of health status, disease progression and complications that may require more intensive and costly care. In Brazil, for example, it is estimated that one out of five hospitalizations for chronic diseases could have been avoided with proper early care. Integrated primary care programs are essential for improving both the financial sustainability of health systems and the population’s health status. Properly designed and implemented programs are capable of meeting the challenges posed by the demographic and epidemiological transition, and helping to set health service priorities.
The IDB works in partnership with the governments of Latin American and Caribbean countries in the design, implementation, and evaluation of integrated primary health care programs. Technical and financial assistance projects are based on diagnostics, information, and analyses that are tailor-made to each country’s needs, and backed by high-quality, up-to-date, applied evidence.
Through loans, technical cooperation, and knowledge and capacity development products, the IDB offers support to integrated primary health care projects through the following channels:
- Innovations in the models and channels of service delivery, including results-based financing, public-private partnerships, and community-based programs.
- Analysis and updating of components of priority procedures and services, including evaluation of the cost-effectiveness of available technologies.
- Incentives to increase the demand for health services, such as health components in conditional cash transfers.
- Investments in infrastructure, if justified, where gaps in coverage are greatest
- Capacity building initiatives and incentive schemes for healthcare workers, as well as information
technologysystems for referrals, counter-referrals, and health network regulation.
Overall, the IDB supports health systems in Latin America and the Caribbean in directing their efforts and investments away from a curative focus and towards a preventive, integrated primary health care model.
- Salud Mesoamerica 2015 (3:03)