INTERNATIONAL CONFERENCE ON THE PRIMARY CARE OF HEALTH AND THE SYSTEMS OF HEALTH IN AFRICA: TOWARDS THE REALIZATION OF THE OBJECTIVES OF THE MILLENNIUM FOR DEVELOPMENT LINKED TO HEALTH OUAGADOUGOU OF 28 - APRIL 30TH, 2008E. ALIHONOU

Introduction The benefits of service are an essential function of the systems of health. They allow to satisfy the needs of populations. To provide services includes: for the contractor the obligation to assure activity, for the State and the society, necessity to guarantee continuity notably for urgent care.In Africa, credit of the services of care which fulfill these 2 conditions: the obligation to be provided, regularity and continuity in the const provisioning

The services of health constitute an investment competing not only to the productiveness of a country, but still to the social stability which the country needs to develop from all points of view.

It is a serious breach of the system of health when efficient services at accessible expense do not touch the populations which should benefit from it.Introduction 2

Plan of prsentationAccount will be subdivided into 3 big parties:

1.Party dedicated to considerations of general order

2 Party dedicated to tries of answer to purposes defined for Conference:. Identification of the essential interventions to be put in the ladder for the attack of OMD and definition of ways and means to implement these interventions in a integrated way,Of the level of use of the services of health which allows to attain OMD Prop

General considerations on the benefits of service 1

General considerations on the benefits of service 2

Indirect benefits 1Existence of a policy of health and an institutional frame of regulations applied:

Training of the health workers

Financing of program

Management

Indirect benefits 2 v) Operational research on services

vi) Activities related to: these are Generative activities of incomes

Strategical alliance with the others areas of development (services of agriculture, education, communication, public works).

vii) Collaboration / collaboration at national and international level

In total, qualified personnel indirect benefits or environment "capacitance enabling environment = Assistance qualifie/soins comptitive / Quality benefits

1.2.-DIFFERENT TYPES OF BENEFITS OF SERVICE 2Benefits according to the nature of careRole of the system of health

1-to preserve health by following benefits:

Promotional care (Education for a change of behavior)

Precautionary care (vaccination, service of screening, treatment of complications

Role of the system of health 22-to Restore health / care remedial and precautionary care (secondary prevention

3-to Favor the readjustment by radaptatifs care

4-to Lighten suffering / re-establishment impossible health / palliative care.

Performance of care according to the place or the level of the system of health: Care in establishment: centre of health / hospital: basic care, secondary care, care service sectors, ambulant careCare except establishment: care individual, at the level of the family, at the level of community1.2.-DIFFERENT TYPES OF BENEFITS OF SERVICE 3

Process of identification, implementation and valuation of the benefits of service1-Conceptualization, Planning Identification of needs / problems // disease = AsksDetermination of priority problemsElaboration of plans

2-Execution of activities3-Valuation General considerations on the benefits of service 3

The actors Contractors and users of services-Level (i): family / health workers of health of family

- Level (ii) :community: Communautaires/relais -Community health workers

- Level (iii) :centers of health / hospitals: health workers, team of health / clerical assistants of supportGeneral considerations on the benefits of service 4

1.7.1 Decentralization of the services of healthCreation of new fixed centers: where people come to accept care (fixed strategy) Mobile units: are taken in villages in a punctual way for specific interventions as PEVAdvanced strategy: regular sessions in villages, carried out by the team of the centre of health / strategy and active screeningActive screeningVisits at home / home of the target populationsGeneral considerations on the benefits of service 5

Strategies of performance of services 21.7.1. Incorporation of services

1.7.2. Draft of community / Community Participation

1.7.3. Use AVS / Intermediary communications

Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions2.1. Identified diseases (AFRICAN WHOPicture: Packet of essential activities of health for the countries of Africa

PROGRAMMEPRINCIPLE INTERVENTIONSVIH/SIDAReinforce screening and education Optimize the contribution of the area of health in the prevention of the HIV

Speed up passage in the ladder treatments and care of the HIV / AIDS

Speed up passage on the scale of the interventions of prevention of transmission mother-child

Security blood transfusion

Invest in strategical information to orientate a more efficient answer

Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 2

2.1. Identified diseases (AFRICAN WHO)Picture: Packet of essential activities of health for the countries of Africa

TuberculosisSpread the treatment of short length under direct observation (DOWERS)Ameliorate the quality of the services of the laboratories of diagnosisPrevention and treatment of the bacilli Resist to several medicamentsActivities of collaboration for the bacillus oftuberculosis and virus of the acquired immune deficiency syndrome

Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 32.1. Identified diseases (AFRICAN WHO)Picture: Packet of essential activities of health for the countries of Africa

PaludismBe taken to the ladder for the treatment of cases with paludal anti of quality at accessible expense

Promote the access to the impregnated mosquito nets and for the vulnerable groups

Be taken to the ladder in paludal prevention for interventions to the gestante

- Reinforce the systems of alert and answer for the paludal endmie

Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 42.1. Identified diseases (AFRICAN WHO)

Picture: Packet of essential activities of health for the countries of Africa

PROGRAMMEMAIN INTERVENTIONSMaternal healthAmeliorate the benefits of service, the access to the care of neonatal and maternal health, quality including the services of family planning

SONU (Obstetrical Care and No Nataux of emergency)

- Reinforce the reference system and against reference

Identification des interventions essentielles/ mise lchelle/ atteinte des OMD/ voies et moyens/intgration interventions 52.1. Affections identifies (OMS AFRO)

Tableau : Paquet dactivits de sant essentielles pour les pays dAfrique

Health of the child and the TeenagerInfantile Taken care inserted by the common diseases, the treatment of care to the children displayed and infected by the HIV

Care in the new - born

Immunization of the mothers and the childrenNutrition, feeding of the child and the young personFeeding of the child and the young person including nutriments, supplementation and screening

Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 62.1. Diseases identified (AFRICAN WHO)

Picture: Packet of essential activities of health for the countries of Africa

Not transmissible diseases:

Mental diseases,

Diabetes

High blood pressure,

OthersImplementation

Passage on the scale of efforts of primary prevention targeting all factors of major risk

National programs of not transmissible diseases in all including countries health buccale, sickle cell anemia, mental health and traumatismTo follow

Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 7

Not transmissible diseases: Mental diseases, Diabetes, Diseases cardiovascular, Tobacco addiction OthersResearch on the socioeconomic impact of not transmissible diseases to put grandiloquence on multistructure approach

Passage on the scale of secondary prevention and service sector of all including transmissible diseases the taking care of the disabled person and mental health

Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 82.1. Identified diseases (AFRICAN WHO)

Picture: Packet of essential activities of health for the countries of Africa

Surveillance of illnessAnd epidemiological answerExtension to all institutions of health in every region

To reinforce the surveillance of the collection of data and the usage of information to act at level centers region of health and at level

Establish and form the team of quick answer

- To lead a supervision formative and orientate the personnel of the centre of health Strengthening of the systems of health and the promotion of health as transverse activities composing passage in the ladder

1.Passage in the ladder ways and means / incorporation of interventionsTwo Levels: Decision-making Level and operational Level Political decision in the most of high levelApproach system, Approach SSP, Approach SWAPFinancing: institute national self-sufficiency at the farthest: produce all necessary means as many as possible to face up needs (WHO):Health insurance: mutual insurance company of health.Identification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 9

Passage in the ladder ways and means / incorporation of interventions 2Operational levelIncorporations of acts: health centers polyvalent, care to the adults, to the mothers and to the childrenof the polyvalent personnel and specialist (training) Incorporations of functions of support (indirect Activities):Decentralization (Zone of health or region of health)CoordinationCommunity participationIdentification of essential interventions / bets in the ladder / attack of OMD / ways and means / incorporation interventions 10

1-Taken into account by the determiners of the coverageModel TANAHASHI 2-Improvement of services / performance / effectiveness output 3-Use of tools / rationalization of services: Definition norms / standards Care / level of scientific proof Strategies Following training of the personnel (change of curricula and mode of training)Level of use of services / Attack of OMD linked to health 1

Strategies (suite and at the end)Incorporation of services: - to resolve the problem of geographical accessibility - to reduce expenses - better coordination of activities between the hospital and the care of the community. Integrated services: - individuals and communities better meet needs - bigger convenience for the expert, more augmented contentment, user Insert the services of community development

1-Taken into account by the determiners of the coverage: Model TANAHASHILevel of use of services / Attack of OMD linked to health 2

Level of use of services / Attack of OMD linked to health 2DETERMINANTS DE LA COUVERTURE

Couverture effective (SRO utilis rgulirement et 20 %correctement quant la dilution et la quantit).

Couverture adquate(SRO utilis pour chaque 25 %pisode de diarrhe).

Utilisation(utilisation dans au moins 30 %un cas de diarrhe)

Accessibilit 80 %(SRO domicile)

Disponibilit 90%(SRO au niveau CCS) 0 10 20 30 40 50 60 70 80 90 100%

Condition 2IMPROVEMENT OF SERVICES: answer in a optimum way at the request of care (meet needs of health, assure the quality of benefits, control expenses and assess) - Profitable approach - Create at the professional's of health, frame of mind service to the beneficiaries - The professionalism and competences of teams procreate a quality production. - Availability kindness of the personnel - Monitoring of the patientLevel of use of services / Attack of OMD linked to health 3 -

IMPROVEMENT OF SERVICESStandard / norms of servicesPurpose: A standard serves for establishing norms and establishes the level of performance requested for the getting of a desired specific result.Advantage: He assures protection the public: this last having criteria however such product they give him.He allows to identify the performance of the practitioner.Characteristics: A standard is efficient if it is: - visible, measurable, accomplishable, - if it is attained- if it is desirablequality has t

Format of standardEvery standard has 7 major elements:

- code and title, purpose / objectives - the swording of standard - result - prrquis - process and audit

Le prrquisThe essential elements which have to be in position so that the agent can carry out standard efficiently for instance: 5.1. Administrative directives5.2. The contents of the training necessary for intervention5.3. The essential equipment5.4. Structures and requested mechanisms so that standard is implementedExamples: An entirely operational reference system is in position for the weakened pregnant womenEquipment for catch of blood; of the soap, of l

4-Modalities of the benefits of service / improvement of the coverage and use of services by the most vulnerable groups 1Identification of the vulnerable groupsAt the stage of comprehension (identification of needs / request), to take into account all population and different coats which compress it. Mother and child - ethnic minorities - handicapped persons - old persons - divested persons (paupers) - displaced persons - persons / country in war

Modality of performance of service / improvement of the coverageApproach SSP: Equity Decentralization: Provide services in the places where live / work people Appropriate technologyFunctional links and provided organiques/services vulnerable groups / and other services and activities of systems of health

4-Modalities of the benefits of service / improvement of the coverage and use of services by the most vulnerable groups 2

Conclusions Without a good management efforts to ameliorate the systems of health will not succeed (26th WHA 1974)

Fundamental principle good management / choice methods adapted to available means / s to act as it / attained definite objective

Constant adaptation of benefits to the health and social needs of the population / progressive needs

Services must be spread in all coats of the population.

The privileged of the health system are always at risk of pollution by those who are not covered by the system of health.

SSP it is the key (Primary Health Care simple percentage the key "OLIKOYE Ransome Kuti"Conclusion 2