From the promising Canadian community health centres to the non-communicable diseases alliance global agenda: horizontal versus vertical developments!

In the week that the worlds’ most famous expert in the domain of primary care and equity, Professor Barbara Starfield, passed away (and we felt sad about this loss) delegates from around the world, including Europe represented by the EFPC, gathered in Toronto from 9–10 June 2011 for two days of presentations, workshops, networking sessions and local tours exploring innovations in community-based primary health care.

Professor Jan De Maeseneer, Chair of the EFPC, joined a series of morning and afternoon plenary speakers to address key issues in building effective health systems around the world. He discussed the global movement for community-oriented primary health care, and the central role of community health centres. Other renowned speakers followed.

Furthermore, the EFPC organized workshops showing primary care innovations from Sweden (the role of Community-Oriented Health Centres in the Västra Götaland region) and Belgium (Maisons Médicales in Wallonia and Community Health Centres in Flanders).

One week later, UN General Assembly President Mr. Joseph Deiss organized an informal interactive hearing in New York about Non-Communicable Diseases (NCDs) with non-governmental organizations, civil society organizations, the private sector and academia. The outcomes of the hearing provide input for the meeting of the UN General Assembly on the prevention and control of NCDs, which will be held on 19–20 September 2011 in New York.

The EFPC provided the only answer to the challenge of NCDs (see World Health Report 2008): investing in strengthening primary health care (including nurses, midlevel care workers, family physicians, health educationalists, health promoters) and integrating person- and community-oriented care (1). Emphasis should be put on training primary health care workers: 50% of all graduates in health care professionals’ education should be trained for primary health care. Inspiration can be found in the Primafamed-network (http://www.primafamed.ugent.be), which is very active in training family physicians and other health care workers for strengthening primary health care in Africa.

This all backed up by Dr Margaret Chan at her closing remarks during the latest World Health Assembly in May this year:

“The rise of chronic non-communicable diseases, which you also discussed, adds tremendous urgency to the agenda for building stronger health systems. It is good that you adopted a resolution on non-communicable diseases as we strengthen our positions ahead of the major event in September. Of course we need population-wide preventive measures for NCDs, developed with other sectors, but we also need to help individual people. We need to detect early, treat, manage complications, and often provide prolonged or even life-long care. It is my strong view that primary health care is truly the only efficient and effective way to do so.“

We have no doubt that the new global health sector strategy on HIV/AIDS, which calls for greater integration with existing services, will also contribute to health system strengthening. We are at an important moment of reflection and re-orientation: we can avoid re-making the mistakes we did with the vertical approach to infectious diseases (with the best intentions, no doubt about that). Time has come to take the WHA Resolution “Primary Health Care, including health system strengthening” into practice to encourage that vertical programmes, including disease-specific programs, are developed, integrated and implemented in the context of integrated primary health care.