Primary health care and public health: foundations of universal health systems

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity [universality, accessibility and affordability]. Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable

Public-private partnership as a success factor for health systems

With few exceptions, social sectors in South Asia suffer from insufficient allocation of public resources, the prime example being the health sector. As a consequence, private facilities and services have steadily emerged to dominate the health sector, a process which took place largely in a policy vacuum with little serious attempt to evolve public-private partnerships. Equally lacking have been explicit social development goals to underpin the development of private sector participation as an essential ingredient in health reform. For example, despite supplying >80% of healthcare in Pakistan, the private sector remains mostly absent at the policy table, even while becoming indispensable in the provision of accessible, affordable and equitable services. Rationalising the private sector's role is therefore increasingly critical to health care reform. While public-private partnerships [PPP] have been legitimized at global level by the World Health Organization, and successful models have emerged in some nations, in many countries there is an urgent need to find ways to encourage genuine partnerships based on mutual recognition and trust so as to extend essential health services to meet the needs of under-served populations. This requires complementary development of a regulatory role for the public sector. We examine these issues from a South Asian perspective, with Pakistan as our primary case study. We also highlight community participation as an important dimension of PPP in health