Quality frameworks are necessary, she said, because frameworks articulate knowledge and priorities. They define quality, they guide measurement, and they provide a common language for improvement. But frameworks are not enough. Without improvement, measurement is simply an exercise.
Dr Jim Campbell, Director of Health Workforce at WHO, discussed some of the key issues around health workforce in the context of PHC. In particular, he spoke to the need to provide decent labour conditions for health workers at all levels of the community. We are seeing in a large number of countries people across the health care system experiencing burnout, stress and anxiety – mental health issues in the very people who are meant to provide mental health services to others. And these are not so much occupational issues as they are people issues.
Nothing succeeds as a concept; it is action that is required in order to create, and maintain, quality. In short, quality is a journey, one in which the goalposts are always shifting.
Climate change is putting at risk the three fundamental pillars of health -nutrition, shelter, and access to water. As just one example, natural disasters destroy crops, destroy people’s homes and can contaminate safe sources of water. This can lead to malnutrition, water-borne diseases, and other health issues. It can also lead to massive migration Another example is air pollution –of the 12.6 million preventable deaths linked to climate change each year, 7 million of them are the result of exposure to air pollution.
Whether it is an Increase in the incidence of asthma, increased mental illness resulting from migration, increases in vector-borne diseases –all of these are having a direct impact on health care providers. As a result, there is a greater need for health services at the same time that the health care infrastructure needed to provide those services is being severely impacted.
So what should PHC professionals do in the face of such challenges? Dr Neira spoke of two separate avenues of action: climate change adaptation and climate change mitigation.
Climate change adaptation is a term used by the environmental community to describe actions that, in public health, are known as secondary prevention. In other words, prepare and take steps to cope. It is about building the resilience of health care facilities and developing their abilities to cope with the changes in disease burden, such as increased cases of malaria or asthma, greater burden of mental illness resulting from forced migration, etc.
It means also putting in place increased surveillance to monitor and report on changing disease burdens, and creating a linkage between public health governance and meteorological authorities to be able to better understand the overall impact on the population.