Strengthening Ministries of Health for Primary Health Care

With the adoption of the Declaration of Alma-Ata and the Global Strategy for Health for All by the Year 2000, in 1978 and 1981 respectively, the primary health care (PHC) approach was endorsed by the Member States of the World Health Organization. Yet it is only by implementing the principles and strategies collectively agreed on in specific national situations that further progress can be made. In this connection, WHO has undertaken much detailed work over the past five years to help clarify the particular issues involved. This book is one step in that process of clarification. While it is recognized that changing to the PHC approach will have major implications for the organization, structure and functioning of ministries of health, little experience of or guidance on those implications is available. For that reason, WHO, in collaboration with the Danish International Development Agency, set in motion a series of meetings and workshops to examine the question of organizing ministries of health adequately for PHC. This book is the first outcome of their discussions. What lessons can be drawn from it? The main conclusion of the analysis that follows is that organizational change processes can be planned and managed to achieve desired performance. Knowledge. Technology, and skills exist for introducing organizational changes, and they can be adapted to the task of changing ministries of health to implement PHC better. Planned change strategies are not always effective, but they do offer useful perspectives on problems of innovation and organizational adaptation. Ministries of health face a wide diversity of challenges, and no single set of prescriptions fits every circumstance. General principles can be applied in a learning-by-doing process that produces organizational innovations appropriate to specific ministries of health. This publication offers general concepts rather than specific answers, for solutions are necessarily specific to the country and ministry concerned. This book is intended to stimulate exploration, not to offer answers. It presents approaches to the analysis of ministries of health, organizational options for the implementation of PHC, and some general ideas on planned processes of organizational change. These ideas are presented in a spirit of enquiry and they should be treated as points of departure: they offer food for thought for decision-makers in ministries of health, points to be debated at ministry workshops by representatives from different settings, and a first approach to the theory and practice of organizational innovation in ministries of health. The "lessons" that emerge take the form of questions rather than answers; the real lessons will be derived from the experience of ministries of health around the world in their efforts to achieve the goal of Health for All.