The World Health Rep evidence. The framework drew the attention of policy-makers to issues such as the cata strophic health expenditure in a number of countries. Although this report does not directly apply the framework, it assumes that policy-makers will use this and other relevant tools to measure the success of an approach to health systems scale-up based on primary health care Valuable knowledge has been gained in recent years about how health systems work and why they fail. Initiatives such as the European Observatory on Health Care Systems are producing important insights(see Box 7.1), though fundamental questions remain unresolved. This report does not propose a complete model of the development of health systems based on primary health care, which would be impossible given the current state of evidence. The aim is to open lines of enquiry that will be of use to countries and international health partners as they weigh options and take action to strengthen systems, making them responsive to the needs and demands of all, especially the poor. The core principles of primary health care Primary health care became a core policy for WHO in 1978, with the adoption of the Decla ration of Alma-Ata and the strategy of"Health for all by the year 2000". Twenty-five years later, international support for the values of primary health care remains strong. Preliminary results of a major review suggest that many in the global health community consider a pri- mary health care orientation to be crucial for equitable progress in health(2) No uniform, universally applicable definition of primary health care exists. Ambiguities were present in the Alma-Ata document, in which the concept was discussed as both a level of care and an overall approach to health policy and service provision. In high-income and middle- income countries, primary health care is mainly understood to be the first level of care. In low-income countries where significant challenges in access to health care persist, it is seen more as a system-wide strategy. Box 7.1 The European Observatory on Health Care Systems Countries in the European Region-diverse in terms of language, his- set of questions and uses clear definitions to create a baseline of infor tory and wealth -have an array of approaches to the organization of mation, drawing attention to what is distinct about a particular country health systems. The European Observatory on Health Care Systems and The Observatory covers the whole European Region and some addi olicies seeks to disseminate information on more than a decade of tional OECD countries, to allow systematic comparisons and the review change, analysing the reforms and generating evidence on what works of reforms over time. in different contexts and why. It ensures that Europe's national policy Analysis. The Observatory produces comprehensive studies on key makers can set their own experiences in the European context and make health system and policy areas, including hospitals, funding, regulation, comparisons across borders, draw on thematic and comparative analy- European enlargement, social health insurance, purchasing, primary care, sis of the key challenges they face, and have access to clear, practical pharmaceuticals, mental health, human resources, and targets. It uses evidence secondary or meta-analytical research, bringing together experts from The Observatory is a partnership that brings together the WHo across Europe to synthesize existing findings, to work country experi- Regional Office for Europe, governments(Greece, Norway and Spain), ences into a conceptual framework and to draw out practical lessons international and nongovernmental agencies (the European Investment and options Bank, the Open Society Institute, and the World Bank) and academia Dissemination. Engaging with policy-makers and their advisers (the London School of Economics and Political Science and the London helps ensure they can use the information and analyses generated. The School of Hygiene and Tropical Medicine). All the Observatorys materi- Observatory runs seminars and workshops for small groups of high level ls are available on its web site I policy-makers, often in partnership with agencies supporting health Information and monitoring. The Health System in Transition tem and policy reform, on matters such as funding options, the implica- series of 70 country profiles provides analytical answers to a standard tions of EU accession for new Member States, or equity Iwww.observatory.dk.106 The World Health Report 2003 evidence. The framework drew the attention of policy-makers to issues such as the cata￾strophic health expenditure in a number of countries. Although this report does not directly apply the framework, it assumes that policy-makers will use this and other relevant tools to measure the success of an approach to health systems scale-up based on primary health care. Valuable knowledge has been gained in recent years about how health systems work and why they fail. Initiatives such as the European Observatory on Health Care Systems are producing important insights (see Box 7.1), though fundamental questions remain unresolved. This report does not propose a complete model of the development of health systems based on primary health care, which would be impossible given the current state of evidence. The aim is to open lines of enquiry that will be of use to countries and international health partners as they weigh options and take action to strengthen systems, making them responsive to the needs and demands of all, especially the poor. The core principles of primary health care Primary health care became a core policy for WHO in 1978, with the adoption of the Decla￾ration of Alma-Ata and the strategy of “Health for all by the year 2000”. Twenty-five years later, international support for the values of primary health care remains strong. Preliminary results of a major review suggest that many in the global health community consider a pri￾mary health care orientation to be crucial for equitable progress in health (2). No uniform, universally applicable definition of primary health care exists. Ambiguities were present in the Alma-Ata document, in which the concept was discussed as both a level of care and an overall approach to health policy and service provision. In high-income and middle￾income countries, primary health care is mainly understood to be the first level of care. In low-income countries where significant challenges in access to health care persist, it is seen more as a system-wide strategy. Box 7.1 The European Observatory on Health Care Systems Countries in the European Region – diverse in terms of language, his￾tory and wealth – have an array of approaches to the organization of health systems. The European Observatory on Health Care Systems and policies seeks to disseminate information on more than a decade of change, analysing the reforms and generating evidence on what works in different contexts and why. It ensures that Europe’s national policy￾makers can set their own experiences in the European context and make comparisons across borders, draw on thematic and comparative analy￾sis of the key challenges they face, and have access to clear, practical evidence. The Observatory is a partnership that brings together the WHO Regional Office for Europe, governments (Greece, Norway and Spain), international and nongovernmental agencies (the European Investment Bank, the Open Society Institute, and the World Bank) and academia (the London School of Economics and Political Science and the London School of Hygiene and Tropical Medicine). All the Observatory’s materi￾als are available on its web site.1 Information and monitoring. The Health System in Transition series of 70 country profiles provides analytical answers to a standard set of questions and uses clear definitions to create a baseline of infor￾mation, drawing attention to what is distinct about a particular country. The Observatory covers the whole European Region and some addi￾tional OECD countries, to allow systematic comparisons and the review of reforms over time. Analysis. The Observatory produces comprehensive studies on key health system and policy areas, including hospitals, funding, regulation, European enlargement, social health insurance, purchasing, primary care, pharmaceuticals, mental health, human resources, and targets. It uses secondary or meta-analytical research, bringing together experts from across Europe to synthesize existing findings, to work country experi￾ences into a conceptual framework and to draw out practical lessons and options. Dissemination. Engaging with policy-makers and their advisers helps ensure they can use the information and analyses generated. The Observatory runs seminars and workshops for small groups of high level policy-makers, often in partnership with agencies supporting health sys￾tem and policy reform, on matters such as funding options, the implica￾tions of EU accession for new Member States, or equity. 1 www.observatory.dk