The World Healtb Report 2008 Primary Healtb Care-Noww More Tban Ever Contents Message from the Director-General Introduction and overview tesponding to the challenges of a changing world Growing expectations for better performance From the packages of the past to the reforms of the future Four sets of PHc reforms Seizing opportunities Chapter 1. The challenges of a changing world Unequal growth, unequal outcomes Longer lives and better health, but not everywhere Adapting to new health challenge: 7 ittle anticipation and slow reactions Trends that undermine the health systems'response 11 Hospital-centrism health systems built around hospitals and specialists Fragmentation: health systems built around priority programmes alth systems left to drift towards unregulated commercialization Changing values and rising expectations 14 Care that puts people first Securing the health of communities 16 Reliable, responsive health authorities 18 PHC reforms: driven by demand Chapter 2. Advancing and sustaining universal coverage The central place of health equity in PHC Challenges in moving towards universal coverag 27 fill the availability 28 Overcoming the isolation of dispersed populations Targeted interventions to complement universal coverage mechanisms Mobilizing for health equity Increasing the visibility of health inequities reating space for civil society participation and empowermentiii Contents The World Health Report 2008 Primary Health Care – Now More Than Ever Message from the Director-General viii Introduction and Overview xi Responding to the challenges of a changing world xii Growing expectations for better performance xiii From the packages of the past to the reforms of the future xiv Four sets of PHC reforms xvi Seizing opportunities xviii Chapter 1. The challenges of a changing world 1 Unequal growth, unequal outcomes 2 Longer lives and better health, but not everywhere 2 Growth and stagnation 4 Adapting to new health challenges 7 A globalized, urbanized and ageing world 7 Little anticipation and slow reactions 9 Trends that undermine the health systems’ response 11 Hospital-centrism: health systems built around hospitals and specialists 11 Fragmentation: health systems built around priority programmes 12 Health systems left to drift towards unregulated commercialization 13 Changing values and rising expectations 14 Health equity 15 Care that puts people fi rst 16 Securing the health of communities 16 Reliable, responsive health authorities 17 Participation 18 PHC reforms: driven by demand 18 Chapter 2. Advancing and sustaining universal coverage 23 The central place of health equity in PHC 24 Moving towards universal coverage 25 Challenges in moving towards universal coverage 27 Rolling out primary-care networks to fi ll the availability gap 28 Overcoming the isolation of dispersed populations 30 Providing alternatives to unregulated commercial services 31 Targeted interventions to complement universal coverage mechanisms 32 Mobilizing for health equity 34 Increasing the visibility of health inequities 34 Creating space for civil society participation and empowerment 35