The Astana Declaration on Primary Healthcare in 2018 was the attempt to revive the ideals of the World Health Organization (WHO) Alma-Ata Declaration 40 years later, together with a call for the political will to provide adequate financing at acceptable quality of care. This approach is taken to achieve the past ideals of Health for All, given the new challenges of universal health coverage. The economic case for Primary Healthcare is justified against the growing demand due in part to the growing costs of chronic conditions and the rise of ageing population, other than the supply-side factors of the Healthcare industry. Past Healthcare systems have evolved greater roles of the state versus the market, but few have involved the Third Sector or civil society in more integrated ways to provide and finance long-term care (LTC) with population ageing. From the extremes of the communist state to capitalist free markets, an optimal public-private system has to reach a balance in access, cost and quality for health and LTC. Recent studies of health and LTC have distilled newer developments in public-private mixes of provision, financing and regulation, in response to the needs of fast-ageing Asian societies. While Japan was the oldest country in the world, other countries in Asia have caught up and are now acknowledged where innovative models of integrated eldercare under economic limits, hold great promise of their transferability to the rest of ageing societies. Besides other forms of integrated LTC delivery with traditional systems, newer forms of financing like savings funds and superannuation have been developed, with participation from government, industry and civil society. There is much to learn from the new Asian models of financing, using appropriate technology and social innovations, and integrating health and social systems for LTC.

Background and purpose: Due to the important role of emergencies and accidents as mainspring of mortality and morbidity, providing emergency services must be taken into account at all levels of health system. The aim of this study was to investigate the perspectives of Healthcare providers on providing prehospital emergency services and its challenges in Primary Healthcare levels in Golestan Province, northern Iran. Materials and Methods: The researchers conducted 31 interviews totally (n=21 community health workers and n=10 family physicians) using semi-structured and in-depth interviews in Golestan Province, north of Iran in the year 2014. All interviews were digitally recorded and transcribed. The collected data was then analyzed through qualitative content analysis. Results: In total, three categories were identified related to emergency services in the Primary Healthcare system, including 1) Different status of providing Primary preventive and emergency care in Primary Healthcare levels, 2) Need to develop the emergency services in health houses, and 3) Challenges of providing appropriate emergency services in the Primary levels of Healthcare system, such as lack of physical and human resources, weakness in monitoring and education system, inadequate skills, motivation in health team, heavy workload, and insufficient cooperation with other related organizations. Conclusion: The Primary levels of Healthcare system were not properly serviced in emergencies. They were also faced with numerous challenges that necessitate health policy makers to plan for promoting and providing required services at this level of Healthcare system.

Background: In planning for universal health coverage, many countries have been examining their fiscal decentralization policies with the goal of increasing efficiency and equity via “ additionalities. ” The concept of “ additionality, ” when the government of a lower administrative level increases the funding allocated to a particular issue when extra funds are present, is often used in these contexts. Although the definition of “ additionality” can be used more broadly, for the purposes of this paper we focus narrowly on the additional allocation of Primary Healthcare expenditures. This paper explores this idea by examining the impact of central level Primary Healthcare expenditure, on individual state level contributions to Primary Healthcare expenditure within 16 Indian states between 2005 and 2013. Methods: In examining 5 main variables, we compared differences between government expenditures, contributions, and revenues for Empowered Action Group (EAG) states, and non-EAG states. EAG states are normally larger states that have weaker public health infrastructure and hence qualify for additional funding. Finally, using a model that captured the quantity of central level Primary Healthcare expenditure distributions to these states, we measured its impact on each state’ s own contributions to Primary Healthcare spending. Results: Our results show that, at the state level, growth in per capita central level Primary Healthcare expenditure has increased by 110% from 2005-2013, while state’ s own contributions to Primary Healthcare expenditure per capita increased by 32%. Further analyses show that a 1% change disbursement from the central level leads to a-0. 132%, although not significant, change by states in their own expenditure. The effect for wealthier states is-0. 151% and significant and for poorer states the effect is smaller at-0. 096% and not significant. Conclusion: This analysis suggests that increases in central level Primary Healthcare expenditure to states have an inverse relationship with Primary Healthcare expenditures by the state level. Furthermore, this effect is more pronounced in wealthier Indian states. This finding has policy implications on India’ s decision to increase block grants to states in place of targeted program expenditures.

The integration of emergency psychiatric care into basic Healthcare services must be given top priority due to the continued prevalence of mental health disorders as a major public health concern. Improving the effectiveness and accessibility of mental health interventions is crucial, especially in Primary care settings. Mental illnesses continue to rank among the top ten global causes of burden; they cause 16% of Disability-Adjusted Life Years (DALYs) worldwide, and their economic costs are projected to be around USD 5 trillion. 1 The National health survey by the Indonesian government presented in 2018 in Indonesia revealed that the cases of Severe Mental Disorders (SMD) were 7 per 1000 population or a total of 1.6 million individuals. 2 Among the individuals with SMD, 15.1% have not sought treatment, and 48.9% of those WHO are taking medication do not adhere to their medication regimen. The high number of SMD cases is not matched by easy access to Healthcare services. 2 This is evident from the high treatment gap in mental health issues, which exceeds 90%, indicating that fewer than 10% of mental disorder cases receive standard management. Primary Healthcare providers play a key role in the early detection and crisis management of mental health issues, but the lack of resources and specialized training poses a significant challenge. 3 There is an urgent need to establish protocols and training programs that enable Primary Healthcare practitioners to identify and address mental health crises effectively. This involves the development of standardized assessment tools, enhancing collaboration with mental health specialists, and ensuring access to crisis intervention resources. By incorporating emergency psychiatric care into the Primary Healthcare setting, 4 we can reduce the stigma associated with mental health issues and facilitate a more holistic approach to Healthcare. Furthermore, addressing emergency psychiatric care in the Primary Healthcare setting can contribute to early intervention, preventing the escalation of mental health crises, and reducing the burden on emergency departments. 5 , 6 This shift towards a more comprehensive and integrated approach is in the same line with the overarching goal of achieving equality between mental and physical Healthcare. In conclusion, addressing the integration of emergency psychiatric care into basic Healthcare services is necessary to tackle the growing burden of mental health disorders in Indonesia. To effectively address this issue, policymakers, Healthcare organizations, and professionals should prioritize several key recommendations. Firstly, Indonesian policymakers need to prioritize mental health in national Healthcare agendas by allocating adequate resources and developing policies that promote the integration of emergency psychiatric care into Primary Healthcare services. This proactive approach will ensure that mental health receives encompass the attention and resources it deserves within the Healthcare system. Secondly, there is a crucial need to invest in training programs for Primary Healthcare practitioners. These programs should focus on enhancing their capacity to identify, assess, and manage mental health crises effectively. Specialized training in mental health assessment and crisis intervention techniques will better equip Healthcare providers to respond to the needs of individuals experiencing mental health emergencies. Moreover, collaboration between Primary Healthcare providers and mental health specialists should be strengthened. This collaboration will ensure timely access to specialized care and resources for individuals in crisis. Adequate funding should be allocated to support the integration of emergency psychiatric care services into existing Healthcare systems. By implementing these recommendations, Indonesia can take significant strides toward improving access to emergency psychiatric care and addressing the mental health needs of its population.