Primary Care: The First Step Toward Stronger Health Systems

Originally posted on Jeune Afrique on September 25, 2015.

Bill & Melinda Gates Foundation/Jiro Ose

The Ebola crisis laid bare major gaps in the world’s ability to deliver life-saving health services. Leaders have a responsibility to mobilize an effective response to prevent future epidemics.

This is the reason I am joining German Chancellor Angela Merkel and Norwegian Prime Minister Erna Solberg to host a high-level meeting Saturday in New York to urge increased attention to strengthening health systems and enhancing the ability to respond to global health threats. Our call, issued as the United Nations General Assembly convenes, advances a shared commitment to these goals we made earlier in the year.

Ebola caught many nations off-guard, even those that were not directly affected by the outbreak. But major lessons have been learned about what needs to happen next.

One of the great lessons of Ebola is that gaps in health systems limit more than the ability to address emergencies; indeed they are a threat to population health and sustainable development. Therefore, actions taken in response should both prevent the next crisis and address the many pervasive and daily challenges countries face.

As a first step, it is time to focus far greater attention, skill and resources on building the foundation of all well-functioning health systems: strong primary health care, a critical component of strong health systems."

When primary health care is effective, it serves as the first point of contact for citizens seeking health services. It is where people receive advice on family planning, vaccinations for their children and treatment when they get sick.

In a well-functioning health system, the health workers who deliver these services in homes and clinics are heroes who address the vast majority of a community’s health needs before they become emergencies.

Yet, in far too many places, primary health care is the weakest link in the health system. I lost my father to prostate cancer and my stepmother to breast cancer – conditions that, though often deadly, can be prevented or cured if detected early.

It is unacceptable that our children, mothers, fathers, sisters and brothers continue to die from causes that could be entirely prevented or better managed if a stronger primary health care system was in place.

As countries work to improve primary health care, as well as strengthen the entirety of their health systems, they can learn from those that have shown it is possible to make improvements.

Ethiopia’s Health Extension Programme, for example, has helped strengthen primary health care in rural areas in part by training new health workers who deliver a comprehensive package of health services to communities. The vast majority of Ethiopia's population now has access to primary health care, and the country is beginning to see notable health gains.

Additionally, Rwanda has integrated a number of disease services into primary health care and seen a more than 75 percent decrease in mortality from HIV, tuberculosis and malaria over a decade.

My own country, Ghana, has also taken significant steps to improve primary health care. In the 1990s, we launched the Community-Based Health Planning and Services (CHPS) program, which shifted facility-based primary health care to mobile, community-based care that is better able to reach everyone in need. The programme relies on specially-trained nurses, who are assigned to specific geographic areas, supported by local volunteers and community leaders, to deliver health services in people’s homes, schools and community centers.

In addition, to ensure our citizens can access health services without financial hardship, we instituted a National Health Insurance Scheme in 2003, which covers more than 95 percent of health conditions affecting families.

Of course, there are still challenges. Not all citizens in my country have access to the quality, affordable health services they deserve. Yet, we have started to see important progress.

The number of children who die before their fifth birthday has decreased over the past 15 years, by more than 30 percent. Life expectancy keeps improving as efforts to contain the spread and impact of HIV, malaria, tuberculosis and other endemic diseases bear fruit.

In New York, I am joining fellow heads of state in signing the global framework for sustainable development, which compels action in many ways – to eliminate poverty, foster peace and security, expand opportunity and ensure healthy lives for all."

I encourage my friends in government, the private sector and civil society to strengthen the delivery of primary health care as a crucial step toward sustainable development. Only then will we be able to meet our populations’ health needs, prevent the next debilitating health crisis and achieve our shared vision of sustainable development and dignity for all.