Primary Health Care: The Path to Universal Health Coverage

PAI

Originally published on the PAI blog on May 16, 2016.

Primary Health Care (PHC) is the heart and soul of medicine. It is the foundation of every health care system: the first contact and ongoing link between people and their health providers. PHC is how individuals and families connect with the health care system throughout their lives, for everything from prenatal checkups and routine immunizations to the treatment of illness and the management of chronic conditions. When PHC works, people are able to get the care they need to stay healthy. The vast majority of a community’s health needs can be met by a well-functioning primary care system.

Yet an estimated 400 million people around the world lack access to quality services at this basic level of care. Despite its crucial importance, comprehensive PHC is often the weakest link in a country’s health system: underfunded, understaffed, and deprioritized. Being unable to rely on public services forces people to seek unqualified providers and paying cash for healthcare pushes people into poverty.

Development resources tend to be concentrated on specific diseases and issues, an approach which can generate significant progress on certain fronts, yet leave the underlying health system starved for support. The result is a primary care system that is dangerously fragile and fragmented. As the Ebola crisis in West Africa exposed all too clearly, the consequences can be devastating.

If the global community is to make real headway on the ambitious health-related Sustainable Development Goals (SDGs) it is essential that we shore up this critical gap in our health systems. Building a health system that can provide access to health inputs and services for the whole population without causing financial hardship is one of the SDG targets – universal health coverage (UHC).

Before achieving universal health coverage, however, a strong primary health care system needs to be in place. "

In 1978, the World Health Organization’s Alma-Ata declaration identified primary health care as pivotal to delivering health for all. Decades of evidence show that a health system based on strong primary care delivers better health outcomes at lower cost, and can mitigate the impact of poor economic conditions on health. A 2013 review of 102 low- and middle-income countries found that greater availability of primary care services was linked to longer life expectancy, lower infant mortality, and lower under-five mortality.

PHC explicitly ensures a focus on equity, accessibility and quality of care. The concepts are key to UHC which is sometimes misinterpreted as primarily about financial risk protection. PHC is, by definition, people-focused: organized around people rather than diseases, and encompassing the full range of interventions that foster good health. PHC core functions include:

• Services are offered within people’s communities, at a price they can afford. PHC is the entry point into the health care system and the first and regular source of care for most health needs.
• PHC delivers a broad spectrum of preventive, promotive, curative and palliative care across the life-course.
• People are connected with trusted providers who address their ongoing health needs throughout their lives.
• PHC serves as a hub from which people are guided through the health system, referring patients to specialists as needed and effectively following-up to monitor health progress.

Civil society organizations (CSOs) and advocates play an important role in advancing primary health care and keep the focus on people and their needs. Community participation contributes to a PHC system that is relevant and equitable and community mobilization builds awareness about access to care. CSOs are the brokers and bridge builders among diverse stakeholders, adept at complex coordination and creating platforms for dialogue and solutions.

To increase recognition and support for PHC in the global development arena, and in particular to advocate for PHC as a foundational pillar of universal health coverage, PAI is convening the Primary Health Care Global Strategy Group (PHCGSG). The PHCGSG is a diverse group of civil society advocates and partners, with representatives from Alliance for Reproductive Health Rights, CHESTRAD International, Global Health Advocates, Kaiser Family Foundation, MamaYe Nigeria, PAI, PATH, Results, Save the Children (UK), and the White Ribbon Alliance.

We come from different sectors, but what we share is the conviction that PHC is essential—to health, to life, to the world we are all trying to build. We believe that robust PHC is the future: not only as a path to UHC, but as a sturdy foundation for development. Instead of a fragmentary landscape of “vertical” development silos, we envision a mutually reinforcing environment where interventions are fully embedded in a wide, concrete base of primary health care.

As the global development community embarks on the SDG agenda, it’s important that we start down the right path. An improved and revitalized primary health care system, combined with the financial protection afforded by universal coverage, is the surest road to health and well-being for all.

Ariana Childs Graham is the Director of the Primary Healthcare Initiative at PAI.