Expert Insight

Five ways to achieve universal health coverage faster

Universal health coverage (UHC) is a world where everyone everywhere has fair access to essential health products and services required to live a healthy life. Primary health care (PHC) is the “expressway” to making UHC a reality.

Holistic PHC systems aim to keep populations healthy by providing a complete package of health promotion and disease prevention, treatment, rehabilitation, and palliative care services. Throughout a person’s lifetime, 80 to 90% percent of the health services they need will be through PHC.

A community health worker from My Home—a key population–led social enterprise clinic in Ho Chi Minh City, Vietnam—administers a COVID-19 vaccine. The government engaged local private clinics such as My Home following recommendations made by the US Agency

To accelerate global progress toward UHC, the global community can support governments, public and private providers, and communities in five ways:

  1. Focus on people-centered care

Integrated person-centered care incorporates the needs and preferences of individuals and communities into the design of health infrastructure and services from the start. Behavioral science and human-centered design (HCD) help identify barriers to care and co-create solutions with users, resulting in health products, policies, and systems that are more inclusive and of higher quality. These innovations in care must often be encoded in policy and practice to ensure they have a sustained impact on service uptake and quality.

In India, PATH recently worked with Access Accelerated to conduct a landscape assessment to help understand barriers and facilitators to care for noncommunicable diseases and to develop priority investment areas for more accessible, higher-quality care. In Vietnam, communities championed a partnership with a local grocery store chain to allow easy access to hypertension and diabetes screening while shopping, bringing health care services closer to people’s everyday lives. Support to LGBTIQ+ leaders in Ukraine and Vietnam enabled the first-ever social enterprise clinics to deliver PHC services through muti-disciplinary teams, creating a new cadre of tailored health care. 

Across geographies, PATH puts our expertise in sexual and reproductive health to use by developing products that meet the needs of women and girls, increasing access to cervical cancer screening and treatment, and creating new technologies for HIV and pregnancy prevention. In Zimbabwe, HCD with adolescent girls led to a revolution in how pre-exposure prophylaxis, a powerful HIV prevention tool, is promoted, packaged, and delivered from a more biomedical approach to one that seamlessly fits into young women’s lives.

  1. Invest in subnational health systems

Despite PHC being recognized as the means of achieving UHC, investments have fallen short or been too siloed to strengthen systems holistically. To make new progress toward global goals, governments and funders should invest not only in PHC—but in PHC systems—without taking resources away from essential health services like maternal, newborn and child health.

Stakeholders can support governments and funders in the prioritization of national and subnational PHC investments, and in the development and passage of national policies and guidelines to enable the delivery of health services that reflect community needs. The real-time data these services and systems provide improves subnational leadership and decision-making on resource utilization, human resources for health, reliable access to oxygen as part of a comprehensive respiratory care treatment package, health insurance coverage, and overall health indices and outcomes.

  1. Digitalize health systems

Digital transformation supports health services beyond the data needed for better care by ensuring consistent availability of the essential resources needed for care. In Tanzania, a nation-wide effort, the Data Use Project, enabled digitalization of a suite of user-friendly software designed to support a range of PHC processes, from ordering new medicines and supplies, to registering new patients and recording their medical history. In practice, this means when a person visits any clinic a health worker can electronically access their complete health history, leading to better and more efficient care. While in DRC, PATH is assisting the Ministry of Health to design the entire digital infrastructure for UHC.

Partnerships with the ministries of health in Kenya and Uganda led to development of a tool to forecast the essential products needed to manage noncommunicable diseases, which led to the first five-year procurement forecasts for hypertension and diabetes medicines. The result is more strategic financing and procurement of these medicines and greater availability throughout public health supply chains.
With strong leadership and capacity strengthening, these technologies are powerful contributors to solving systemic problems that inhibit progress toward UHC.

  1. Prioritize community-led services and self-care

Supporting community-led services and self-care can be the best of both worlds, responding to preferences for easier access to products and services from trusted community providers, while also making best use of domestic funding for health and taking pressure off overburdened clinics. Pharmacies, clinics, and e-commerce play a vital role in expanding access to innovative self-care products, including self-testing options for HIV, viral hepatitis, sexually transmitted infections, COVID-19; screening tools for diabetes, hypertension, and some cancers; and family planning methods like the self-injectable DMPA-SC. With expanded access to convenient and confidential health care tools, individuals and communities can seek quicker treatment and management of conditions like hypertension or hepatitis C.

  1. Increase health system resilience 

A health system’s ability to identify and respond to emerging health threats is central to its resilience. Since the emergence of COVID-19, PATH has been partnering with countries to adapt and transform their pandemic response measures into sustainable national, subnational, and local interventions like community-based surveillance, diagnostic networks, and vaccine administration mechanisms.
Once established, these tools and mechanisms increase health system resilience because they make it easier to identify and respond to future epidemics, easier to maintain essential health services during epidemics or other disruptions, and easier to track and mitigate antimicrobial resistance (AMR), effects from climate change, and other emerging barriers to health equity.

A healthier world is possible
COVID-19 has taught us that addressing pandemics, epidemics, and other persistent health challenges requires unity and sustained commitment. To achieve UHC, we must keep PHC at the top of global, national, and subnational agendas, and work to address broader determinants of health. Now, more than ever, is the time to act and invest in strong, resilient PHC that is fit for purpose and enables attainment of global UHC goals by 2030. 

This opinion piece is part of a blog series by the Allies Improving PHC for the 75th World Health Assembly that aims to highlight Primary Health Care as the foundation for achieving universal health coverage, health security and healthier populations globally. Pieces will be posted throughout the week of the 75th World Health Assembly, read more here.