Primary health care investment is the 3-for-1 investment that can help us get there
At the Seventy-Fifth World Health Assembly (WHA75, 22-28 May 2022) in Geneva, agenda item 15 is on human resources for health. Several sub-items and documents – such as the Working for Health: draft 2022–2030 action plan, Global health and care workers compact, WHO Global Code of Practice on the International Recruitment of Health Personnel, and Global Strategy on Human Resources for Health: Workforce 2030 – are up for consideration by WHO Member States.
This moment reminds me of 2017, when I had the opportunity to implement what members of the People’s Health Movement call, “The Struggle For Health.”
I was among the 13 WHO Watch team volunteers for the 70th World Health Assembly, representing PHM Africa, Asia, Europe, America and Latin America. Of all the agenda items in focus that year, I preferred to work in the Human Resources for Health group.
We generated policy briefs and statements to advocate to WHA70 delegates and the WHO Secretariat at large. We also consulted with delegates from each member state to share information and make our case, including delegates from my home country, Tanzania, who were very receptive to the policy brief. This culminated in a statement in front of delegates of WHA70 and interviews to give weight to the Human Resource for Health agenda.
The work did not end there. The following year, we continued the struggle for health with the help of The Elders, who provided us with a platform that helped our voice and our work reach a much wider range of stakeholders. 2018 was a lucky year, as the WHO published a guideline on health policy and system support to optimize community health worker programs.
This was not an easy task, but we were largely successful because we partnered with various stakeholders who gave us the opportunity and platform to do so.
Unfortunately, the challenges have only gotten harder in these times when the world is still treating the challenges posed by COVID-19. It is regrettable that COVID-19 has illustrated to us that PHC is under-resourced and that there are ripple effects across the entire health system, impacting countries’ ability to meet the needs of communities in times of crisis and calm. In many ways, we have taken a step backward on PHC commitment.
However, WHA75 is the perfect moment to make our voices heard. Right now, we have a limited window of opportunity to ask world leaders to put primary health care at the center of plans for COVID-19 recovery and health systems strengthening.
That is why this WHA75, PHM Tanzania is taking this unique opportunity to connect with and join all primary health care advocates around the world to highlight how PHC is central to achieving WHO’s Triple Billion Targets. I am excited to join and stand with the Allies Improving PHC and issue a call for highlighting PHC as a “3-for-1” investment towards UHC, health security and healthier populations.
However, as it has always been in my career, I especially want to highlight the area of Human Resources for Health, specifically on Community Health, by defending the argument of community health workers (CHWs) in improving PHC. Strong community health systems are essential to reaching hard-to-reach populations and improving PHC that will advance universal health coverage, protect communities in times of crisis, and ensure healthier populations everywhere.
To give an example from my country Tanzania, the time is right for development partners to build back better together. All bilateral relations with the government should focus on implementing and sustaining the WHO guideline on health policy and system support to optimize community health worker programs. We need government leaders, donors and all development partners to pay more attention to the PHC Workforce and invest more and better in primary health care overall.
I am advising this based on data that shows Health Financing in Tanzania and many countries is still lagging behind. We know that primary health care as a proportion of total health spending in Tanzania is still unsatisfactory although we rely on donors (for a large percentage) in healthcare financing. We have US$15 of PHC spending per capita while sources of PHC spending are 19% from the government and 81% from foreign donors and households (out-of-pocket). While the country has made enormous strides in improving its population’s health, the Government of Tanzania and its development partners should recognize this is not sustainable: Instead, we need to move toward greater pooled public financing such as government tax-based revenue or health insurance. At the same time, if any donors withdraw their contributions suddenly, the Tanzanian government may not be able to contribute enough to fill the gap right away. That’s why our new health financing strategy should be implemented in alignment with the UHC political declaration and the Health Sector Strategic Plan.
In Tanzania, data also shows there is nothing legally binding remuneration for CHWs, but remuneration and the role of CHWs in UHC are mentioned in the Tanzanian national CHWs Guidelines and the Health Sector Strategic Plan. Moreover, the world, including Tanzania, has recognized the invaluable contribution made by community health workers (CHWs) in achieving UHC, and CHW's vital role in the delivery of primary health care within their communities.
This has motivated me – at WHA75 and in preparations for the 2023 High-Level Meeting on UHC, and beyond – to continue reminding, commenting and advising our national and world leaders that monitoring key community health indicators is important for countries to assess how their policies, investments, and actions are impacting the delivery of health care services and people’s lives.
Ultimately, by investing in strong primary health care, community health and CHWs, communities will be better equipped to respond to health emergencies; detect, prevent, and control threats to health; promote healthier populations; and achieve Health for All.
In short, we are #StrongerWithPHC.
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