Primary healthcare – the cornerstone to maternal care

Primary healthcare remains the most underfunded, and commonly overlooked, area of healthcare. With some of the highest return on investment, PHC provides the most basic measures of care and has the power to impact whole communities. According to the World Health Organization, expanded access to Community Health Workers (who make up a core component of primary healthcare) could prevent up to 3 million deaths per year, and can result in an economic return of up to 10:1 in sub-Saharan Africa. Primary healthcare (PHC) also delivers vital maternal objectives, that would go unfulfilled in its absence in regions where access to mid-level care is either limited or completely absent.

In many low-resource countries such as Nigeria, the country of my birth, the absence of established institutions and infrastructure paired with a chronic funding deficit creates a situation whereby PHC is often the only avenue to access any form of care. More specifically, it is often the only access women have to maternal care. Midwives play a key role in delivering PHC, and have the potential to change the global face of maternal health and greatly improve the opportunities of expectant mothers and newborns around the developing world.

PHC works by strengthening capacity and building resilience to endure crises from the bottom-up. Spanning a spectrum of medical practices, from providing vaccinations to educating women on nutrition, PHC provides the backbone to healthcare systems across much of Africa and Asia.

It is my belief that PHC becomes increasingly crucial in remote and rural areas. Infrastructure and larger health institutions are costly, and many countries simply cannot afford such investments. PHC is the most basic element of healthcare, and reaps visible, tangible rewards that can be measured, monitored, and evaluated.

To maximise the return on investment in PHC, midwives must be positioned at its core. The role of a midwife is diverse, and high quality midwifery is critical in improving health outcomes of communities at large. From birth to age, midwives have a positive impact on people’s lives - perinatal care, HIV and TB testing, basic obstetrics and family planning services are all performed by midwives, and serve as key aspects of healthcare. It is via midwives - the foot soldiers of PHC – that equity, quality and dignity can be realised in healthcare and beyond.

PHC also has a levelling effect on populations: through the bottom-level provision of care, PHC has the power to reduce inequalities and close the divide between rich and poor. Investing in mid-level care is less likely to impact the world’s poorest people than its primary-level contemporary, and although valuable, fails to counteract the gaping disparities that are seen in societies across the globe.

Sadly, there remain barriers to PHC. Underfunding and a lack of government commitment to drive PHC pushes this key area of healthcare to the wayside, and renders PHC uncoordinated and ineffective in much of the developing world. In Nigeria, PHC is run by local authorities– the lowest and weakest level of government – giving rise to a weak and disorganised health system, in which widely varying patterns of outcomes depend on local situations. As Chair of Nigeria’s Primary Healthcare Revitalisation Support Group Program, PHC is close to my heart. Working in partnership with the Nigerian state and other development groups, we strive to deliver the PHC commitments that the government has pledged but failed to achieve. We urge the government to harmonise financing towards PHC and to reduce the barriers to access that restrict healthcare services to so many across the nation.

Not only do we need to see a concerted effort to expand the breadth and scope of PHC, but greater focus must be made on improving the quality of PHC services around the world. In the absence of effective monitoring systems, there is little incentive to make tangible improvements to this failing sector of healthcare. Therefore I advocate the installation of a system of surveillance that better evaluates PHC, enabling policymakers and stakeholders to engage on the issue of PHC to improve overall quality of care.

In 2008 the WHO identified 4 sets of reforms needed to see tangible improvements in PHC: universal coverage reforms, leadership reforms, public policy reforms and service delivery reforms. Yet nearly a decade on, many of these reforms have not been implemented universally. We know where the problems in effective delivery lie, and must not shy away from PHC altogether due to the failure to commit in the past.

PHC can no longer be ignored in the public health debate – growing populations in the context of increasingly fragile health systems render PHC increasingly crucial, to improve and to save lives. It is my hope that governments align commitment with action, to give people the best opportunities in life, from birth to age.

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