Primary health care (PHC) has the potential to address 90 percent of health care needs. However, country governments spend, on average, only one third of their health budgets on PHC.
Everyone, everywhere deserves access to high-quality and affordable health care. The global community showed its dedication to achieving this goal earlier this year, when global leaders formally committed to achieve Universal Health Coverage (UHC) by 2030.
UHC means everyone can both afford health care and access high-quality services when they need them. It means a mother does not have to walk long distances with her sick child, only to find out the health clinic does not have the right medication, or worse, that she doesn’t have enough money to pay for it. It means that adults are screened for high blood pressure before they develop hypertension, not just treated after the fact.
Commitment from global leaders is a critical starting point, but there’s a lot of hard work yet to be done. Last year’s UHC Monitoring Report from the World Bank and World Health Organization revealed that 400 million do not have access to essential health services and 6 percent of people in low- and middle-income countries are tipped into or pushed further into extreme poverty because of health spending.
The solution? Primary health care.
The promise of primary health care
Strengthening primary health care is the most efficient and affordable way to achieve UHC. Primary health care can deliver nearly all the essential services people need throughout their lives, and is less expensive and more accessible than hospital-based care.
Strong primary health care systems:
Meet the vast majority of health needs. Well-equipped primary health care providers can manage 90 percent of health care needs, so that patients only require hospitals or specialists 10 percent of the time.
Save lives. Primary health care prevents people from catching diseases, like malaria, and developing chronic condition, such as diabetes. When patients do fall ill, primary health care should be their first stop for high-quality, affordable treatment.
Save money. By identifying illnesses early and offering effective treatment, primary health care can support a healthier population and lead to lower health costs.
Protect marginalized and disadvantaged people. A well-developed primary health care system ensures that poor and vulnerable populations have access to the same important services as the rich and well-connected.
Promote health security. The Ebola outbreak in West Africa was a wake-up call. It showed that we must do more to ensure the world’s health systems can withstand shocks. Good primary health care is a country’s first line of defense: it detects and stops outbreaks before they turn into epidemics and can mitigate the effects of other disasters, such as earthquakes, climate change, or armed conflict.
Barriers to strong primary health care
We know that primary health care has the potential to dramatically accelerate progress toward UHC, but barriers remain. Primary health care systems are complex, requiring many moving parts to work together as a whole. Three challenges stand out:
Patients and their families shoulder the cost of PHC. Low-and middle-income country governments spend, on average, only one third of their health budgets on primary health care, despite the fact that primary health care has the potential to address 90 percent of health care needs. As a result, out-of-pocket payments account for nearly 60 percent of all spending on primary health care services, more than what global donors and government contribute combined. This forces families to make impossible choices between health and other essentials like food, clothing and education.
Patients don’t receive the high-quality care they deserve. Too often, patients arrive at health facilities and find no health care worker on duty. In the seven countries that provide data on absence rates, unannounced visits to health facilities showed that workers were absent — often with a supervisor’s approval — an average of 29 percent of the time. Even when health workers are present, care is often lacking, failing to follow guidelines for diagnoses and treatment for over one in four patients.
We don’t have the right data to focus their improvement efforts. Even when primary health care has been identified as an urgent priority, governments and development partners lack the information they need to make improvements. We hear from countries around the world through the Joint Learning Network for Universal Health Coverage that they are “drowning” in data, but the information they do have doesn’t tell them what they need to know. Despite the avalanche of information, they don’t always know where to focus their time and money to have the greatest impact.
Removing barriers and strengthening primary health care
To effectively support countries in their journey to UHC — or health for all — and to strengthen primary health care we must provide data and information that policymakers can use. This transformative promise of PHC is why Results for Development joined the Bill & Melinda Gates Foundation, the World Health Organization, the World Bank Group and Ariadne Labs to form the Primary Health Care Performance Initiative (PHCPI). Supported by policymakers, advocates, and other development partners, PHCPI works with low- and middle-income countries to extend the benefits of primary health care to all their citizens.
We must mobilize additional resources for primary health care — and advocate for more effective use of existing resources. And we must ensure that primary care is consistently high-quality.
But most importantly, we need to do so in a way that focuses on practical solutions that respond to the real-world challenges policymakers face. It requires listening, and acting in partnership — and in our experience, it also frequently requires a greater focus on supporting policymakers as they determine how to implement changes.
This systems-level work is sometimes referred to as the messy middle, and while it’s certainly not glamorous, it is essential. But on this 2016 Universal Health Coverage Day, we’re more committed than ever to this important work.