Primary Health Care: The Engine to Universal Health Coverage
The Global Conference on Primary Health Care hosted in Astana, Kazakhstan, in October 2018, renewed the core principles included in Alma Ata Declaration in 1978, emphasizing the essential role of primary health care (PHC) around the world. The Declaration of Astana focused on primary health care to ensure that everyone everywhere is able to achieve a good standard of health.
On 23 September 2019, the United Nations General Assembly held a high-level meeting on universal health coverage. This meeting, held under the theme “Universal Health Coverage: Moving Together to Build a Healthier World,” identifies primary health care as the route to universal health coverage (UHC).
UHC shouldn´t be a luxury that only high-income countries can afford. However, it needs some levers that must be strengthened everywhere. One of the most important ways to achieve UHC is to prioritize PHC as a crucial strategy in health systems. PHC is the most efficient way of using available resources in health services, ensuring effective interventions are delivered at the lowest cost within the health system. Two main reasons support this statement: firstly, PHC contributes to financial protection for individuals and households; secondly, PHC is also the most equitable way of delivering much needed services. For these reasons, it is the most cost-effective way to address comprehensive health needs close to people’s homes and communities.
To translate this strategy into reality, the WHO 2019 Global Monitoring Report, released just a day ahead of the High-Level Meeting on UHC, emphasizes the need to invest in strong primary health care: “The report issues a clear call to action for governments in all countries to invest an additional 1% of their gross domestic product for primary health care, which can be achieved through additional investments or through efficiency and equity gains”. Local context will determine the best strategies for mobilizing or redistributing resources to increase investment in health systems. In this regard, Commission on Investing in Health recommends an increase of 1%–2% of GDP in public spending on health by 2035. According to Xu et al, higher total spending (both public and private) is strongly associated with service coverage, whereas higher public spending is particularly associated with financial protection.
This Global Monitoring Report points out that to achieve the targets for PHC requires an additional investment of around US$ 200 billion a year, and to achieve UHC requires a further US$ 170 billion a year. These amounts are significant, but they would represent only about a 5% increase beyond the US$ 7.5 trillion already spent on health globally each year.
This investment is essential to improve four main dimensions of health system capacity: physical access, human resource availability, infrastructure and quality. Ensuring physical access to facilities is not enough, because it needs also the capacity to deliver high-quality services, and this requires trained and supported health workers, essential medicines, health equipment and information systems, along with key infrastructure foundations. Health care workers are central to the delivery of high-quality services. The unequal distribution of health workers around the world, particularly in rural and remote areas, is one of the most important challenges to achieve UHC.
The route to UHC is clearly defined, and in this route, PHC is the engine for UHC in most contexts. But it needs a strong political commitment.