Text by Aurora Hirvonen
The World Health Organisation (WHO) defines primary health care (PHC) as a whole-of-society approach with the aim of distributing basic health and well-being services in an equitable manner based on the needs of individuals and communities (WHO and Fund (UNICEF) 2018). Hence, PHC does not solely cover medical care. It envelopes a broad set of aspects such as multisectoral policy, empowerment, growing self-reliance as well as addressing determinants of health (WHO 2019b; WHO 2021). PHC is a key commitment of all UN Member countries as part of the Declaration of Alma-Ata (WHO 1978; WHO 2010). But why is PHC so critical for achieving a more resilient and equitable future?
The Declaration of Alma-Ata (WHO 1978) did not only highlight the importance of PHC as an independent factor but explained who it aligns with and drives the Sustainable Development Goals (SDG), Universal Health Coverage (UHC) and overall strengthening of health systems (WHO and Fund (UNICEF) 2018). While these entities have for long developed independently from each other, numerous reports demonstrate how PHC is the best way for us to achieve UHC and other health-related goals (Dugani, Veillard and Evans 2018; van Weel and Kidd 2018; Universal Health Coverage Partnership 2021; Martin and Sturmberg 2022). Besides, worldwide comparisons of countries’ population health with their health care infrastructure demonstrate the beneficial effects of a robust primary health care system (Dugani, Veillard and Evans 2018). Hence, the overlapping aims of these three agendas drive a slow evolution towards a novel and bold approach for leaving no one behind.
Achieving UHC is Target 3.8 of the SDG (Sachs et al. 2022). UHC means that all individuals and communities receive a full spectrum of quality health services without encountering financial burden (WHO 2021). To achieve this, investing on PHC has been named the route for success. The process is heavily dependent on considerable strengthening of health systems specially in low-income contexts (WHO 2019a). As the WHO report Primary Health Care on the Road to Universal Health Coverage states, a 5% increase in PHC spending could “save a 60 million lives and increase average life expectancy by 3.7 years by 2030” (2019, 5). This result may be fundamental in all courtiers but particularly in low- and middle-income settings with significant resource constraints (van Weel and Kidd 2018).
Moreover, UHC Partnership countries have also demonstrated innovative and diverse ways in which PHC can be brought closer to UHC – namely through health system reforms, involvement of the private sector, engagement of communities and actioning of workforce (van Weel and Kidd 2018; Universal Health Coverage Partnership 2019; Martin and Sturmberg 2022).
A health system that is based on PHC aims at people-centred, equitable and efficient care (WHO 2010). PHC not only gives basic access to health care but ensures the sustainability of these services (Universal Health Coverage Partnership 2021). Strengthening health systems based on primary health-care approach – report (WHO 2007) highlights how countries where PHC has been successfully implemented also demonstrate a well-established health system. PHC approach should and can be adopted in every country in accordance with its socio-economic situation, existing healthcare system and quality of resources. Similar actions as those suggested for UHC achievement can be translated towards a PHC based health system. These include fostering multisectoral collaboration, promotion of transparency and equitable financing (WHO 2010).
References
Dugani, S., Veillard, J. and Evans, T.G. (2018) ‘Quality primary health care will drive the realization of universal health coverage’, CMAJ : Canadian Medical Association Journal, 190(15), pp. E453–E454. Available at: https://doi.org/10.1503/cmaj.180186.
Martin, C. and Sturmberg, J. (2022) ‘Universal Health (UHC) and Primary Health Care (PHC)—A complex dynamic endeavor’, Journal of Evaluation in Clinical Practice, 28(2), pp. 332–334. Available at: https://doi.org/10.1111/jep.13654.
Sachs, J. et al. (2022) Sustainable Development Report 2022. 1st edn. Cambridge University Press. Available at: https://doi.org/10.1017/9781009210058.
Universal Health Coverage Partnership (2019) DEEP DIVE – On Priamry Helath Care (PHC) in the UHC Partenership, p. 3. Available at: https://uhcplaunch.com/sites/default/files/media_documents/Deep%20Dive%20on%20PHC_UHC%20P%20annual%20report%202019.pdf (Accessed: 13 November 2022).
Universal Health Coverage Partnership (2021) Primary health care. Available at: https://extranet.who.int/uhcpartnership/featured/primary-health-care (Accessed: 12 November 2022).
van Weel, C. and Kidd, M.R. (2018) ‘Why strengthening primary health care is essential to achieving universal health coverage’, CMAJ : Canadian Medical Association Journal, 190(15), pp. E463–E466. Available at: https://doi.org/10.1503/cmaj.170784.
WHO (1978) Declaration of Alma-Ata. WHO/EURO:1978-3938-43697-61471. World Health Organization. Regional Office for Europe. Available at: https://apps.who.int/iris/handle/10665/347879 (Accessed: 16 November 2022).
WHO (2007) Strengthening health systems based on primary health-care approach. SEA-HSD-298. WHO Regional Office for South-East Asia. Available at: https://apps.who.int/iris/handle/10665/206410 (Accessed: 15 November 2022).
WHO (2010) Primary health care. The basis for health systems strengthening: frequently asked questions. SEA-HSD-338. WHO Regional Office for South-East Asia, p. 40. Available at: https://apps.who.int/iris/handle/10665/205658 (Accessed: 12 November 2022).
WHO (2019a) Primary health care on the road to universal health coverage: 2019 monitoring report, p. 12. Available at: https://www.who.int/publications-detail-redirect/9789240029040 (Accessed: 15 November 2022).
WHO (2019b) Young Leaders Blog. Available at: https://www.who.int/teams/primary-health-care/conference/young-leaders-network/blog/young-leaders-blog (Accessed: 12 November 2022).
WHO (2021) Universal health coverage (UHC). Available at: https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) (Accessed: 13 November 2022).
WHO and Fund (UNICEF), U.N.C. (2018) A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. WHO/HIS/SDS/2018.15. World Health Organization. Available at: https://apps.who.int/iris/handle/10665/328065 (Accessed: 15 November 2022).
Author:
Aurora Hirvonen is a student at Laurea University of Applied Sciences where she is pursuing a Master’s degree in Global Health and Crisis Management. She has a background in Biomedical Sciences at Karolinska Institutet, Sweden. Recently, she was part of the Regional Reference Centre in the WHO Project for the World Eradication of Poliomyelitis at the University of Milan. For her future, she seeks a career that intertwines global well-being, disaster management and humanitarian efforts.
