Universal Health Coverage? Not Without Primary Health Care
COMMENTARY

July 25, 2023by Dr. Kimberly Green, Global Program Director, Primary Health Care, PATH
Universal Health Coverage? Not Without Primary Health Care
In a June 2013 file image a doctor draws blood from a patient during an exam in Los Angeles. (Glenn Koenig/Los Angeles Times/TNS)

With COVID-19 public health measures largely in the rearview mirror, many countries are refocusing on pre-pandemic commitments to achieve universal health coverage by 2030. This health-for-all goal is founded on equity and the right for everyone to access the services they need, when they need them and without financial hardship. 

Primary health care is the “expressway” to achieving UHC. It meets 80%-90% of lifetime health care needs and is associated with better health outcomes, improved equity, increased health security and better cost-efficiency. PHC encompasses routine care from empaneled health care teams, public health functions, including first-line disease surveillance and reporting, contact tracing and vaccination campaigns, and an outreach function through community health workers that can engage in health promotion, disease prevention, early screening, home-based care and much more. The critical role of PHC in advancing health equity was encoded in the Alma-Ata Declaration of 1978 and re-affirmed in the 2018 Astana Declaration. 

Despite strong declarations and global commitments, PHC remains underfunded and underutilized with nearly half of the world’s population not having access to essential health services and 100 million going into poverty due to health care expenses. There are several reasons for this — allocations of national health funds may be more weighted to tertiary or secondary care, and overall allocations from national coffers in health funds. 

PHC is a three-in-one investment, enabling not only UHC but also health security and better health and well-being. At PATH, we support breaking down long-existing disease or health area funding siloes, and focusing instead on integrated services and systems that encompass a lifecycle approach. The aim is for greater investment in country-defined plans for PHC and health systems overall to enable increased coverage, sustainability and resiliency over the long term. 

Demand on PHC workforce and systems during the COVID-19 pandemic clearly reinforced the importance of resilience, and we worked with countries to enable a strong and tailored pandemic response. The pandemic laid bare the overwhelming impact that under-funded or under-resourced heath systems can have on population health and ultimately on life expectancy. The importance of having strong, responsive and trusted health services and systems in place in times of calm cannot be overstated. 

Three critical elements to resiliency of PHC that emerged during COVID-19 are stronger digitalization of health systems, increased access to self-care approaches and technologies, and purposive social engagement to foster stronger trust. Digital transformation enables multi-level strengthening of PHC such as through electronic decision support tools and longitudinal case management, generation of data for decision making and quality improvement, and offering greater precision with resource planning, staff deployment and supply chain management. 

Self-care is, in essence, about an individual’s agency over their body and health. It translates into people having access to the information and tools they need to determine how best to manage their health. Strengthening self-care options complements services needed from health professionals, and can serve to relieve pressure on health facilities, so they can focus on maintaining essential services.Strong social engagement means true partnership with communities where they are able to co-design, monitor and keep leaders accountable for commitments to quality and affordable PHC.

We know that PHC is the most cost-effective, inclusive and impactful means to achieve health for all. For UHC by 2023 to become a reality, we must keep PHC at the top of global, national and subnational agendas, and work to address broader determinants of health. 

To achieve UHC, PHC must be inclusive, welcoming and equipped to reflect the needs of all people. The late Paul Farmer said, “If access to health care is considered a human right, who is considered human enough to have that right?” His words ring true today — access for some is not sufficient. We must demand access for all.


Kimberly Green, Ph.D., leads PATH’s Primary Health Care program, which includes teams focusing on health systems and health areas across the life cycle. Green has more than 30 years of experience in public health management, policy development and research. Before joining PATH, she directed and supported several global and regional primary health care projects in Africa and Asia, partnering with ministries of health, communities and the private sector to incubate and scale up evidence-based approaches. Green is a clinical associate professor in the University of Washington’s Department of Global Health and deputy editor for the Journal of the International AIDS Society. She also serves on a number of World Health Organization and other scientific guideline and advisory committees. You can reach the Global Self-Care Federation on LinkedIn and Twitter.

A+
a-

In The News

Health

Voting

Opinions

E15 Fuel Can Be an Important Tool to Tackle Climate Change

On Earth Day this April, many Americans reflected on what we can do to protect our planet. We are already... Read More

On Earth Day this April, many Americans reflected on what we can do to protect our planet. We are already seeing the effects of climate change, and we know this is not a problem for future generations to solve — it’s up to us. One fact remains clear:... Read More

Latest Cyberattack Is Yet Another Wake-Up Call to Protect the Practice of Independent Medicine

With the rapid increase in drug and labor costs, more administrative burdens from insurance companies, and growing demand for health... Read More

With the rapid increase in drug and labor costs, more administrative burdens from insurance companies, and growing demand for health care, it’s more challenging — yet even more important — for doctors to continue serving their communities. Nevertheless, independent practices in towns across the country have... Read More

June 11, 2024
by Trump Agonistes
Trump Agonistes

One of the intriguing stories in the Bible about the power of vengeance is that of the death of Samson,... Read More

One of the intriguing stories in the Bible about the power of vengeance is that of the death of Samson, which is described in Judges 16.  The strong-man judge of Israel and scourge of the uncircumcised Philistines had finally been betrayed by Delilah and captured by... Read More

The Supreme Court: Term Limits and Mandatory Retirement

Recent Supreme Court decisions have served as reminders of the politicization of the high court. This does not imply that... Read More

Recent Supreme Court decisions have served as reminders of the politicization of the high court. This does not imply that there hasn’t always been a political element to Supreme Court nominations, confirmations and subsequent decisions. However, in recent years, replete with acrimonious Senate hearings, the politicization... Read More

Large Cannabis Companies Spending Millions to Shut Down Hemp 

The year thus far has been enlightening for lawmakers and hemp industry stakeholders. Just as the hemp industry started to... Read More

The year thus far has been enlightening for lawmakers and hemp industry stakeholders. Just as the hemp industry started to recover after a rocky start, a fellow product category took aim — the cannabis industry. And coming out of the House Farm Bill markup, the agenda... Read More

Congress Should Do More for Fans of Live Events

The Department of Justice’s lawsuit against Live Nation/Ticketmaster tells the story of the company’s monopolistic behavior and calls for the... Read More

The Department of Justice’s lawsuit against Live Nation/Ticketmaster tells the story of the company’s monopolistic behavior and calls for the company to be broken up.  The complaint highlights incidents regarding Ticketmaster’s use of exclusive contracts, pressure on artists to use its services, threats of financial retaliation... Read More

News From The Well
scroll top