In 2015, the international community officially enshrined universal health coverage (UHC) in the Sustainable Development Goals which guides development efforts through 2030. A strong primary health care (PHC) system is the first step toward achieving UHC and we must address the funding shortfall as well as develop innovative financing strategies.
In many countries in Africa, health services remain unaffordable; often far from home, and quality can be uneven. Crises such as the Ebola epidemic bring into sharp focus how communities and individuals struggle in getting the care they need, sometimes resulting in death that could have been prevented. Primary health care ensures that all people in a community stay healthy and receive care when they need it.
I serve as a Policy Advisor at WACI Health whose mandate is to create political good will to end life threatening epidemics and the improvement of health for all in Africa. PHC is critical to achieving our vision and mission. As an advocate, I engage with Governments and the citizens to embrace PHC and for each of the parties to play their roles to ensure PHC is a functional system. This is not an easy task especially where there is so much mistrust of PHC by a large number of middle income citizens who prefer out of pocket spending for example over the counter drugs rather than seek services from the public facilities. This practice comprises the health outcomes of individuals due to missed or wrong diagnosis and treatment hence end up bearing heavy costs for specialized treatment when the complications occurs leading to draining of family resources increasing the likelihood of poverty.
We are also advocating for increased domestic resources, for example in Kenya where the devolved system of Government has health as a nearly fully devolved function with the exception of policy formulation to ensure that County Governments allocate resources to PHC and that they strengthen the systems such that their citizen can access the services they require at the nearest facilities to where they live.
Earlier this year, I found myself immersed in rich conversations on PHC with other civil society advocates, technical experts and development partners. I participated in a consultation hosted by PAI and Save the Children UK, convened in Johannesburg, South Africa. The three-day consultation, sharpened my understanding of the complexities that countries face in the quest for affordable, accessible and quality primary health care. Common threads in the conversation included: the need to address access, financing, removal of barriers, strengthening health systems and engaging citizens to make PHC work. It was however, clear to me that it is up to each country to define their own meaning and understanding of PHC.
The challenges confronting the health sector range from the spread of non-communicable diseases to inadequate funding of health interventions and over reliance to the international aid rather than domestic funding. A few key messages stood out for me from this consultation:
· A high-functioning PHC system is key to ensure a productive and a healthy population. Millions of people in Africa are driven to poverty by healthcare-related expenditures and in return poverty predisposes them to disease slowing all aspects of growth in the economy. Strengthening healthcare systems to increase access to affordable, appropriate and quality health services in any country is a prerequisite for long-term development and structural transformation.
· Basic curative, preventive and promotive healthcare should be available and accessible to all if we are to achieve the Sustainable Development Goals by 2030.
· Financing for health falls short of the 2001 Abuja Declaration, where nations committed to allocating 15 per cent of their national budget to health.
The verticalization of health programs has a negative effect to the health system, leading to the prioritization of certain services or diseases causing a fragmentation of PHC services. Rather, government and other support to PHC is more beneficial in addressing issues of access to services by all.
Countries must define PHC in their own context, based in essential health services with a clear funding stream and develop indicators and outcomes to measure progress and success.
The report and recommendations from the Primary Health Care Expenditure and Budget Advocacy Consultation is available here.