Following the approval of the Political Declaration on Universal Health Coverage (UHC) at the United Nations General Assembly High-Level Meeting on Universal Health Coverage (UHC) on September 21, 2023, the Republic of Chile, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) Organization)/WHO Regional Office for the Americas co-hosted a strategic dialogue on investing in primary health care (PHC).
“Many countries with state-of-the-art health care systems have been surprised by COVID-19 because of their historical lack of investment in primary health care. This meeting is critical to discuss two key areas for action,” said WHO Director-General Tan Dr. Desai said. “First, world leaders must make a political commitment to a primary health care approach. Second, there needs to be a strong financial commitment to primary health care as a national development priority.”
Dr. Jarbas Barbosa da Silva Jr, Regional Director of PAHO, explained: “Health systems rooted in primary health care will benefit every region, country and community. By co-investing, innovating and implementing, we can carve a path to transforming health. A systematic path to a healthier future for all.”
In his opening remarks, His Excellency Gabriel Boric Fuente, President of the Republic of Chile, stressed the importance of solidarity in promoting health and cited the experience of the Chilean government in treating health as a fundamental human right. “Primary health care is not just the elimination of disease, it is the idea of well-being and therefore the vision of prevention. It is a change, not just of throwing more money at it, but a cultural change. How we think about health And how we bring into government the things that are important to us. . . . We believe our citizens are entitled to these.”
PHC is considered the best way to accelerate progress towards universal health coverage. If implemented effectively, a primary health care approach can help deliver 90% of the basic health services a person needs throughout their lifetime – from health promotion to disease prevention, treatment, rehabilitation and palliative care. It will also help increase average life expectancy in low- and middle-income countries by 3.7 years by 2030.
national perspective
The session on “Investing in the radical realignment of health systems towards primary care” highlighted how continued national investment in health systems towards primary care can lead to positive health outcomes. Statements from countries and stakeholders further confirmed the growing body of concrete experience on how primary health care works in different resource settings and national contexts.
For example, the Chilean government “implemented a completely free public health system. This is a major indicator of progress. It reduced expenditure per capita. Now we need to improve efficiency, how to implement telemedicine, how to improve the management of inventories and waiting lists. This That’s what we’re working on, and we’re on the right track. That’s equivalent to a savings of $113 million in one year from the Chilean Fund, where we eliminated out-of-pocket costs,” said President Boric.
UK Health Minister William James Quince reiterated that primary health care is the most cost-effective and equitable way to deliver universal health coverage and health security. “It has been at the heart of the UK National Health Service from the beginning. A fundamental challenge is the political commitment to a primary health care approach. The rollout of large infrastructure projects and expertise such as tertiary hospitals certainly has political appeal, but primary Health care can deliver 75% of the projected health gains in the Sustainable Development Goals if we listen to communities, which is the basis of what they want to see…high-quality care that meets their individual needs.”
“Political leadership provides adequate funding for primary care. In the UK we are committed to increasing domestic investment in primary and community care faster than the overall National Health Service budget and are committed to increasing public funding for primary care over the long term, underpinning Progress towards universal health coverage. Political leadership can unleash government partnerships with the private sector and, most importantly, communities to deliver the multi-sectoral approach needed to fundamentally reorient health systems towards primary health that prevents and treats disease health care,” Minister Koons said.
In Brazil, primary care is a very important foundation for a unified health system. Dr. Nísia Trindade, Brazil’s Minister of Health, said their “family health strategic model has reduced infant mortality, hospitalizations for primary care-related illnesses, and mortality from cardiovascular disease.” She also noted, Primary care in the new era needs to embrace science, technology and digitization.
“Egypt has successfully fought against hepatitis C after becoming one of the countries most affected by it. This happened through the point of care within primary health care. We successfully screened 65 million Egyptians. We do this It is also done for women’s health (breast cancer), congenital heart disease in children, and four recently discovered cancers,” said Dr. Khaled Abdel Ghaffar, Egypt’s Minister of Health and Population. He further emphasized that the effectiveness of primary care will reduce the pressure on secondary and tertiary health care in Egypt by 60%. “We can solve a lot of problems by promoting good quality services in the primary health care sector, and then secondary and tertiary care can play a role.”
Dr. María Teresa Baran, Paraguay’s Minister of Health, described primary health care as the only viable option to achieve universal health coverage. “Health is not only the responsibility of health budgets, but is also influenced by social, environmental and financial factors. We need to comprehensively confront these determinants of health and work with other sectors to pursue public policies that promote health equality,” she said. Since 2008, Paraguay has made great strides in primary health care through a comprehensive cross-cultural model based on the healthy family unit.
Kazakhstan hosted the Almaty and Astana conferences in 1978 and 2018 respectively. At these two historic conferences, countries declared their support for achieving universal health through primary health care. Kazakhstan’s Minister of Health, Dr. Azar Ziniyat, said that they launched a primary health care demonstration platform at the regional level in March 2022 to share the country’s experience. The International Conference on Primary Health Care was held in Kazakhstan on October 23 to commemorate the 45th anniversary of the Declaration of Alma-Ata and the fifth anniversary of the Declaration of Astana.
Dr. Karina Lando, Minister of Health of the Republic of Uruguay, said Uruguay has moved to a new model, moving away from reliance on hospitals and towards stronger primary care. The country’s integrated public health system is supported by public health service providers and provides a number of free private services covering the most remote areas of the country. Post-pandemic, Paraguay has also worked to strengthen telemedicine to help address health workforce shortages, especially in rural areas.
“For millions of people, especially the poorest women, their first and only contact with the health system is with female community health workers,” said Rupa Da, executive director and co-founder of Women in Global Health Dr. Te said. “Last year, Women in Global Health calculated that at least 6 million of these women were working unpaid or severely underpaid in the formal health system. Our greatest opportunity to radically strengthen primary health care is to move them into formal sector work. Health systems will be stronger when they have paid, decent jobs and their work is recognized and documented.”
WHO priorities
In his closing remarks, Dr. Bruce Aylward, WHO Assistant Director-General for Universal Health Coverage and Life Course, emphasized the urgency and politics of rapid action in primary health care through strong governance, financing and participation. necessity. It all must be based on the right to health. He emphasized that supporting countries to fundamentally adapt their health systems to achieve primary health care is a core priority for WHO.
In 2015, governments agreed on the 2030 Agenda for Sustainable Development, and the world is not far away from achieving universal health coverage. More than half of the world’s population is not fully covered by basic health services, and billions of people face financial hardship due to out-of-pocket costs.
The WHO-UNICEF operational framework for primary health care provides action guidance for all countries around the world to get back on track to universal health coverage.
In short, the highlights
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