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Primary Health Care: Now or Never

On the occasion of the 40th anniversary of the Alma Ata Declaration, leaders and representatives from all over the world met last week in Astana with the aim of reaffirming the principles of the original declaration.

The anniversary of this historic landmark in global health, renewed the commitment to primary health care (PHC) and to achieve universal health coverage (*UHC) and the Sustainable Development Goals (SDGs).

The declaration defined three essential principles. Firstly, PHC is an integral part and central function of robust health systems. Secondly, it plays a crucial role in achieving social and economic development. Thirdly, PHC must be universally accessible through full community participation and based on the practical, evidence-based, and socially acceptable methods and technologies (WHO, & UNICEF. 2018).


What is primary health care?

According to the World Health Organisation (WHO), primary health care is health care received in the community, usually from family doctors, community nurses, staff in local clinics or other health professionals. It should be universally accessible to individuals and families by means acceptable to them, with their full participation and at a cost that the community and country can afford.

The relation between PHC and health equity

According to the previous statements; would it be sensible to place PHC as the cornerstone for achieving UHC and decrease inequalities?

The answer is; absolutely yes. Primary care represents the entry point and cornerstone of many health systems. Experts consider that PHC is at the core of providing accessible person-centred, appropriate and equitable care from a population-based perspective (EXPN, 2017).

Extensive scientific evidence has shown a strong positive correlation between the strength of primary care dimensions and key health system performance indicators and outcomes variables, such as healthcare spending, patients perspectives, quality of care, potentially avoidable hospitalisations, population health and socioeconomic inequalities (Kringos DS.et al., 2013). Besides, the emphasis of PHC on community-based services is a meaningful way to ensure access, even in rural, remote and disadvantaged populations (Richard, L. et al.,2016).

So it's not nuts to say that nowadays, strategies to cope with challenges in the healthcare sector often include strengthening primary care systems.

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How can we strengthen PHC

The recently adopted Astana declaration (WHO, & UNICEF. 2018) stresses some of the main ones to strengthen PHC. At the core, we can find the need for sharing knowledge, build capacity and improve the delivery of health services and care. Investment in education, recruitment, and retention of the PHC workforce, with an appropriate skill mix. The need to increase the promotion of Health literacy and work to satisfy the expectations of individuals and communities for reliable information about health.

Aligning stakeholder support to national policies, strategies and plans and making sure that through digital and other technologies, individuals and communities are able to identify their health needs, allowing them to participate in the planning and delivery of services and play an active role in maintaining their own health and well-being.

But how do countries measure PHC performance and progress towards UHC?

Strong PHC does not emerge spontaneously. It requires appropriate conditions at the health care system level and in actual practice to make PHC providers able and willing to take responsibility for the health of the population under their care.

There is a strong need to collect and share information about what structures and strategies matter. To measure the performance and progress made towards PHC and UHC, systems need to monitor and evaluate through well-functioning health information systems that generate reliable data (Boerma T et al., 2014).

Proper health data collection systems are a critical source of information to improve decision-making at the local, subnational, national, and global levels (Nutley, T., & Reynolds, H. W. 2013).

In order to present conclusive information for decision making, the collected data needs to be accurate, valid, reliable, timely, relevant and complete.

The crucial role of proper data collection in decreasing health inequalities

Health policy decisions are fundamentally based on health specific data. Data can be a catalyst for improving community health and well-being. Collecting and understanding data can help to focus efforts to enhance community health.

Up to date, there are still remaining considerable gaps and challenges in health data coverage among many countries. To achieve real progress countries need quality data, this allows for comparison within and between countries and population groups. The equity element of existing systems needs to be reinforced, allowing for the correlation of health data with social, economic and environmental data (Sadana, R et al., 2011).

The collection of good quality data in PHC will make this possible. However, the potential will only be unlocked if staff in primary care understands why such data is valuable, have the resources available to support its collection and possess the appropriate tools and knowledge needed to use the information effectively.

Therefore, it's clear the crucial role that data plays in health. If it's unavailable, it means that policy and practice can't catch up with science.

I want to finish quoting Dr Tedros WHO general director statement in Astana: “Health is the right for all people, not a privilege for those who can afford it. We can take action now. Each of us can do everything to realise this vision”.

Definition:

UHC: This means ensuring that everyone, everywhere can access essential quality health services without facing financial hardship.

(WHO, 2018)


References:

  1. A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. Geneva: World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), 2018
  2. Boerma, T., Eozenou, P., Evans, D., Evans, T., Kieny, M. P., & Wagstaff, A. (2014). Monitoring progress towards universal health coverage at country and global levels. PLoS medicine, 11(9), e1001731. doi:10.1371/journal.pmed.1001731
  3. Expert Panel on effective ways of investing in Health (EXPH), Opinion on Tools and Methodologies for Assessing the Performance of Primary Care, 18 December 2017
  4. Kringos DS, Boerma W, van der Zee J, Groenewegen P. Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health Aff (Millwood). 2013; 32(4):686-694.
  5. Nutley, T., & Reynolds, H. W. (2013). Improving the use of health data for health system strengthening. Global health action, 6, 20001. doi:10.3402/gha.v6i0.20001
  6. Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J. F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. International journal for equity in health, 15, 64. Doi: 10.1186/s12939-016-0351-7
  7. Sadana, R., & Harper, S. (2011). Data systems linking social determinants of health with health outcomes: advancing public goods to support research and evidence-based policy and programs. Public health reports (Washington, D.C.: 1974), 126 Suppl 3(Suppl 3), 6-13.
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Diana Castro Sandoval

I'm somebody passionate about international relations, public health, innovation and economic policy. Currently working at the European Forum For Primary Care while trying to shape the future of healthcare.

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