Primary health care
Commitment to Primary Health Care (PHC) has been reinvigorated in recent years by the 2018 Declaration of Astana and the World Health Assembly resolution of recognizing its role in providing the full range of health services needed throughout the life course, including prevention, treatment, rehabilitation and palliative care.
Why is this an important issue?
PHC has three essential elements. Firstly, the delivery of primary care, that is the delivery of integrated health services. Secondly, PHC is made possible through actions and policies that cut across different sectors – such as health, agriculture and financing. At the heart of PHC, and thirdly, are empowered people and communities supporting the drive for better health.
PHC is a whole-of-society approach to health. It aims to ensure the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and preferences as early as possible along the continuum of care and as close as feasible to people’s everyday environments. It can improve equity by reaching disadvantaged groups with essential health services. These services are close to communities and can help to identify changing needs among service users, increasing the resilience of health systems.
Alliance track record
We now have a firm global commitment to PHC, what is needed is greater evidence and guidance to enable us to address the financial, infrastructural, political and technical challenges of policy implementation in different LMIC settings.
The Alliance has demonstrated its commitment to PHC in mutually reinforcing ways. We have brought together policy-makers and other stakeholders from low- and middle-income countries to form consensus on priority areas for support and research. We have funded the generation of new knowledge to track progress and identify gaps in our understanding of how to strengthen PHC. Finally, we have brought thinkers together to publish their research.
In 2015 the Alliance convened a group of PHC experts to explore the dynamic processes and contextual factors that impact health systems performance. Presentations on experiences and lessons learned from decentralized health systems and health reforms in Thailand, Brazil, India and Malawi were shared. In 2017 a rapid scoping review of PHC research in LMIC was conducted. This created a research agenda focused on: Quality, safety and performance; PHC policies and governance; organization and models of care and; financing for PHC. Policy-makers and researchers were brought together to identify areas where new knowledge is needed and potential research questions.
This consultation led to the creation of Primary Care Systems Profiles and Performance (PRIMASYS) to develop case studies to support policy-makers, practitioners, development agencies, and other similar entities think strategically about health systems issues in relation to PHC. It also catalysed the publication of a ground-breaking Supplement of BMJ Global Health - Strengthening Primary Health Care Through Research: Prioritized knowledge needs to achieve the promise of the Astana Declaration.
More recently, in 2020, a new project - Embedded primary health care research to engage communities and build learning health systems – led to two regional consultations with policy-makers representing more than 20 countries. In part this responds to the COVID-19 pandemic and the need for health systems to build and develop the ability to learn in their responses, address the broader determinants of health, as well as engage communities in efforts to mitigate and contain the outbreak.
Future commitment/call to action
Building PHC for the future will require clear regional and national coordination and work across sectors such as water and sanitation, urban development and design, commercial regulation, education. These efforts should have equity, and a gendered approach at their core.
Related news