In many low and middle-income countries, quality – not access – poses a barrier to care
While global programs focused on specific diseases have improved the health of populations worldwide, until recently there has been a lack of focus on programs or initiatives to improve primary health care. Services provided in a primary care setting can encompass nearly 90% of all health needs, and numerous studies have found that strong primary health care contributes to improved health status. Attention to primary health care has grown in the last few years, particularly in reaction to the UN’s 2015 Sustainable Development Goals calling for Universal Health Coverage by 2030.
With a renewed focus on primary health care comes the challenge of identifying how to quantify and evaluate access to primary health care in order to plan effective and targeted programs. However, traditional methods of measuring access to primary care often fail to take account of a central limiting factor: quality. In many low and middle-income countries, patients have ready access to primary health care facilities, but providers lack sufficient training and skills to provide high-quality care. Access without quality can have deleterious effects; in addition to inaccurate diagnoses, patients may receive unnecessary or harmful treatment.
A recent article in the Economist – “In poor countries it is easier than ever to see a medic” – explores why patients do not always receive the care they need, even in areas with few financial or geographic barriers to care. The article highlights perverse financial incentives that often exacerbate the gap between a providers’ knowledge and actions as well as the pervasiveness of informally trained providers. A deeper understanding of the global landscape of primary health care quality – as well as the gap between access and quality - can ultimately help policy makers and other stakeholders plan interventions grounded in the realities of patient-centered experience of care.