Reflections from PMAC 2020: The Promise of Astana is Within Our Grasp

    As the global community inches closer to 2030, the promise of the Sustainable Development Goals (SDGs) has galvanized more energy and attention than ever before. And SDG 3, which aims to ensure healthy lives and well-being, is at the heart of every goal. At the end of January, the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand – which implemented its national universal health coverage policy in 2002 – served as the perfect setting for the 2020 UHC Forum. Global leaders from near and far came to discuss progress toward achieving health for all.  

    The week’s discussions focused on several themes including:

    Developing PHC-based health systems
    Strengthening country leadership and global coordination
    Harnessing innovations that help to accelerate progress towards UHC goals
    PHC IS THE FOUNDATION OF UHC

    Since the Global Conference on Primary Health Care took place in Astana in October 2018, the global community has continued to solidify its commitment to ensuring a world where everyone has access to high-quality primary health care (PHC). Throughout the week of PMAC, the promise of PHC as a driver of UHC was a critical point of discussion among country leaders and global organizations. At a side meeting on the margins of the conference, PHCPI – in partnership with UNICEF, The World Bank and the World Health Organization – hosted an event titled Primary Health Care Measurement and Improvement to Accelerate Progress toward UHC: Examples of Country Leadership. At the event, Dr. David Hipgrave, Senior Health Advisor of Health Systems at UNICEF, noted, “while UHC focuses on the “what”, PHC addresses the “how” – how to achieve health services that are effective and equitable in a cost-effective and efficient way. At least 80% of health contacts occur at the primary health care level.”

    PHC was also the focus of an event organized by the World Health Organization, titled Revitalizing Primary Health Care – Astana and Beyond, where speakers examined what it will take to achieve the promise of Astana, and how key actors will need to adapt in order to deliver on our collective commitments. Dr. Edward Kelley, Director of Integrated Health Services at the World Health Organization, emphasized that there is greater attention to PHC than ever before, so the time is now for us to uphold the promise of Astana.

    GLOBAL AND COUNTRY COORDINATION

    Conversations at PMAC unpacked how global and country-level stakeholders can work together to accelerate PHC. In a panel conversation with country partners from Senegal and Ghana, and representation from multilateral organizations at the World Health Organization and UNICEF, speakers emphasized the need for global and country-level stakeholders to align priorities and activities, which could in turn reduce the burden on countries and allow stakeholders to focus on purpose-driven collaboration to catalyze progress. Dr. Kumanan Rasanathan, Coordinator, Health Systems, WHO Cambodia, underscored the desire of global partners to cultivate a symbiotic relationship with their country counterparts. He said, “The capacity of strong country leaders to push partners to align is critical. Senior leadership in-country must drive the way, and our role as global organizations is to facilitate more of this leadership.”

    At our side event, Dr. Hipgrave highlighted the SDG3 Global Action Plan (GAP) Accelerators as one promising mechanism to coordinate global and country-level activities. This joint initiative of 12 global health and development agencies is committed to advancing collective action and accelerating progress towards the health-related SDGs, with PHC highlighted as one of the seven cross-cutting areas where more innovative efforts – such as digital technologies – can accelerate progress.

    COUNTRY LEADERSHIP

    Our session also brought together country leaders from four PHCPI Trailblazer countries (Senegal, Ghana, Malaysia, and Kenya) to share their experiences in pursuing health system improvements through innovations in PHC measurement. All four countries have developed and publicly released Vital Signs Profiles (VSPs), snapshots of their primary health care systems that demonstrate where those systems are strong and where challenges exist.

    • Ghana: Dr. Belinda Nimako, Acting Deputy Director for Information, Monitoring and Evaluation at Ghana Health Service, shared that the exercise of populating Ghana’s VSP unearthed weaknesses in Ghana’s PHC system and pointed the government in the right direction to improve PHC in the country. Dr. Nimako shared that “Although measurement is important, measuring alone is not sufficient. Ghana is using the data generated from our profile to improve our programs, one step at a time.”
    • Senegal: Dr. Youssoupha Ndiaye, Director for Planning, Research and Statistics at the Ministry of Health and Social Action, presented on the country’s progress in measuring and responding to gaps in PHC performance – with a specific focus on quality and patient-centered care. Dr. Ndiaye also shared that measurement of PHC performance using the VSP-informed new goals in the global strategic plan for health in Senegal.
    • Malaysia: Dr. Nazrila Hairizan Nasir, Deputy Director, Primary Health Care, Ministry of Health, also shared that developing Malaysia’s VSP allowed her country to analyze their PHC system and brought to light many weaknesses in Malaysia’s health system. Dr. Nazrila spoke about her country’s experience with the PHC Progression Model, a rubric-based mixed-method assessment tool that will enable Malaysia to systematically measure central PHC capacities such as governance, inputs, and population health management.
    • Kenya: Kenya has declared a political commitment to achieve UHC by 2022 and recognizes that PHC is the backbone of health for all. Dr. Helen Kiarie, Head of the Monitoring and Evaluation Unit, Ministry of Health, shared that Kenya’s national VSP has been adapted for county-specific settings, and is expected to be used by all relevant county stakeholders to assess and strengthen PHC. This exciting and innovative adaptation of the VSP tool will have a big impact on communities at the local level of the Kenyan health system.

    These stories from Trailblazer countries underscore that the process of developing VSPs can help unearth rich and diverse PHC data that can unite country stakeholders around a common agenda of primary health care improvement.

    THE BOTTOM LINE

    The conversations in Bangkok reminded us that the promise of Astana is within our grasp: We have political commitments from country and global leaders, a strong foundation of experience to build and learn from, and renewed recognition that people must remain at the heart of PHC. The time is now for the global community to coordinate efforts to ensure health for all in 2030 is a reality.

    If you are interested in partnering with PHCPI to develop a Vital Signs Profile for your country, please contact us at info@improvingphc.org