Driving triple-duty health impact through primary health care

A Haitian nurse based in New York, works to serve local children as a volunteer nurse during the S.O.S. Medical and Relief Mission in the Philippines, after Typhoon Yolanda (Haiyan) devastated the area. © 2013 Jaime Singlador

Imagine a world where essential health care is based on relevant, practical, proven methods co-created with communities and therefore socially acceptable and accessible everywhere. That was the vision behind the International Conference on Primary Health Care (PHC) held in Alma-Ata, USSR (now Almaty, Kazakhstan) in September 1978. Nearly 44 years after, amid a global pandemic that has exposed tragic inequities and vulnerabilities of national health care systems, the urgent need to achieve "health for all" could not be more urgent.  
 
Over the past two years, we have seen two high-impact tools on PHC. WHO launched the Operational Framework for PHC in December 2020, and jointly released a new primary health care (PHC) monitoring framework and indicators with UNICEF in February 2022. The latter is a tool to monitor primary health care performance and accelerate progress toward Universal Health Coverage (UHC) and the other health-related Sustainable Development Goals (SDGs). The COVID-19 pandemic is not over, but we can already draw lessons from how we responded, those we have lost and why we lost them.
 
Pursuing health security, healthier populations, and sustainable development through PHC
 
Everyone might have had an equal opportunity to contract COVID-19, but not everyone has had an equal opportunity to protect themselves. People in deprived communities have been on the frontlines of the economic impact and disruptions to essential health services. Similarly, people living with noncommunicable diseases (NCDs) are at higher risk of developing severe COVID-19-related illness and death. The PHC monitoring framework includes indicators that monitor equity, quality, and resilience in health emergencies, and rightly so. We must move from mere acknowledgement to preventing the vulnerability of populations. Integrating primary care and the public health functions of health systems has saved lives and fostered collaboration with governments in the ongoing pandemic. PHC played a crucial role in providing acute care to both COVID-19 and longer-term care for non-COVID-19 patients living with chronic conditions. In communities where governments have failed to provide strong PHC systems, people continue to pay with their lives. The journey to achieving health security, healthier populations, and universal health coverage will vary from country to country, but the starting point for all is strong PHC. 
 
Investing in PHC capacities will save lives now and safeguard health gains.
 
The PHC monitoring framework demonstrates how and why investments in the core elements of the health system can improve PHC performance, processes and outputs and, ultimately, save lives. This is invaluable guidance for actors responsible for resource mobilisation for health. While we have witnessed a rapid increase in funding for disease-specific initiatives over the past two decades, such initiatives have primarily increased the volume of resources for combating infectious diseases and, to a lesser extent, noncommunicable conditions. Also, the efficiency of such funds continues to be plagued by weak alignment among different actors. The new PHC framework suggests that prioritising primary healthcare investments will benefit all disease conditions. This implies better access to NCD care for all and protection for the hard-won gains of past investments for infectious diseases. 
 
NCDs make up 7 of the top 10 causes of death globally, but NCD prevention and control is the weakest link in PHC in many countries. According to the WHO's latest "Saving lives, spending less: the case for investing in noncommunicable diseases," governments can change their disease trajectory and deliver significant health and economic gains for their citizens with suitable strategic investments. Over the years, the lack of investment in NCD prevention and care has amplified the toll of the COVID-19 pandemic. Most of the millions of people who died lived with one or more NCDs. NCD services with the highest return on investment are low-cost primary prevention and control that can be delivered at the PHC level. 
 
Every United Nations Member State pledged to deliver health and wellbeing for all, achieve universal health coverage, and build a more prosperous, equitable and sustainable world in 2015. Similarly, governments committed to "build sustainable primary health care" and acknowledged that “we will benefit from sustainable PHC that enhances health systems’ resilience to prevent, detect and respond to infectious diseases and outbreaks” in the Astana Declaration. Prioritising PHC should be seen as fulfilling a long overdue promise.

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This opinion piece is part of a blog series by the Allies Improving PHC for the 75th World Health Assembly that aims to highlight Primary Health Care as the foundation for achieving universal health coverage, health security and healthier populations globally. Pieces will be posted throughout the week of the 75th World Health Assembly, read more here