Addressing challenges in primary health care as pathway to achieving universal health coverage

All people, everywhere, irrespective of location or socioeconomic status, deserve the right care, right in their community. This is the fundamental premise of primary health care (PHC).

In Africa, PHC has been grossly inadequate, with less than half of the population having access to basic health services, which in many communities are ineffective or of questionable quality.

Primary health care and universal health coverage

Achieving universal health coverage (UHC) is one of the most prominent global health policies under the United Nations Sustainable Development Goal: “Ensure healthy lives and promote wellbeing for all at all ages.” Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”

PHC plays a critical role in achieving UHC as it provides a framework for organising and delivering care based on a patient-centred, efficient, fair, and cost-effective way. Core features of PHC, including patient-centredness, comprehensiveness, integration and continuity of care, have repeatedly been associated with better health outcomes and higher user satisfaction.

Challenges confronting primary health care in Africa

Over the years, African governments have developed policies aimed at improving PHC delivery in their respective countries. An example is the Basic Health Care Provision Fund (BHCPF) established in Nigeria as a catalyst funding to improve access to PHC.

Unfortunately, despite such policies, PHC on the continent has remained confronted by several challenges, preventing it from reaching its full capacity. These challenges include fragmented governance and coordination, poor and dilapidated health facilities, shortage of human resources and poor funding, among others.

It is also worth mentioning that even where PHC services are available, rising inflation often forces families to choose between using their limited resources to access healthcare or purchase other necessities like food.

Strategies to strengthen primary healthcare in Africa

There is an urgent need to strengthen PHC systems in Africa as a non-negotiable pathway to sustainable, resilient health care for the over 1.37 billion people on the continent.

In Nigeria, transforming PHC has been a major priority for the government. In the recently concluded Primary Health Care Summit 2022, themed ‘Re-imagining Primary Health Care in Nigeria,’ stakeholders in the public health sector convened to identify gaps and develop strategies for a sustainable transformation of the PHC system.

The National Primary Health Care Development Agency (NPHCDA) in collaboration with the Nigerian government, international partners, and the private sector has adopted a 10-year Transform PHC Programme that will aim to build over 80 new health centres, upgrade over 7000 health facilities, recruit over 10,000 new nurses, and over 9,000 new community health extension workers.

We at Bloom Public Health believe this is a bold plan that is achievable through the commitment of all relevant stakeholders.

In view of these, the following are key strategies, which must be adopted for the successful implementation of this transformational programme in Nigeria and other such PHC interventions across Africa:

1. Increasing investment and funding for the PHC system: There is a need to pool funding and resources from the government, private sector, and international organisations to invest in the PHC system.

Most public health funding narrowly targets specific threats like Malaria or HIV/AIDS, but to sustainably transform PHC, we need to move from providing siloed curative services to preventive care.

There is a need for intensified direct investment to boost health workers, medicines, equipment, facilities and ambulances across the continent. According to the WHO, achieving the global targets for PHC requires an additional investment of around $200 to $370 billion a year for a more comprehensive package of health services.

2. Strengthening human resources, particularly in rural communities: To achieve a sustainable transformation in PHC, we need to address the issues of human resources to attract and retain more skilled health workers, and significantly improve the distribution of human resources to rural communities.

3. Strengthening the health supply chain through the drug revolving fund (DRF) scheme: The provision of access to quality and affordable essential medicines is a critical element in implementing PHC.

According to the WHO, about 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10 percent or more of their household budget.

It is for this purpose that the DRF exists, to solve the problems in the financing of PHC in sub-Saharan Africa and to develop a capacity for sustainable delivery of satisfactory care that is affordable to all.

Bloom Public Health has made tremendous progress, by the recent signing of the MoA with the Ebonyi State government, along with its strategic partners, to establish a DRF in Ebonyi State. Bloom Public Health is looking forward to scale this project across Africa.

PHC is the most inclusive, equitable, cost-effective and efficient approach to enhance healthcare.

Evidence of the wide-ranging impact of investment in PHC continues to grow around the world, particularly in times of crisis, such as the COVID-19 pandemic. Strengthening PHC systems in Africa is therefore the gold pathway to achieving universal health coverage and health for all.