Strengthening primary healthcare to achieve universal access to healthcare in Africa

Primary healthcare acts as the bedrock for building a vibrant healthcare system that ensures positive health outcomes and health equity. The World Health Organisation (WHO) enhanced its role in primary healthcare (PHC) in 1978, when it was identified as the key to the attainment of the goal of “Health for All” and as a central mechanism for promoting health throughout the world.

Access to healthcare services is a universal human right, which reinforces the persistent call for universal healthcare coverage. This call is more pronounced in developing countries like those in Africa, where there is a lack of access to basic healthcare services. Due to this, the WHO is championing PHC as the answer to attaining universal healthcare coverage. Unfortunately, in Africa, PHC remains 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.

Impact of primary health care

In both developed and developing countries, PHC has been linked with improved access to healthcare services, better health outcomes, and a reduction in hospitalisation and the use of emergency department visits. In many developing countries in Africa, various forms of PHC have a positive effect on health costs, appropriateness of care, and results for most of the key health indicators, including a reduction in childhood and maternal deaths.

Furthermore, PHC can also assist in preventing the negative effects of poor economic conditions on health. PHC is meant to serve the population, especially the poor, vulnerable, and low-income earners. Studies show that the establishment of primary health centres in communities increases accessibility to healthcare services and helps to bridge the inequalities suffered by people in the communities. Ultimately, countries associated with a vibrant PHC orientation have stronger and more equitable health outcomes than countries that are oriented toward specialty care.

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

Challenges confronting primary health care in Africa

Enormous challenges continue to limit the effectiveness of PHC systems in Africa. A major challenge is the shortage of human resources and poor funding for health care in Africa. The African continent has 25% of the global disease burden but only 3% of the world’s health workers and less than 1% of the world’s health expenditure. In many countries, the health workers who form the main primary care workforce have limited training. Doctors are rarely seen in primary care outside of the private sector and are often in short supply, particularly in rural areas. Few African countries meet the target of 15% of general government expenditure on healthcare that was agreed upon in the Abuja Declaration of 2001. Hence, there are fewer resources to go around, and those resources available are often concentrated in prestigious central referral hospitals.

Another significant challenge is fragmented governance and coordination, coupled with poor and dilapidated health facilities. Primary care providers typically have a limited range of resources and medications and work in poorly maintained infrastructure that is often rural or remote. In addition, governance systems are weak and lack supportive supervision and managerial leadership.

Strengthening primary health care systems in Africa

Despite the challenges, several African countries are making concerted efforts to strengthen their PHC systems, with increasing political commitment to comprehensive PHC and universal health coverage. For example, Ghana has introduced a national health insurance scheme with a focus on universal health coverage and community-oriented primary care (COPC). In Nigeria, the government established the Basic Health Care Provision Fund (BHCPF), which aims to extend Primary Health Care (PHC) to all Nigerians by substantially increasing the level of financial resources to PHC services.

In view of these, Bloom Public Health recommends increasing investment and funding for PHC systems. 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. In Africa, there is a need to pool funding and resources from the government, private sector, and international organisations for direct investment in boosting health workers, medicines, equipment, facilities, and ambulances across the continent, particularly for rural populations.

The provision of access to quality and affordable essential medicines is a critical element in implementing PHC. Hence, another key strategy is to strengthen the health supply chain through the implementation of sustainable drug revolving fund (DRF) schemes. Effective DRF schemes can help address the problems in the financing of PHC in Africa and develop a capacity for sustainable delivery of satisfactory care that is affordable to all. Bloom Public Health and its partners are currently implementing innovative supply chain systems in various states in Nigeria to ensure that all health facilities, including those in remote areas, are well-equipped with quality and affordable medicines and medical products.

In conclusion

PHC is the most inclusive, equitable, cost-effective, and efficient approach to enhancing healthcare. Evidence of the wide-ranging impact of investment in PHC continues to grow around the world. It is therefore imperative that African governments strengthen PHC systems on the continent as a non-negotiable pathway to achieving universal healthcare coverage.