SEATTLE — The World Health Organization published its 2019 list of “Ten Threats to Global Health”. While high-threat pathogens and vulnerable settings made a return from the 2018 list, the WHO included weak primary health care this year, drawing on a meeting that took place in October 2018.
This meeting, the Astana Conference, called on global leaders to renew the commitments their governments made to primary health care in the 1978 Alma-Ata declaration. While the focus of global health has been on the rise of noncommunicable diseases in low-and-middle income countries, the administration of care in emergency settings and infectious diseases, this new priority signals a shift in the trajectory of global health.
Funding Primary Health Care in Developing Countries
Primary health care does not only cover the provision of medical services. Both the Alma Ata and the Astana Declarations identified interdisciplinary work in social and economic research, community-led initiatives and accessible technologies as key tenets of an effective primary health care model.
Incorporating these facets is most challenging in lower to middle-income countries; many governments lack the infrastructure to mobilize academics and communities to explore these channels. Although hospital systems in large cities possess the resources to address the health needs of the urban populations, economic barriers inhibit poorer members of rural communities from accessing these same treatments and guidance. In some countries, the primary health care systems exacerbate inequalities such as when poor and marginalized communities receive discriminatory treatment in healthcare settings. The result is that they are less likely to benefit from treatment, let alone see a doctor.
In Uganda, for example, financing primary health care relies heavily on private, out-of-pocket funds. Moreover, while 79 percent of Ugandans live in rural areas, only 30 percent of medical doctors and 42 percent of nurses practice in these regions. Coupled with a lack of regulation in medical practices, poor Ugandans and their families are less likely to seek medical guidance from a physician and only travel to the hospital after an easily preventable or manageable disease has exacerbated to fatality.
However, the government has made efforts to curb the inefficiencies in the system. The Ministry of Health has declared the Community Health Extension Workers Program as a priority moving forward. The CHEWP trains traditional healers (which account for 70 percent of medical caretakers in rural areas) and health workers to serve as quasi-primary health care practitioners.
Having identified the barriers to effective care, provider and payer systems have developed different approaches to tackling a crumbling primary health care infrastructure. One such strategy is the patient-centered medical home, in which the patient is placed at the center of care and is provided with services delivery, utilization monitoring and behavior tracking. Although this approach is beneficial to the patient, it does not completely address barriers to care for lower-income individuals.
Identifying a weak health care system as a challenge to global health is a step in the right direction and will allow governments to reconsider the inefficiencies in their existing systems. Hopefully, with the publication of the WHO’s list, member nations can make primary health care a primary priority.