As a physician, I know firsthand the important role that primary health care plays in the health of individuals, families, and communities. When it works well, it is the foundation of a good life and a thriving national health care system. When it is weak, people suffer.
We’ve seen that play out, with tragic consequences, during the COVID-19 pandemic. Primary health care has been the weakest link in the pandemic response despite its importance in “flattening the curve” through such measures as surveillance, testing and contact tracing, and in keeping hospitals from overflowing with critically ill patients.
Though the pandemic has shone a light on the weaknesses of countries’ health systems, it has also highlighted the important role that primary health care can play during health emergencies. A new report by the World Bank, “Walking the Talk: Reimagining Primary Health Care After COVID-19”, shows how countries can revitalize their primary health care systems to improve health outcomes and be better prepared for the next global pandemic.
In the report, we outline four structural shifts that will be required of countries in the design, financing, and delivery of primary health care:
• From low-quality to high-quality services delivered by multi-disciplinary teams to strengthen the range and quality of care.
• From fragmented care to person-centered integration, in which cohesive, local primary health teams coordinate care around patients’ needs.
• From inequity to fairness and accountability, in which equitable, efficient primary health care delivery fosters and rewards accountability for health outcomes.
• From fragility to resilience in which primary health care teams conduct public-health surveillance and outreach, and health sector planning and resource allocation include financial and human-resource surge capacity.
These shifts are not only important in combating the COVID-19 pandemic and preventing the next terrible health calamity, but they are also critical in providing health security, stability, and prosperity.
Fit-for-purpose primary health care offers integrated, responsive, continuous, and community-oriented care delivered by a competent health care workforce. To achieve this, governments should reform medical education and assist providers in retooling skills for multidisciplinary team-based care.
We need to change how we compensate providers to encourage them to work as general practitioners rather than as specialists and in rural communities rather than in cities. It will also require reforming licensing requirements for health care practitioners and strengthening information technology.
Crucially, we must revamp the way primary health care is financed.
Health financing for PHC needs to increase significantly in developing countries – investments that need to be made by the countries themselves and financial support from donors. For governments it will be key to develop a political strategy to deliver financing reforms and pay for health care through their own revenues rather than through user fees, which poor people cannot afford, and instead levy taxes on tobacco, alcohol, and sugar to pay for reforms.
The World Bank stands ready to assist countries in these vital reforms, whether it be through accelerating access to financing, providing technical assistance, sharing knowledge, or developing policy options through dialogue with national leaders.
We saw the remarkable speed with which scientists in several countries developed a safe, reliable, and highly effective vaccine to protect people from COVID-19. They succeeded because governments invested in the research and because there was a tremendous will and determination to succeed.
Imagine if governments applied the same investments and the same will to revitalizing their primary health care systems. Think of the diseases that we will prevent, the health that we will improve, and the prosperity that it would bring to nations.
What in the world are we waiting for?
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