Primary Healthcare Is the Nucleus of Resilient Universal Health Coverage

The pivotal role of primary health care (PHC) as a cornerstone for attaining Universal Health Coverage (UHC) has been an enduring concept since the Alma-Ata Declaration of 1978 and reaffirmed in subsequent milestones like the Astana Declaration in 2018. PHC functions as a nucleus for integrated health systems, not only responding to challenges but capitalizing on opportunities. Its importance transcends health outcomes: PHC is the foundation of comprehensive, equitable, and inclusive human rights-affirming health systems and solutions. Like UHC, its umbrella is broad, which can make systemic solutions and progress difficult to see in an ever-evolving global health landscape—but there are many innovative and proven strategies we can point to that underscore PHC's importance in health systems.

A Best Bet Against Future Pathogens

Evidence increasingly underscores the role of PHC in delivering equitable, high-quality health services while also strengthening health systems against emergent diseases. Responding to outbreaks disproportionately strains health systems' resources, often entailing protracted recovery timelines. The COVID-19 pandemic underscored PHC's significance in pandemic preparedness and response and the importance of integrating disease detection and prevention in primary care—as a potent strategy to proactively address health threats at the community level and bolster health system resilience. The comprehensive, community-centric nature of PHC makes it a vanguard in responding to public health crises and promoting holistic well-being.

Investing in PHC can strengthen a health system's ability to respond to health threats in the short term while also building long-term preparedness and resilience. The Kyrgyz Republic, for example, faced significant challenges in its PHC system during the COVID-19 pandemic, including inadequate infrastructure, overcrowding, and a lack of standardized infection prevention and control (IPC) measures. These issues left the PHC system ill-equipped to handle infectious diseases like COVID-19. But the solutions can be straightforward: in this case standardized guidance and training provided the foundation for significant systems improvements.

To address this, the Local Health System Sustainability (LHSS) project supported the Kyrgyz Republic to enhance IPC in PHC facilities. This included developing a comprehensive IPC manual aligned with global best practices from the World Health Organization and the U.S. Centers for Disease Control and Prevention. Additionally, LHSS updated and strengthened the capacity of health workers on IPC quality assessment through monitoring and evaluation guidelines and self-assessment tools which equipped them with the knowledge and skills necessary for effective IPC implementation. This resulted in the creation of five practical manuals to guide health workers in IPC and the management of COVID-19 patients. The IPC manual became a valuable resource in medical education, further preparing future health workers to detect and respond to diseases effectively.

Innovative Financing for PHC Can Catalyze Change

Despite global commitments enshrined in the Astana Declaration, persistent challenges impede consistent investments needed to ensure comprehensive PHC coverage, uninterrupted access, and uncompromising quality. Channeling investments into PHC infrastructure and workforce training is imperative to enhance the adaptive capacity of health systems in managing and mitigating future health challenges. By adopting innovative financing approaches, we can activate a transformative shift in health delivery, reducing health inequities and enhancing health outcomes for all. Innovative financing models encompass blended financing mechanisms, community-based health insurance frameworks, and the transformative potential inherent in social impact bonds.

In Bangladesh, for example, rapid urbanization creates major challenges in urban health centers, with population density and resource limitations leading to deepening inequities and gaps in coverage. Addressing these issues requires non-traditional funding models and innovative financing solutions for PHC. In what could be a model for analogous problems in other health systems, LHSS has introduced pioneering financing mechanisms, forging public-private partnerships and community-based health insurance schemes to expand PHC access. By engaging multiple stakeholders—from local governments to the private sector--the project has not only secured sustainable funding sources but significantly enhanced the availability of PHC services in urban areas with a total of seven new PHC clinics opening in Bogura, Habiganj and Natore municipalities. This innovative approach has broadened access to essential health services and rendered it financially feasible for low-income urban residents through the community-based health insurance model, which Abt has implemented in over a dozen countries since 2010.

Community-Led and SDG-Focused PHC: A Paradigm of Inclusivity

Moving towards a community-driven approach to PHC, predicated on partnerships that co-create health systems solutions, is critical to shift from prescriptive approaches towards more inclusive PHC strategies. Localized solutions foster trust, understanding of community needs, and heightened collaboration between stakeholders within the health system. They also more purposefully integrate the social determinants of health—such as nutrition, food security, preventive care, mental health, and strategies for climate adaptation—into PHC services.

Community-led approaches bring these issues and others—like the dire shortage of consistent energy supply across Africa's healthcare landscape—to the fore as central to quality health care delivery. They prove the interconnectedness of SDG-driven strategies. An SDG-responsive PHC system must integrate dependable energy sources into health systems. The Abt-led Health Electrification and Telecommunications Alliance project, for example, highlights how investing in the productive use of energy allows health facilities to harness renewable energy solutions, notably solar power, to ensure a steady supply of electricity—which enables facilities to operate more efficiently (and safely) and strengthens health system infrastructure. Integrating sustainable energy not only advances SDG 7 (Affordable and Clean Energy) by embracing renewable sources but also contributes significantly to SDG 3 (Good Health and Well-being). Reliable power enables accurate diagnoses, ensures the safe storage of vaccines, and facilitates more efficient patient care. Healthcare can become a catalyst for achieving broader sustainable development objectives, and vice versa, bridging the gap between health system needs and energy sustainability.

Looking Ahead: Navigating the Complexities of Future Health Systems

Health systems are confronted with complex and evolving challenges that undermine optimal health outcomes. These challenges include widening disparities in health access, recurrent outbreaks and health emergencies, the menace of climate change, the escalating threat of antimicrobial resistance, and the growing issue of healthcare worker burnout. Amidst these challenges, many opportunities emerge such as advancement of digital transformation, artificial intelligence, innovative financing models, new technologies, and heightened global interconnectedness. Rethinking developmental efforts to address these complex challenges and harness the potential of transformative innovations is imperative.

Follow The Future of Health Systems webinar series for pragmatic solutions, diverse perspectives, and actionable strategies to strengthen the adaptive capacity of health systems.