Build back better to achieve universal health care
Strong PHC services that are publicly financed help mitigate the social and economic determinants of health and reduce out-of-pocket costs
The world will soon enter the third year of the Covid-19 pandemic. In the Southeast Asia region, and across the world, the severity and scale of the crisis have exposed longstanding gaps in national and sub-national health systems, and stalled decades of economic growth and progress on poverty alleviation. The World Bank estimates that in 2020 alone, the region suffered an economic contraction of -5.4%, pushing tens of millions of people into extreme poverty and limiting fiscal capacity for years to come.
Throughout the response, the health system and cross-sectoral performance in the region have yielded an array of lessons learnt — lessons not only on how countries can better prevent, prepare for, and respond to Covid-19 and other health emergencies, but on how they can build a health and economic recovery from Covid-19 that is fairer, healthier, more resilient, and sustainable for all.
Countries of the region unanimously agree: Primary health care (PHC) is the way forward. PHC services that are comprehensive, integrated at all levels of care, and which include all essential public health functions, achieve the highest possible level of health and well-being. They empower and engage individuals, families, and communities, increasing social participation, self-care and self-reliance in health — outcomes that are essential to achieving universal health coverage (UHC).
Strong PHC systems meet people’s health needs close to where they live and work, and provide a high return on investment. Between 2001 and 2011, a quarter of all economic growth in low- and middle-income countries resulted from improvements in health, with an average return on investment in health of nine to one.
Strong PHC services that are publicly financed help mitigate the social and economic determinants of health and reduce out-of-pocket costs. Among all World Health Organization (WHO) regions, the Southeast Asia region has the highest proportion of out-of-pocket spending on health, in addition to accounting for a disproportionate share of the world’s poor.
As part of International UHC Day celebrations, and in pursuit of a landmark resolution adopted at the WHO regional committee in September, WHO has launched a new regional strategy for PHC that will help all countries of the region build back better to achieve UHC and health security, and accelerate towards the health-related Sustainable Development Goals.
Several priorities must be addressed.
First, reviewing and updating health-related national policies and plans, ensuring that they are PHC-oriented. Such processes could be facilitated by a national task force comprised of key stakeholders — including civil society — that draws on experiences and lessons learnt, and which prioritises expanding universal benefits packages and ensuring essential public health functions.
Second, increasing and improving the financing of PHC: Since 2019, WHO has advocated with all governments to allocate at least 1% of their Gross Domestic Product (GDP) to PHC to achieve the 2030 targets. At a minimum, a higher proportion of the additional resources available for the health sector should be allocated to PHC.
Third, implementing governance reforms that enable action on the social determinants of health. Partnerships between the public and private sectors should be better defined and strengthened. Funds, functions, and functionaries should be decentralised to enhance local oversight. Health-related ministries should develop and implement multisectoral action plans that promote a culture of shared ownership and accountability, in line with the “health-in-all-policies” approach.
Fourth, reorganising PHC service delivery. Policies, strategies and service standards are required to support a continuum of care across programmes and services, ensuring they are people-centred and community-led. Essential public health functions and programmes must be better integrated, and the specific needs of communities should be accounted for, including in urban areas.
Ongoing efforts to strengthen the availability, competency, and performance of the PHC workforce are essential. In all countries of the region, the full array of available health workers should be included in and organised as multi-disciplinary teams that are capable of meeting the full range of people’s health care needs throughout the life-course.
New innovations — particularly in digital and disruptive technologies — must be appropriately leveraged and introduced in a way that is context-specific, and which is ethical, safe, secure, reliable, equitable, and sustainable.
Through it all, we must continue to not just ask, but answer a basic yet vital question: Who is missing out and why? To do this, we must strengthen health information systems, ensuring that data is stratified by key equity indicators such as sex, income, and age; that they prioritise the needs of PHC providers and managers; and that they are shared with communities and civil society to promote accountability and trust — values that are at the core of WHO’s new regional strategy.
Our journey will not be easy, but it is a journey that will yield game-changing health, social and economic progress in the months, years and decades ahead. To leverage this once-in-a-century opportunity, we have the will and the way forward. We must act now.
Poonam Khetrapal Singh is regional director, WHO Southeast Asia
The views expressed are personal