The closest thing to a silver bullet: primary health care for Universal Health Coverage

Universal health coverage (UHC) – a world in which all people can get the health services, vaccinations and medicines they need without financial hardship – is an ambitious goal. There is no silver bullet. But we do have something close.

A strong primary health care system can meet 90% of healthcare needs, according to the World Bank. Primary health care is a first line of defence against communicable and non-communicable diseases alike, and vital to the survival and health of women, children and adolescents. Strong primary health care services are crucial to early diagnosis and delivering preventative, curative and palliative care across the life course. The health workers who deliver primary health care are essential gate keepers, guiding people through the health system and improving efficiency by directing patients to the most appropriate and affordable services.

This makes primary health care a smart investment and a critical foundation for all countries working to achieve UHC by 2030 under the Sustainable Development Goals.

Why then are we running out of time to achieve UHC by 2030?

WHO estimates that 400 million people are still living without one or more basic life-saving health services. And each year another 100 million people are pushed into poverty by the cost of health care. We know that women and children from poor and marginalised populations face the greatest barriers to accessing essential healthcare. In Nigeria, for example, a child from a wealthy family is 15 times more likely to be vaccinated against diseases like pneumonia than a child from a poor household.

Primary health care systems in many countries are underfunded and not prioritised by governments or donors. Current health funding typically focuses on vertical health issues like HIV, TB and malaria and higher-level health care, leaving limited funds for strengthening primary health care. Recent modelling looking at how to achieve the SDG health targets found that the majority (57%) of funds should go to primary health care. But forthcoming analysis by the Primary Health Care Performance Initiative (PHCPI) examining data from 31 low- and middle-income countries shows that just one-third (33%) of government health expenditure goes to primary health care (median figure).

Findings from the same study show it is patients who are picking up the bill. PHCPI found that the median contribution of governments to primary health care expenditure was 17%. Donors spent the same amount while households contributed a massive 59%.

WHO has found that out-of-pocket spending by households must be kept below 15%–20% to avoid catastrophic and impoverishing health expenditure.

How do we get to UHC by 2030?

No country will achieve UHC without first delivering primary health care for all. Investing in strong primary health care systems that deliver high-quality, accessible services free at the point of use should be the foundation for the global community as we work toward UHC by 2030.

UHC is an ambitious but affordable dream and there is no substitute for public investment. How funding is spent is as important as how much is spent. All countries can make progress towards UHC by improving the way they spend money on health. Governments should work to increase fiscal space through progressive taxation and spend at least 5% of their gross domestic product (GDP) on essential health services, prioritising primary health care systems. Country context matters – countries need to clearly define and cost their essential health benefits packages to guide health financing and delivery.

The international community still has a role to play. World health leaders should work to develop a roadmap to help coordinate national governments, civil society, donors and the private sector as we work together to achieve UHC. Where 5% of a country’s GDP is too little to deliver priority health services, donor funding should support investment in primary health care. Donor funding to countries struggling to raise revenue should aim to improve taxation to grow government budgets to deliver all essential services, including primary health care as a critical first step toward UHC.

The Universal Health Coverage forum being held in Japan this week is a crucial opportunity to galvanise support for an accelerated and strategic push toward 2030. Save the Children will launch the report Primary Health Care First: Strengthening the foundation for universal health coverage on 12 December 2017 for Universal Health Coverage Day. The findings will be presented at the panel event Building blocks for change: Strengthening primary health care systems for change on the final day of the conference, 15 December 2017 – register here to join.

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