Primary care: the first step to UHC

Following on from the Declaration of Astana, UNICEF executive director Henrietta H. Fore urges leaders to position primary health care as the foundation of their universal health coverage policy

Today, by every measure, the world is a healthier place than at any time in history. Life expectancy has grown and the rate of young child mortality has fallen by almost 60% since 1990. Child malnutrition is also declining, and new technology has improved the detection and treatment of many diseases.

But as we mark this progress, we must also face a difficult fact: for hundreds of millions of people, good health remains a distant dream. The stubborn barriers of distance, poverty and discrimination deny them access to the preventive and curative health care they need. In many countries, high out-of-pocket costs also prevent access to services. These barriers exact a heavy toll on the efforts of low- and middle-income countries to shape a healthier, more equitable future for their citizens.

Consider especially the effect on children, whose health in early life can determine not only their future well-being and prospects, but also the prosperity and security of their communities. Poor countries, in particular, cannot afford to condemn large segments of their child populations to poor health and limited opportunities to fulfil their potential.

Investing in the health of every child is the surest means to build the human capital that every society needs to prosper.
But without affordable and equitable care through universal health coverage, the healthier and fairer world envisioned by the Sustainable Development Goals will remain out of reach.

We can avert this failure by ensuring access to effective, quality primary health care for all members of every society.
This means providing primary care and population health services near where people live and work. Such services are not only more convenient – they also promote demand for and participation in the design and delivery of health care among beneficiary communities.

When we increase access to quality health care, we improve the health status of entire communities throughout people’s lives. This includes through safe maternal care, vaccinations for children, HIV treatment, prevention of severe acute malnutrition, confidential services for adolescents and early child development support.

But along with these benefits of community-based primary health care to individuals, we also recognise the benefits to entire economies.

For example, the World Bank estimates that scaling up community-based nutrition-specific interventions would generate about $417 billion in economic benefits – and that every $1 invested in stunting reduction generates $11 in economic returns. The World Health Organization estimates that increasing the availability of community health workers can yield a 10-to-one return on investment through future health costs averted and less dependence on social assistance.

But these human and economic benefits can only be realised if governments make the necessary political and financial commitments.

This year, the World Health Assembly urged members to implement the Declaration of Astana on primary
health care.

As leaders gather in Osaka for the G20 meeting, there is no better time to build on this commitment. We call on all G20 members to follow Japan’s leadership and prioritise universal health coverage, with primary health care as a foundation.
First, we call on G20 leaders to encourage all countries to ensure public financing of quality, community-based primary health care. This requires not only domestic financing, but also expanded contributions of both resources and technical assistance from donor countries. Throughout, this must include investing in the quality of health care. We cannot accept ‘poor care’ for ‘poor people’.

Second, we call on G20 leaders to expand their partnerships in building primary health care. These partnerships must yield new mechanisms for public and private financing to prioritise training and salaries for community health workers, and better integration of health services so that families can easily access a range of services or referrals in one place.
And third, we call on G20 leaders to underscore their commitment by supporting a range of actions by global health partners, who are aligning around primary health care as a foundation of universal health coverage. Health is a fundamental human right, and one that should never be denied because of geography, distance, poverty or any other barrier.

Across all of these areas, UNICEF stands ready to share our experience and expertise as we translate the promise of universal health coverage into accessible, affordable quality health care for every person, throughout their lives, no matter where they live.