Making the Case for Primary Health Care around the Globe

"As we enter 2023, it’s officially time to set aside the myth that primary health care is too complex, too expensive, or too ambitious to act on," said panelist Dr. Jeff Markuns, Executive Director of the Primary Health Care Performance Initiative (Archive) , during a live event on primary health care as the foundation of Universal Health Coverage, hosted by Management Sciences for Health last month. 

Dr. Markuns was part of an impressive panel of global health experts and advocates that MSH convened to shed light on the state of global efforts to strengthen primary health care systems worldwide and achieve Sustainable Development Goal 3. 

“As we approach the midpoint for achieving the SDGs, we know that we are in a perilous position,” said moderator Dr. Dan Schwarz , MSH's Associate Vice President for Global Health Systems Innovation, in his opening remarks. “The pandemic, climate change, fiscal austerity, and growing inequities around the world threaten our progress to date and make us question if we will truly be able to achieve these global goals.”

Dr. Serge Raharison, MD, MSc. , Chief of Party of the USAID ACCESS program in Madagascar, led by MSH, shared the story of his own dangerous birth in rural Madagascar, which he and his 18-year-old mother narrowly survived. "I do not know by what miracle my mother and I survived that day," he said. "I am in this business of public health with a mission: that is, to do my best [so] that no pregnant woman, no newborn baby, no child, no adolescent — no one is left behind."

Health systems must be designed to respond to people's needs, regardless of where they live, added Rosemary Mburu , Executive Director of the advocacy group WACI Health . She debunked the all-too-common excuse that some communities are simply too hard to reach. “In every small village in Africa there is a Coca-Cola kiosk,” she said. "We do not necessarily have hard-to-reach communities. What we have are hard-to-reach health services."

"We do not necessarily have hard-to-reach communities," said Rosemary Mburu of WACI Health. "What we have are hard-to-reach health services."

Perhaps no group has closer ties to rural communities than community health workers, many of whom are volunteers. In low- and middle-income countries, CHWs are the first trusted entry point into the health system for many people. Shoring up this workforce is crucial to achieving health for all, said Diana Frymus , Director of USAID's Accelerating Primary Health Care Collaborative.

She noted that the projected global health workforce gap is 10 million, 5.3 million in Africa alone – numbers that underscore the need for an increased focus on the health workforce, especially those on the front lines delivering primary health care.

Shifting the conversation to another critical component for ensuring high-functioning quality primary health care systems, Peter Hansen , Head of Results and Learning at the Global Financing Facility (GFF) for Women, Children and Adolescents, said countries need support allocating their limited resources. 

“We support countries to conduct resource mapping,” he explained, “to help unpack how much money is available from different sources and help support the alignment of those resources with the priorities that countries have defined.” To do this most effectively, he added, governments must have inclusive coordination platforms that bring stakeholders together to dialogue, review progress, and ensure mutual accountability.

After a lively 90 minutes, Dr. Schwarz sought to bring it all back around. “We are unquestionably at a crossroads as we think about the future of the SDGs. There is a deep amount of skepticism from many people around the world that we will succeed,” he said, “that we truly have the ability to accomplish health for all. While acknowledging these challenges, I humbly disagree. I not only believe it is possible. I believe we have to succeed.” 

Dr. Schwarz added, "Serge’s story reminds us of why. These are human beings, these are our colleagues, these are our friends, these are our mothers, these are our children. If that is not a reason enough to reach these communities and to deliver on these goals, then I don’t really know what is."

Watch a video recording of the event in English, French, or Spanish here.