IT'S TIME TO BETTER UNDERSTAND WHAT MAKES PRIMARY HEALTH CARE WORK
Staff, patients and visitors at Pokhara Regional Hospital, Nepa
Recent crises from the earthquake in
Nepal to the Ebola epidemic in West Africa have been wake-up calls: too many
primary health care systems are under-resourced and fragmented, leaving
countries unprepared to reach everyone with needed health services. This is
true when disasters strike, and it’s also true in times of relative calm.
functional primary health care systems that people trust, critical health
services including prevention and treatment of infectious diseases, management
of chronic conditions and access to family planning are often inadequate or non-existent.
This fuels a daily crisis that is for the most part avoidable: In 2013, of the
approximately17,000 children under 5 who died every day,
most died from causes that could have been treated and prevented through a
strong primary health care system.
number of countries are making progress building high-performing primary health
care systems and providing instructive models. For instance, Rwanda has
integrated services for a range of community health needs including malaria,
pneumonia, family planning, and HIV and AIDS into its primary health care
system as a core part of the country’s health reforms. This approach has helped
Rwanda come close to universal health coverage for its citizens.
a major stumbling block to improving primary health care is the availability of
specific and relevant information to guide improvements. Countries that want to
improve their primary health care systems often do not know in what ways their
systems are getting better or worse and most importantly, why.
of the most basic indicators of the health of primary care systems is whether
providers are present and appropriately trained. Yet systematic data on
provider absence rates and the accuracy of their diagnoses areavailable for only a handful of low- and
middle-income countries and where available, they are often not
comparable. From the data we do have, it is clear that in many countries,
provider absence rates are high and, when present, diagnostic accuracy rates
are low factors contributing to far too many preventable deaths.
better measurement of what drives strong primary health care systems, there is
tremendous opportunity to have a major impact on health.
The recentMillennium Development Goals report made
clear that the effective collection, dissemination and use of data was key to
achieving global health targets. In Mexico, for example, data on the number of
births attended by health professionals revealed stark inequalities between
indigenous and nonindigenous populations, which led to new efforts to reduce
inequities and save lives.
fall, theUnited Nations is expected to ratify
a bold new agenda for sustainable development for the next 15 years. For global
health, the success or failure of this important agenda will depend in large
part on measuring and improving primary health care. It is very difficult for
countries to make sustainable gains in health including reaching global goals
such as universal health coverage without strengthening access to and delivery
of essential care in communities.
and measuring what’s working with primary health care systems will guide
decisions about meaningful improvements at all levels of the health system from
doctor-patient interactions to district planning to national health strategies.
And when countries know how to improve care, they can ensure that giving a
mother and her child a healthier future isn’t a guess, but a guarantee.