Why the world needs to rethink primary healthcare after the pandemic

It is more than 40 years since a global declaration on primary healthcare (PHC) called for world governments to take urgent action. Since then, according to the World Bank there has been plenty of talk but not enough action.

In its report Walking the Talk: Reimagining Primary Health Care After COVID-19, the World Bank says: “For nearly half a century, countries have struggled to walk the talk on PHC. We have not built health systems anchored in strong PHC where they were needed most.”

The consequences of that failure to deliver robust healthcare services were revealed by the COVID-19 pandemic, according to the report: “PHC was often the weakest link in the national and community response, despite its critical importance as a backstop to ‘flatten the curve’ and prevent hospital saturation.”

Likening the pandemic to a day of reckoning for PHC implementation, the report highlights some of the wider health-related challenges and details how systemic PHC failures could be overcome.

Healthy life expectancy matters

Life expectancy at birth is frequently used as an indicator of health status. In 1990, it was 65.4 years. By 2018, that had risen to 72.6 years. People in low-income countries have a lower average life expectancy at birth, however. High rates of maternal and child mortality, conflict and violence, and the HIV pandemic are among the reasons why.

But the World Banks says another measure could provide a clearer picture of overall population health – healthy life expectancy (HALE).

HALE takes into account a wider set of health outcomes, including non-fatal. It also shows an income-based disparity. “The average HALE in high-income countries exceeds the global average by almost 7 years,” the report says.

What that means is that some people aren’t just living longer. Sometimes, they’re living longer in poor health, which can have implications for their ability to work and further jeopardize their overall circumstances.

Preventable and noncommunicable diseases are a significant problem in developing countries. In low- and middle-income countries, the World Bank says: “Over three-quarters of diabetes patients and 90% of individuals with hypertension receive zero or inadequate care to control their conditions.” Poor quality PHC is thought to be responsible for around 60% of all healthcare-preventable deaths in these countries, the report continues.

Rebuilding post-pandemic PHC

This is, the World Bank says, a “once-in-a-generation chance for structural health-system change.” It is calling for reforms and a reassessment of goals to make the delivery of robust healthcare for all a priority. This will create a more equitable distribution of healthcare, and should mean the world is better prepared to cope with any future pandemics or similarly large public health calamities.

But, the World Bank says: “The walk has to finally match the talk.”

To that end, the World Bank will focus its efforts in three key areas – lending, learning, and leadership – to help bring improved PHC to fruition in countries where it is most needed.

Lending: accelerate access to funding for PHC reforms

Focusing on making it easier for countries in need to access funds for PHC-oriented system reforms.

Learning: mobilize practice-relevant PHC knowledge

Strengthening global knowledge hubs, and offering help to support the integration of PHC knowledge into policies and programmes.

Leadership: develop country-specific policy options through dialogue

Supporting national leadership in PHC reform efforts and working to establish a platform for policy dialogue, advice, and technical assistance to Ministries of Health and Ministries of Finance around the world.

"A life-course approach to healthy ageing is ever more important now life expectancy has increased globally," says Sofiat Akinola, Project Lead, Shaping the Future of Health and Healthcare at the World Economic Forum. "We must ensure that the years gained is lived in good health, focus on prevention and ensure that our health system is sustainable in meeting the demands of present and future generations."