There's perhaps no health topic more important than primary health care

In just one week time, world leaders at the UN General Assembly will meet for the second high-level meeting on universal health coverage. The last high-level meeting, in 2019, took place just a few months before the COVID-19 pandemic began. The pandemic reversed many of the gains we had made, but it also showed why universal health coverage, built on the foundation of strong primary health care, is so important – for all levels of economy.

This year’s high-level meeting is vital for re-energising the movement towards universal health coverage, and for reminding the world that although COVID-19 is no longer a global health emergency, political commitment to primary health care is essential for keeping the world safe against future epidemics and pandemics. Here's my take.

A primary health care approach is an inclusive, equitable and cost-effective path to universal health coverage. Of course, that does not mean that secondary and tertiary care are not also important. Universal health coverage means ensuring people have access to essential health services at all levels of the health system. The point is that investments in primary health care are the most cost effective, in terms of the amount of investment required and the returns delivered in preventing or delaying the need for more costly secondary and tertiary care.

Primary health care is also one of the most misunderstood concepts in public health. Many people, even within the public health world, understand primary health care to mean health service delivery at the local level. Primary health care certainly includes delivering primary health services in communities. But a primary health care approach is far broader, bringing together primary care and public health to address the needs of individuals and populations in an integrated way:

• It includes action across sectors to address the social, economic, commercial and environmental determinants of health.
• It includes engaging and empowering people to take charge of their own health.
• It enables systems to respond to the population’s health needs from health promotion to disease prevention, treatment, rehabilitation, palliative care and more.
• It recognizes that health does not start in hospitals or clinics, but in homes, schools, streets, and workplaces – in the air people breathe, the food they eat, and the conditions in which they live and work.
• It strengthens the resilience of health systems to prepare for, respond to and recover from shocks and crises. ?

Many countries with the most advanced medical care systems were surprised by COVID-19 because of their historic lack of investment in primary health care.

Strong primary health care requires long-term investments in health and care workers, and specifically in decent working conditions. Investments in education must be matched to jobs and careers, with the right salaries and incentives. In many countries, and particularly the poorest ones, the main driver of shortages is insufficient resources to create jobs and pay wages. Given that two-thirds of the global health and care workforce are women, investments in the health and care workforce can also advance gender equality.

The primary health care approach brings health care closer to communities.

If implemented successfully, it can help deliver at least 90% of the health services people need throughout their lives. We estimate that expanding primary health care in low- and middle-income countries could increase average life expectancy by 3.7 years by 2030. Realising these gains will not just happen. It takes at least three key ingredients:

1. Strong political commitment In every country that has made serious transformations to primary health care, it has done so on the basis of political support from the highest levels of government.
2. Strong financing Domestic financing must be the backbone of primary health care in all countries, supplemented where needed by international support. The new Health Impact Investment Platform aims to attract investment by development banks to support country-led primary health care investment to speed up progress toward universal health coverage.?
3. Careful planning and meticulous implementation We remain committed to supporting all countries on their primary health care investment plan, and to develop social safety nets to tackle out-of-pocket health spending.?

We live in a world of many competing priorities, but we need to keep the attention of world leaders on health as the foundation of sustainable development. I urge leaders to invest in educating and expanding a health and care workforce to deliver on primary health care goals.

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