Primary health care still matters today

Published on Thursday, 13 June 2013

Published by Susann Roth and Dr. Jean-Jacques Bernatas on Thursday, 13 June 2013

We have read with great interest World Bank President Jim Yong Kim's speech to the World Health Assembly on 21 May. It was a passionate speech that highlighted the need to focus on the daily public health concerns of populations.

President Kim reminds us that the Alma-Ata declaration in September 1978 where the notion of primary health care (PHC) took its origin is still very relevant. The Alma-Ata declaration is about how to make healthcare sustainable not only in limited resources setting. The emphasis is on the need for strong primary health care, which includes health promotion.

So, after 35 years how much have we achieved? 

I believe PHC is the foundation of any healthcare system in both developing and developed countries. It is the practical translation of sustainability in healthcare. However, we have to admit that we still cannot say with confidence that we provide primary health care to the population in Asia and the Pacific.

In the past – and this was also one of the critiques of the MDGs – health issues, such as maternal and child health were addressed in verticals programs without linking to a country’s health systems. This led to unsustainable programs, which provided short-term solutions.  One example given in the speech was the often-unsustainable infrastructure investments in the health sector.

I agree with the description of the "epidemic of hospital building" in middle-income countries. Most of them are very shortsighted looking for an immediate profitability – putting aside infectious disease control and quality of care. 

See what is happening now in Vietnam. Low quality health care infrastructure is built without ensuring quality control, which is of utmost importance for providing safe health care. These mushrooming hospitals can put population at risk and do not address basic health care needs in an efficient and effective manner.  

One of ADB’s roles should be to advise governments and investors on the right investments decision that would improve quality and quantity of health care service delivery, which is linked and built on quality primary health care in a sustainable manner. 

I like also the "science of delivery" discussion taken up by the World Bank. This applies to all settings – from high to low-income countries, private and public. 

My current concern is that health is increasingly recognized as a business, which on the one hand is good since it drives supply and demand. However, I am worried that the quality of health care services and products suffers as long as many Asia and the Pacific countries have no standard operation procedures and regulation in place for the health sector. Moreover, the general low education levels of consumers limits the informed decision making on health care and health products, which in most cases have to be paid out-of-pocket.

For example in the Philippines consumers can shop online for all kinds of medical tests. But without adequate advice on what is really necessary for their condition, it leads to increase in out-of-pocket expenditures. One can argue that online ordering of medical tests or products provides better access to care, but on the other hand, it is uncontrolled practice that could lead not only to unnecessary expenditures for the individual but also to false diagnosis. 

Thus, what we need is high quality primary health care that includes health promotion and health education to create aware, informed and healthy populations.

Let’s get the basic right first. The Alma-Ata declaration is still valid!