Challenges to Global Primary Healthcare

Although global health care recorded significant improvements with the Millennium Development Goals, the UN General Assembly and governments of member countries agreed in November 2015 to collaborate towards achieving seventeen (17) Sustainable Development Goals (SDGs). The aim was to ‘ensure healthy lives and promote well-being for children and adults’ (Luisa et al., 2015). The SDGs were categorized into 13 core domains: Reproductive & child health (3 target areas); Communicable/non-communicable diseases & Addiction (3 target areas); Environmental health (2 target areas); Universal Health Coverage (UHC) (1); Tobacco control, Vaccines and Medicines, as well as Health financing and Workforce, and Global health risk preparedness (4 target areas).

However, evidence-based study by the UNICEF and WHO presented at the 2018 Global Conference on Primary Health Care held in Astana, Kazakhstan shows that countries have made significant progress in primary health care. The researchers noted that the progress in PHC has been uneven in the last four decades. Disparities in health outcomes were also noticed with and between countries analysed. But PHC has been a driver of economic development—not just an outcome of sustainable development as misconstrued by critics of the primary care model. Thus, the principles of PHC facilitate attainment of the UHC, SDGs, and various national health objectives (Kalra et al., 2021).

Health providers, patients and stakeholders in the global health industry must therefore recognize that the world is a different place than it was before the 1978 Declaration of Alma-Ata (Denis et al., 2001; Sheikh et al., 2013). With the new Declaration of Astana (2018) which reaffirms that ‘health is a right, not a privilege for those who can afford it,’ there is an indebt and more comprehensive understanding of the practical implications on running primary health care systems in today’s world based on the original PHC principles of solidarity, equity, and justice for all. Here’s a brief analysis of the current challenges to global primary health care (Atchison & Bujak., 2001):

–Funding of PHC Systems

One of the challenges to establishing high-quality primary care and ensuring equitable access across the population is funding. PHC systems all over the world require huge governmental allocations to run smoothly. For example, investments in research and development (R&D), ICT and new health technologies involve huge budgets that increases cost of care borne by patients (Starfield., 2011b). However, inadequate funding of PHC systems in developing or less-developed countries—specifically those running the Out-of-Pocket model of care—increases payment burden on care users unlike the Beveridge, Bismarck or NHI frameworks. This implies that health care financing under the Out-of-Care model may militate against universal access to primary care thereby stagnating actualization of SDGs in developing ad less-developed countries (Rawaf et al., 2008).

Developed economies operating health care models that allow tax-based financing are favoured to achieve equitable access to medical services. However, these features of the Beveridge, Bismarck and NHI models may lead to low budgetary allocations to the health sector, and resultantly, under-investment in health care systems. The consequences would include underuse of modern technology and reliance on outdated health care practices that not only reduce productivity but increases risks to human life (Rasanathan et al., 2011; O’Connell et al., 2013).

–High Cost of Care Incurred by Patients

Evidence-based studies have demonstrated that total cost of medical services incurred by patients in the Out-of-Pocket model is largest when compared to expenditure in both public and private facilities found in countries practising the other three models of care (Starfield., 2011; Roshanghalb et al., 2018). Low- and middle-income earners in less-developed countries also contribute nearly 60% of 57% of outpatient out-of-pocket expenditure on medicine purchased at public facilities and over 50% of outpatient out-of-pocket expenditure at private facilities (Escobar et al., 2010; Saksena et al., 2010). In addition, the amounts paid as consultation fees at PHC facilities and private-sector providers has deterred most low-income earners from seeking medical services. The impact of this challenge on global health outcome is significantly high (Sheikh et al., 2013). Thus, studies in primary health care suggest a broader health coverage with extended risk pooling and prepayments (Ewan et al., 2005). This strategy is better than Out-of-Pocket payments and is certain to ensure better access to basic health care and improved population health—with larger benefits for individuals and households in rural communities (Moreno & Smith., 2012).

–Dysfunctional Facilities

Most PHC centres around the world are not properly equipped to offer advanced services for stroke, diabetes and heart disease which have been identified as the leading causes of death in both developing and developed countries (Rao et al., 2011). This is considered a major challenge to PHC systems because a vast body of evidence proves that these prominent ailments share common modifiable risk factors that can be treated in PHC centres or controlled with a change of habits/lifestyle recommended by well-trained staff (Koppel et al., 2013). Unfortunately, most facilities are dysfunctional and staff in primary care setting are incapacitated and unable to improve life expectancy as well as quality of life. This challenge results in a lifelong burden of Out-of-Pocket expenditure for patients in less developed and developing countries where payments for consultation, diagnosis and treatment are outrageously high (Saksena et al., 2010). For this reason, low-income earners who can’t afford adequate medical services eventually forgo necessary treatment, with high risks to their lives. Access to affordable or free medicines is essential for every country to continuously deliver effective PHC services (Rawaf et al., 2008; O’Connell et al., 2013).

–Unprofessionalism and Lack of Incentives

The professional of experience of caregivers in PHC facilities reflects on the quality and impact of services provided rendered to patients (Currie & Lockett., 2011).  This implies that the overall performance of a PHC centre largely depends on adequate staffing levels and on the knowledge, skills and motivation of the team responsible for delivering services (Pollard ET AL., 2014). Although there is no ‘one size fits all’ solution to PHC administration in all countries, studies show that countries with strong primary care-based health systems such as Holland and the United Kingdom show how a multi-disciplinary team comprising of doctors, nurses and community health workers can provide effective, comprehensive primary care (Ewan et al., 2005). The problem is inadequate investment in staff training, remuneration, safe work environment, and misconception of motivation as a human resource development tool capable of driving performance in healthcare organizations (Sheikh et al., 2013).

–Political factors

Delivering health care services in conflict/crisis zones around the world has been a huge challenge to global PHC systems (Sheikh et al., 2013). In addition to the difficult task of containing disease outbreaks in peaceful zones, providing basic health care in countries rife with conflict adds more to the burdens shouldered by employees of the World Health Organization (WHO) and affiliated international agencies risking injuries and death every day. According to the global health institution, its health care workers and medical facilities in 11 countries were attacked about 1,000 times in 2019—killing at least 193 medical staff and injuring many. It is rather unfortunate that despite huge investments in ICT and use of strict surveillance gadgets, WHO employees are still vulnerable to attacks from warring factions. Moreover, there is often little or no access to basic health care for the millions of displaced persons forced to flee their homes (Agass et al., 1991; WHO., 2019).

–Reduced Life Span

Access to quality health care creates a gap between the rich and poor segments of every society. For example, individuals in developed countries/cities have better access to cheap and affordable medical services unlike people in less-developed countries/communities who can hardly afford the high-cost Out-of-Pocket expenditure on health services (Saksena et al., 2010). By contrast, health indicators for people in developed countries show an 18-year gap in life expectancy as compared to less-developed countries. This is more so because dysfunctional PHC systems expose individuals and groups to deaths caused by treatable ailments such as diabetes and chronic respiratory conditions (Chan., 2009).

–Social media

For PHC systems to continue delivering safe and reliable services to rural communities, there is need for trust and confidence-building measures. This is necessary because good healthcare programmes (such as oral polio vaccinations and condom use) can be undermined by the rapid spread of misinformation on social media. This challenge has led to serious anti-vaccination movements around the world and resultant deaths from preventable diseases—such as pneumonia and diarrhoea. And in some areas, wrongful use of social media has stirred unnecessary attacks resulting to the untimely death of health workers assigned to render services in rural communities (Evans et al., 2010).

However, the social media and ICT still provide a reliable information dissemination tool that can be maximised to build public trust in healthcare. In addition, implementation of relevant community programmes is another way of boosting confidence in health care providers and medical practices utilized to diagnose, treat and prevent spread of diseases (Preston et al., 2010).

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