A strong primary care system is key to providing crucial services in a public health crisis, such as testing, contact tracing, and vaccinations. Photo credit: Asian Development Bank.
The debilitating effects of the current pandemic call for increased investments in health care. Nearly four million people have died from the coronavirus disease (COVID-19), and countries continue to experience waves of infection even in places where vaccinations are in full swing. The socioeconomic costs of the pandemic also threaten gains in poverty reduction.
The COVID-19 crisis has underscored the importance of universal health coverage and a strong primary care system. Countries that have made progress toward providing health services for all were better prepared to deal with the outbreak. The quality of the primary health care system is key to providing crucial services in preventing and controlling the spread of the disease. These include testing, contact tracing, isolating the infected, and vaccinations. A good system can also manage the flow of patients to hospitals and avoid straining health care workers and resources.
High returns on investment
The World Health Organization (WHO) says “scaling up primary health care interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.” It recommends an additional 1% of the gross domestic product be set aside for primary health care from government and external funding sources.
Meanwhile, universal health coverage will ensure that people will receive health care without driving them into poverty. WHO estimates that “about 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget.”
A new World Bank report also calls for a significant increase in financing by both countries and donors since investments in primary health care yield high returns and promote resilience and sustainability. It points out that a well-designed primary care system has the potential to help flatten the curve during a health crisis like COVID-19.
The report also makes a strong case for governments to recommit to improving people’s health, with an aim to achieving universal health coverage and preventing future health crises.
Structural reforms
The World Bank recommends four high-level structural shifts in how primary health care is designed, financed, and delivered:
- From low-quality to high-quality services delivered by multi-disciplinary teams to strengthen the range and quality of care.
- From fragmented care to person-centered integration, in which cohesive, health care teams coordinate care around patients’ needs.
- From inequity to fairness and accountability, in which equitable, efficient delivery of services fosters and rewards accountability for health outcomes.
- From fragility to resilience, in which health care teams conduct public health surveillance and outreach, and health sector planning and resource allocation include financial and human-resource surge capacity.
“As countries reimagine their systems, the World Bank has three main mechanisms of support. We will accelerate access to financing, mobilize practice-relevant public health care knowledge, and establish a dedicated platform for policy discussion and technical assistance,” says Muhammad Pate, World Bank Global Director for Health, Nutrition, and Population.
Renewed commitment in the region
In September 2020, more than 40 finance and health ministers and deputy ministers from across Asia and the Pacific pledged support for universal health coverage and underscored the need for stronger collaboration to mobilize health care financing at a symposium jointly organized by the Asian Development Bank (ADB), the World Health Organization (WHO), and the Government of Japan.
The symposium was held to outline concrete actions that build on commitments at the G20 Leaders’ Summit in Osaka in June 2019 and at the United Nations’ High-Level meeting in New York in September 2019.
"We have to build health systems where people from all walks of life, including the elderly, the poor, and the vulnerable, can access health services at an affordable cost while maintaining these health systems' financial sustainability—even in aging societies that many countries in Asia and the Pacific are heading toward,” says ADB President Masatsugu Asakawa. “In this regard, close collaboration between finance and health ministers is crucial for our member economies to provide cost-effective, inclusive, and high-quality health interventions, underpinned by sustainable finance."
Over the past 50 years, countries in the region have made great strides in improving population health. Despite this, COVID-19 has exposed significant gaps in preparedness and response capacities, as well as the link between health security and economic stability.
To help meet these gaps, ADB has committed to support the efforts of its developing members to pursue and achieve universal health coverage by providing technical advice and increasing the share of health operations to 3%–5% of total commitments from the 2019 share of 2.66%.