Primary Promises: Access, Equity and Quality

By: Fred T. Sai, M.P.H., PAI Board-Emeritus Member

Primary Health Care (PHC) is the cornerstone of every country’s health system, with providers serving as the first source of care for individuals and families. They are the continuous connection between patients and an array of services people will need throughout their lives, from access to contraceptives, checkups during pregnancy and routine vaccines for children, to treating illness, managing chronic conditions and addressing end-of-life care.

Indeed, a strong PHC system is essential to ensuring that people stay healthy, which in turn contributes to creating productive, prosperous societies. PHC is most effective when it is able to deliver high quality, accessible and equitable care that focuses on patients’ needs and expectations, and when providers cultivate a trusted, open environment among the families and communities they serve. Well-functioning primary care is also a first step toward achieving universal health coverage, where an entire population has access to reliable health services and products that are affordable. Evidence shows that a health system anchored by strong primary care has better outcomes at a lower cost. Primary care services are also linked to longer life expectancy, lower infant mortality and fewer deaths of children under five in many low- and middle-income countries.

However, the reality is that PHC systems across the world — including in my home, Ghana — are in need of a booster shot.

Consider this: An estimated 400 million people worldwide still do not have access to quality services at this most basic level care. This is compounded by other inequities such as lack of access to sanitation and clean water. Despite the full range of interventions that PHC provides to promote good health, and despite government endorsements of such care, the system is often understaffed and underfunded. By not prioritizing primary care, this core link to countries’ health systems weakens. It becomes fragmented. That has a multiplier effect: When families are unable to rely on public services, they are forced to seek unqualified providers, which can endanger their health and wellbeing. And when people — especially those struggling economically — have to pay cash for health care, they are pushed deeper into poverty.

To address the deficiencies in primary care systems requires dedicated engagement from civil society organizations (CSOs). As a unifying force and liaison between a variety of stakeholders, CSOs are in a unique position to advance primary health care and ensure that the people’s needs remain a top priority. That is why it is essential for civil society to continually press for improved PHC — in partnership with the communities in which they work and with governments — if we intend to achieve universal health coverage. Using their capacity to mobilize communities, foster connections among diverse actors and create platforms for dialogue, CSOs can help to fill the gaps in primary care service quality, equity and access. It is this kind of sustained advocacy that is required to guarantee a strong, fair and reliable primary health care system that the people of Ghana and beyond deserve.

This blog post was cross-posted from Dr. Sai’s foreword in Primary Promises: Access, Equity and Quality.

View the Primary Promises: Access, Equity and Quality digital photo book.