Back to the Future: A return to Alma-Ata and investing in stronger primary health care for UHC
By Kirsten Mathieson, Senior Health Policy & Research Adviser, Save the Children
This year marks the 40th anniversary of the Alma-Ata Declaration. This was a historic global breakthrough in recognising primary health care as vital to the goal of Health for All.
A lot has (and hasn’t) happened since then. The last several years have seen growing political momentum for Universal Health Coverage (UHC).The inclusion of UHC in the Sustainable Development Goals (SDGs) and the establishment of UHC2030 – a global movement and multi-stakeholder platform to drive progress on UHC — are just a couple of the momentous achievements on the global front. However, these will only matter if translated into national change that leads to improved health access and outcomes, towards making health for all a reality. And in a number of countries it has. For example, both Sierra Leone and Vietnam have improved service coverage and financial protection, while in Burkina Faso and Lao PDR, financial barriers to accessing health services have been reduced. These are but a few examples that show encouraging change happening in countries.
Unfortunately, it is not all sunshine and roses. In far too many countries, patients are picking up the bill for primary health care. Out-of-pocket spending makes up over 25% of total health spending in 110 countries. Our projections show that in 2030, 282 million people will face the hardship of spending an impoverishing 25% of their household income on healthcare due to growing catastrophic out-of-pocket health payments. Over a billion people will spend at least 10%. This is income taken away from other critical household necessities such as food.
All people have the right to health. To fulfil this right, people must be able to access and use the health services they need, free at the point of use. Primary health care is the first point of contact between people and the health system. 90% of all health needs can be met at the primary health care level, according to World Bank estimates. But 400 million people currently don’t have access to 1 or more essential health service. Our recent report, Primary Health Care First: Strengthening the foundation for Universal Health Coverage, shines a spotlight on the fact that primary health care is often underfunded and has not been prioritised by donors or governments, with instead vertical health issues and higher-level secondary and tertiary health care taking priority. Investing in strong primary health care that delivers quality services free at the point of use must instead be prioritised as the first step towards achieving UHC.
All countries have committed to deliver UHC by 2030 under the SDGs. Now is time to put the money where their mouth is by turning commitments into action and (importantly!) achievements. Save the Children calls on countries to strengthen primary health care systems, increasing spending to at least 5% of GDP, as they move towards Universal Health Coverage. However, with 80% of countries currently not spending this, there is a long way to go towards achieving this goal. Donors and development partners should support counties in reaching this goal, helping them to strengthen their primary health care systems and to raise more domestic resources for health.
The momentum around primary health care and UHC must be matched with leadership and action. The Global Conference on Primary Health Care, taking place in Astana, Kazakhstan this week, is a critical opportunity to chart the way forward for ensuring primary healthcare for all and an important milestone on the path towards UHC.
