Will COVID-19 Bring Primary Healthcare Back on Our Priority List?
“By the time a case gets to the hospital, it’s usually past the early stages.”
No big insight here.
Anyone who has anything to do with healthcare (which is most of us, either as professionals or patients or caregivers) gets this idea. It is galling to realize this quote comes from the 1937 novel, The Citadel. More than 8 decades have passed, and we aren’t any close to identifying, preventing, and managing patients before they get to a hospital; before they even become patients. Despite the technological progress and tools available to us, our healthcare system still over-relies on patients coming to the hospital, usually past the early stages.
Is primary healthcare in decline?
Primary healthcare has been a bugbear of mine! In a series of essays from a few years back, I lamented the state of primary healthcare. The essays discussed at length, demand and supply side issues that constrain our ability to make the most of effective primary healthcare. For instance, on the demand side, patients routinely seek out specialist care in the mistaken belief that a doctor with the most qualifications is best suited to manage routine conditions (not always true). They miss the point that utilizing doctors trained in specialist care for primary care makes little health or economic sense.
On the supply side, doctors very often don’t have the incentives to practice at the primary care level, when just a few more years of medical school can give them access to a substantially higher return on investment, both financially as well as in terms of social standing. I argued there was a need to raise the profile of primary healthcare and to support primary healthcare workers with better training and incentives.
The case for primary care has always been very strong. A 2017 issue of the Economist talked about the need to raise investments in primary care as a way to cost-effectively manage healthcare burdens globally. Several studies had already shown strong linkages between primary healthcare and better community health. Other studies had found that the least effective health systems allocate resources to only certain types of interventions. The focus on primary healthcare, despite the strong case for it, remained weak globally. My essays bore a despondence the entrepreneur within me struggled to come to grips with.
A reason to hope
As we enter 2021, I have become more optimistic that primary healthcare may finally get the priority position it should have always had. The COVID-19 pandemic has highlighted what happens when resilient, high-quality primary healthcare is not in place: not only do people face a deadly virus without frontline support, but they also suffer collateral damage to their health from a dramatic drop in access to, availability of, and demand for the essential health services they rely on. Today, 90% of countries are experiencing wide-ranging interruptions to essential health services, with low and middle-income countries hit hardest. Early models predicted an additional 1.2 million children and 50 000 mothers could die from interrupted maternal and child health services alone, with new data from the Global Financing Facility and World Health Organization (WHO) confirming fears about the scale of these disruptions. Strong health systems grounded in primary healthcare are able to maintain essential health services even during emergencies, including treatment for reproductive, maternal, newborn, and child healthcare; noncommunicable diseases; malnutrition; HIV/AIDS, TB, and malaria services; and more.
The difficult times of 2020 have shown that primary care plays a significant role in gatekeeping and clinical responses: differentiating patients with respiratory symptoms from those with COVID-19, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, and reducing the demand for hospital services.
When primary healthcare is strong, these same systems also become a robust first line of defense against disease outbreaks and global health security threats. From testing to contact tracing, to treating and referring those who fall ill, the frontline health workers who deliver primary care every day are also the backbone of pandemic response efforts. Effective testing and tracing depend on people’s trust and confidence that the health system is there to serve them, and that recommended public health measures can keep them safe. This trust relies on the people-centered orientation that primary healthcare providers show in their daily work.
Within the SDGs, primary healthcare has been identified as critical to achieve universal health coverage. The recently set up Lancet Commission for Universal Health Coverage in India will be guided by four key principles, one of which focuses on the prevention of mental and physical health problems and long-term care, not only clinical treatment. My own company was recently selected by India’s National Health Authority to work in the category of “Maximizing beneficiary awareness”, a theme that frankly, I didn’t think would have existed a decade back!
We need to act now
While the importance of primary care has been acknowledged for a long time, it does seem like COVID-19 has amplified the urgency and the value proposition of building stronger primary care systems. It won’t be easy to move from talk to action (although talk of action is better than just talk!). Low- and middle-income countries would need to at least double current spending to strengthen their systems and universally provide essential primary care services. We’ll need to figure out innovative ways to find the money for these investments. As we mobilize partnerships and resources, I do hope we don’t end up building a primary healthcare system from a century ago. Reimagining primary healthcare must require a bold rethinking of community-based care, leveraging the latest technologies, and recognizing the shifting role of the patient as an informed, proactive, and participative health consumer. Our experience with COVID-19 has shown that citizens today are ready to invest in preventive health, if they understand the stakes involved. Future investments in primary healthcare must account for these new tools at our disposal.
So, I am ending 2020 on a more optimistic note, that our healthcare czars will bring primary healthcare back to the top of our priority list. In doing so, I hope we don’t miss out on reimagining what primary healthcare for the 21st century must look like.
Dr Aakash Ganju is the CEO of Saathealth, an AI-powered, chronic care digital health platform.
