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The Optimist

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Primary health care is exactly that

Even in the world’s richest countries, COVID-19 is reminding us how fragile access to basic health care can be. In the United States and European Union, health systems have been stretched past the breaking point. Frontline health care workers in desperate need of basic protective equipment are being forced to triage the overwhelming number of COVID-19 patients. Many people are postponing treatment for other conditions and are justifiably worried that a disrupted supply chain will deny them the drugs they need.

Now imagine this crisis if there were no doctors, nurses, EMTs, or hospital beds in your town. More than half the world’s population (perhaps as many as two-thirds) lack access to essential health services and now face this reality. As my colleague Oumar Seydi recently pointed out, while COVID-19 has thus far been concentrated in wealthier nations, it’s coming to everyone else soon.

That’s why it’s imperative that, as part of our global response to COVID-19, we invest in strengthening primary health care (PHC). PHC is precisely what the name says. It’s where people get all the basic health services they need: vaccines, prenatal care, and treatment for common yet life-threatening illnesses like diarrhea, pneumonia, HIV, TB, and malaria. PHC systems keep families healthy in normal times and are the first line of defense when global health crises like COVID-19 arise.



Before this pandemic, everyone agreed PHC systems were one the best investments a country could make. Nations that saw the greatest improvements in key health indicators like child mortality, including Ethiopia and Rwanda, succeeded in large part by investing in PHC. In 2018, WHO’s member nations collectively affirmed in the landmark Astana declaration that PHC “is the most inclusive, effective, and efficient approach to enhance people’s physical and mental health, as well as social well-being” and “a cornerstone of a sustainable health system for universal health coverage.” In 2019, WHO estimated that investing an additional $200 billion a year in PHC could save 60 million lives by 2030.

But with COVID-19 upon us, there’s a danger this long-fought-for consensus will fall apart. As African countries now mobilize against the pandemic, they face almost unlimited demands and very limited resources. Half of the world’s population still lack access to essential health services, like maternal care for pregnant women and basic immunizations for children, and much of that 50 percent lives in Africa. While the first instinct may be to move all current funding towards more ICU beds and ventilators, in the long term, strong primary health care systems remain the best way to fight COVID-19 and improve global health.

We have already seen what happens when PHC networks are overwhelmed by a viral epidemic. During the 2014-2015 Ebola outbreak in West Africa, most of the deaths were due not from the virus itself but the breakdown of PHC systems providing essential health care services. When access to health care was blocked by the outbreak, 10,000 more people perished from malaria, HIV/AIDS, and TB. Similarly, in the most recent Ebola outbreak in the Democratic Republic of Congo, 2,000 died from the Ebola virus and more than 5,000 died from measles.

The good news is that PHC systems in Africa are already pioneering lifesaving innovations to fight COVID-19. Rwanda was among the first African country to institute a COVID-19 lockdown, and health officials there started reworking their health management data system to track infected patients. Rwandans can get SMS texts with valuable health information as well as notifications if someone they know has tested positive. (Similar cellphone applications are being put into use for e-prescriptions and to address the economic impacts of the crisis, such as mobile banking and digital financing.) Ethiopia, meanwhile, has enlisted its 40,000-strong PHC volunteer force to monitor for signs of COVID-19 and encourage hygienic practices like hand-washing to stop its spread.

COVID-19 hasn’t changed anything about the absolute necessity of investing in PHC. In fact, the best way to successfully address this crisis is to help build strong, dynamic PHC systems that can deliver essential health services to all who need them, both now and after COVID-19 has run its course. To do that properly, we need a broad, coordinated, and multi-sector effort that builds on what’s already working.

Our foundation strongly encourages governments and donors to keep investing in PHC, including the many partner organizations that are working to build more robust and resilient PHC systems.

COVID-19 has shown us all why everyone needs access to health care—let’s make it happen.

Jean Kagubare is Deputy Director for Health Systems Design at the Bill & Melinda Gates Foundation.

About the Author

Jean Kagubare
Jean Kagubare is Deputy Director for Health Systems Design at the Bill & Melinda Gates Foundation.

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