During September, world leaders began to converge on New York for this year’s United Nations General Assembly (UNGA), with its welcome focus on the urgent need to put the 17 Sustainable Development Goals (SDGs) back on track after the COVID-19 pandemic. One of the most important topics up for discussion during UNGA was the future of primary health care (PHC).
We must seize upon this energy to ensure quality health care is available for everyone, including those previously under-reached. That is why VillageReach and the Malawi Ministry of Health hosted the “Responsive PHC as a pathway to accelerating SDGs” roundtable UNGA event this year, alongside key government and civil society partners including: Hon Khumbize K Chiponda, Minister of Health Malawi; Emily Bancroft, CEO and President of VillageReach; Dr. Matshidiso Moeti, Regional Director of WHO AFRO; Dr. Ilesh Jani, Deputy Minister of Health Mozambique and Mr. Thabani Maphosa, GAVI Managing Director, Country Programmes Delivery.
PHC is the foundation of a healthy society. When people have access to quality proactive PHC, they are more likely to be healthy and productive members of their communities for longer. Remarkable progress has been made over the last twenty years, but too many people across Africa – up to 615 million people – do not have access to basic PHC.
As Hon. Minister Khumbize said in her introductory remarks, “Health care services should be available to everyone, regardless of socioeconomic status or geographical location…Understanding community needs will be essential to achieving the ambitious public health goals for Malawi and globally over the next decade.”
To meet the needs and preferences of hard-to-reach populations, PHC delivery must routinely integrate insights and data from under-reached communities. Without this, health systems risk widening the inequities in access to care and health outcomes.
At the roundtable event, we heard how the COVID-19 pandemic and increasingly extreme climate events have exacerbated the existing gap in access to health care. In many countries, health care systems have been overwhelmed, and routine services have been disrupted, devastatingly impacting people’s health. We need a new way forward.
Running the race together
It was a whirlwind roundtable, buzzing with busy minds and compelling words. VillageReach President Emily Bancroft started the discussion by outlining the challenges ahead in this critical moment and point of reflection on our progress towards achieving universal health coverage and SDG health targets.
“Progress [towards achieving UHC] is uneven – with outcomes lowest within under-reached and under-served communities….To reach the finish line, we need to run our part of the race as fast and as well as we possibly can, and we have to know when to hand the baton onto another partner, to trust our teammates, our partners, to run their part of the race as well. Achieving UHC is a relay race. We all have a part to play but won’t reach the finish line alone.”
I was buoyed by the level of synergy in the room, leaving us ready to take on the coming few days to run our race with a united purpose. As the Hon. Minister Khumbize said, “Achieving responsive PHC requires governments, health care providers, policymakers, communities and all of us to work together to ensure that everyone has access to the health care services they need, when they need them, leading to improved health outcomes and accelerating SDGs.”
Achieving responsive PHC for all
Historical systems strengthening efforts have focused on big health facilities, excluding less visible community provision. But when 70% of the population is rural, like in Malawi, this is a big problem. We need to reach people where they are, investing more in community-level health systems to ensure that people have access to a well-trained health workforce, adequate supplies and medicines, and reliable transportation and communication systems.
To reach those currently excluded by health systems, we can center our work on the needs and preferences of the most vulnerable and marginalized communities. This includes considering race, economic status, gender, climate vulnerability and other characteristics in the co-design and delivery of health services to ensure that services are consistent and responsive to the specific needs of the community and that those who receive services are also invested in their success.
The Malawi Ministry of Health has already started integrating responsive PHC into its Health Sector Strategic Plan III (HSSP3 2023 – 2030) through the innovative “ONE Plan, ONE Budget, ONE M&E” approach. By aligning national development priorities to achieve maximum impact for all Malawians, the government focuses on holistically integrating quality people-centered services that consider each individual’s needs.
Using technology and innovation to open up new pathways to quality health care for under-reached communities is important. We have great examples of how mobile health technologies and supply chain innovations can be used to provide remote consultations, support community health workers and get essential medicines quickly to where they are required.
But ultimately, it comes down to us. All of us. It is important to coordinate efforts across different sectors, including working with education systems to ensure that children are vaccinated and have access to school health services, for instance. Governments, donors, and civil society organizations are crucial in achieving responsive PHC.
Leadership cannot be substituted
The consensus in the room was clear: this week, we’d like governments to commit boldly to investing in responsive PHC systems. They must also work together to address the root causes of health inequities, such as poverty, gender inequality, and climate change.
Donors must provide financial and technical support to governments and civil society organizations working to strengthen PHC systems. They also need to advocate for policies that promote responsive PHC.
Civil society organizations need to work with governments and donors to ensure that PHC systems are responsive to the needs of communities. They also need to hold governments accountable for the commitments they make.
As noted by Mr. Maphosa, “Sustained leadership intent cannot be substituted. We need leaders who have a sustained effort and focus on health, not only when they are afraid [of an extreme weather event or pandemic]. We must act, every day, as if we are afraid.”
Let’s make it a reality
Responsive PHC is essential for accelerating progress towards SDG 3, which calls for good health and well-being for all. It is the foundation for a healthy society.
As we concluded the roundtable, I was struck by the words of Dr. Moeti and the Hon. Minister Chiponda. Dr. Moeti reminded us, “Collective action is essential to achieving our ambitions. We must find language to inspire and empower others to join us.” Minister Chiponda outlined the challenge ahead, “This is the critical moment to recommit to SDG 3. Let’s close the gap and make a difference in the lives of everyone.”
The will to make positive change as a partnership was evident, and I am looking forward to the days, weeks and months ahead – including the forthcoming International Conference on Public Health in Africa in November, as I work alongside government and partners as a track lead for “Whole-of-society the Power of Engaging Civil Society, the Private Sector and Local Philanthropy.” We are putting a stake in the ground: responsive PHC can be the key to a healthier and more equitable world. Let’s build momentum together to make it a reality for all.