Underscoring the urgent need to transform how essential health care is delivered in low- and middle-income countries, the Bill & Melinda Gates Foundation, World Bank Group and World Health Organization today are launching a new partnership to support countries in improving the performance of primary health care. Primary health care is the pillar of health systems and is central to preventing epidemics like Ebola; improving women's and children's health; controlling major infectious diseases, such as HIV and TB; and managing the rising burden of non-communicable diseases, such as heart disease and cancer.
The new partnership, the Primary Health Care Performance Initiative (PHCPI), will support countries to strengthen monitoring, tracking and sharing of key performance indicators for primary health care. While many countries have identified primary health care as an urgent priority, they lack the data needed to pinpoint weaknesses, understand their causes and drive improvements.
- Primary Health Care Performance Initiative
The partnership will be launched at an event co-hosted by the governments of Germany, Ghana and Norway, where German Chancellor Angela Merkel will release a new framework, "Roadmap: Healthy Systems - Healthy Lives," for global cooperation to strengthen health systems. The launch of these two complementary initiatives are taking place as world leaders meet at the United Nations to adopt 17 Sustainable Development Goals.
PHCPI partners highlights the far-reaching benefits of stronger primary health care, including as a pathway to universal health coverage.
"For the first time, the world has set a goal with specific targets for universal health coverage by 2030," says Dr Jim Yong Kim, President of the World Bank Group and co-founder of PHCPI. "To ensure that everyone has access to essential and affordable health services, countries must have strong primary health care systems to deliver them—that's how we'll reach the poorest and most vulnerable people with the care they need, in the most equitable way."
Primary health care is a weak link in most health systems
As the foundation of health systems, primary health care connects people and families with trusted health workers and supportive systems throughout their lives and provides access to services ranging from family planning and routine immunizations to treatment of illness and management of chronic conditions. Health systems built on strong primary health care are more resilient, efficient and equitable.
"Strong primary health care systems are where people turn in their communities to stay healthy and get care when they fall sick. When primary health care works, it can meet the vast majority of people's health needs," says Dr Margaret Chan, Director-General of the World Health Organization. "Yet Ebola revealed what can happen, starting with primary care, when health systems are broken and in need of repair."
All too often, primary health care is a weak link in health systems. More than 400 million people worldwide lack access to essential health services typically delivered through primary health care. The recent outbreak of Ebola, a disease that can be prevented through basic health measures, both exacerbated and was partially fueled by broken primary health care systems.
Several countries offer examples of high-performing primary health care. Brazil's efforts to train and assign primary health care workers to specific neighborhoods have led to dramatic gains in health, especially in the country's poorest areas. Ghana's efforts to implement mobile-based primary health care have helped the country achieve reduced infant mortality and increased life expectancy.
Better data is essential to improving primary health care performance
Better data is essential to improving primary health care performance Closing gaps in primary health care will require better data. While countries regularly track the total amount of money spent on health care and measure the coverage of select interventions, there is comparatively little monitoring and sharing of data about the performance of primary health care.
"We know that better measurement can guide smarter, more effective planning and action," says Bill Gates, co-chair of the Bill & Melinda Gates Foundation and a co-founder of PHCPI. "It's time to get serious about tracking and measuring primary health care performance, so that countries have the data they need to efficiently direct resources to improve the health of their citizens, especially women and children."
PHCPI brings together health policymakers, practitioners, advocates and development partners, and will:
Monitor primary health care vital signs
A new website, PHCperformanceinitiative.org, tracks 25 "Vital Signs," performance indicators for primary health care across 135 countries, where data is available. These indicators can help the global health community and countries better understand how well or poorly their primary health care systems are performing, and are intended to shine new light on what actually happens in health facilities.
Improve the quality of primary health care data
While much can be learned from existing data on primary health care performance, there are major limitations. For example, systematic and comparable data on how often health workers are present at health centers and the accuracy of their diagnoses are collected in only a handful of low- and middle-income countries. PHCPI will work with countries to expand availability of existing data, as well as develop additional indicators that countries can use to diagnose and monitor underlying challenges.
Promote country collaboration and improvements:
The partnership will collaborate with country partners on an ongoing basis and provide a platform for countries to share lessons and co-develop tools for improving primary health care. As part of this effort, PHCPI is partnering with the Joint Learning Network for Universal Health Coverage, originally established by The Rockefeller Foundation. The Joint Learning Network currently includes 22 member countries committed to ensuring that essential health services are available and affordable for everyone who needs them.
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