Expert Insight

Achieving Global Health Goals by Strengthening Primary Health Care

Mother and child
hadynyah via Getty Images
Originally posted on the Huffington Post on October 22, 2015.

Last month, world leaders came together to adopt the Sustainable Development Goals (SDGs)--a new global development agenda that sets ambitious targets, such as eliminate poverty, achieve gender equality and end hunger globally.

Now, comes the hard work: figuring out exactly how we achieve them.

At least one of these new goals--SDG3, ensure healthy lives and promote well-being for all--has a clear action: strengthen our health systems. This begins with improving primary health care, the foundation of health systems and the main source of health services in people's communities.

As a family doctor in Australia, I understand the importance of this all too well. My team and I strive each day to deliver the best quality care to our patients, with the goal of not only improving the health of every individual, but of our communities and nation as a whole."

At the same time, I often have unanswered questions. Are some people in my community missing out on these services, and if so, why? What steps should my practice take in order to maximize our impact on overall health and well-being?

Addressing these questions is critical to making concrete improvements in primary health care globally, which is the goal of an important new effort called the Primary Health Care Performance Initiative (PHCPI).

PHCPI was founded by the Bill & Melinda Gates Foundation, World Bank Group and World Health Organization, and launched just after leaders from around the world formally adopted the SDGs, which included a commitment to making Universal Health Coverage a reality.

The new initiative uses data on a tailored set of indicators to shine a light on how low- and middle-income countries' primary health care systems are performing, and provide insights on what makes these systems work well or not. It also provides a platform for countries to share lessons and best practices so that policymakers, and practitioners like me, can make informed decisions about how to ensure everyone has access to quality health care.

For example, PHCPI looks at data on the percent of women who report difficulties in accessing health care due to the cost of treatment. Having well-run health facilities in communities can only do so much if patients are reluctant or unable to use them due to financial barriers.

Recognizing that data and measurement have helped drive much of the world's progress on health over the last few decades, my organization, the World Organization of Family Doctors (WONCA), has been supporting this partnership by inputting on what we believe are some of the most critical indicators to track. Some of these indicators are already part of PHCPI's measurement framework and some may come later.

Several examples of those we believe are most important include the following:

  • Location of Primary Health Care Clinics: It's vital to measure where primary care clinics are based in relation to the populations they serve. If half the population of a country is living in rural areas, then half of the health services, and half of the doctors and nurses and community health workers, should also be based in rural areas. We also need to measure whether clinics are effectively supporting those populations in greatest need, including the poor, disadvantaged or marginalised.
  • Size and Training of Health Workforce: We need to regularly evaluate the numbers of family doctors, primary care nurses, midwives, birthing attendants and community health workers available to meet the needs of local populations. In addition, we need to measure the percentage of graduates from nursing and medical schools who are expected to work in community-based health services. We know that some countries are training too many hospital-based medical specialists at the expense of strengthening their primary care medical workforce. This leads to health services not being available in the communities where they are needed most.
  • Value of Primary Care Providers: Developing measures of whether a country values health care professionals who work in the community is also important. For example, do nurses and doctors working in primary care, especially in remote rural areas, receive higher incomes than nurses and doctors working in hospitals in big cities?
  • Patient and Health Worker Interactions: One of the great challenges to achieving health care for everyone is ensuring services are focused on the entirety of an individual's health needs, with attention to how and when they need to access them. This can be measured through indicators such as patient satisfaction; access to care after hours, home-based care, interpreters, disability-friendly clinics and services; and the integration of preventive care and health promotion into primary care services.

If comprehensively measured, these indicators can show us the strength of primary health care in countries around the world, and help us understand how to further improve our systems.

Ultimately, better understanding these dimensions of primary health care will allow family doctors like me around the world to provide better health care services for our patients, and enable countries to live up to their recent commitments to provide access to quality health care for everyone, everywhere.


Michael R. Kidd is the President of the World Organization of Family Doctors (WONCA).