PHC in the News

Zika Outbreak Signals the Urgent Need for Strong Primary Health Care Systems

Infant and mosquito net
World Bank/Arne Hoel
Originally published in The World Post on February 9, 2016. 

On February 1st, the World Health Organization declared the spread of the Zika virus a public health emergency. The declaration was the WHO's highest level of warning--so dire, in fact, that it has only been declared three times in the organization's history. We believe that, as with Ebola, the lesson we learn must be the importance of robust universal primary health care services.

Spreading rapidly throughout Latin America and the Caribbean, the Zika virus is now emerging in other parts of the globe. Experts anticipate the virus' impact may be even greater than the Ebola epidemic. As many as four million people in Latin America and the Caribbean alone are at risk of infection by the end of the year.

Media coverage of Zika in North America and Europe is already prolific, with the declaration spawning primers on the virus and precautions against mosquito bites, assessments of the adequacy of responses from the WHO and individual governments, updates on vaccine and gene technology, and a plethora of travel advisories--including speculation about the fate of the Olympics in Brazil. Each of these stories is well-meaning, but it's time to shift the lens and focus on those worst-affected.

The individuals living in affected communities cannot fly away to other locales. They have to deal with the ripple effects of the responses from the WHO and their governments, whether they were effective or not--and no, they cannot simply stop having babies at the behest of policymakers.

The Zika outbreak brings into sharp relief just how important primary health care systems are in identifying, preventing, treating, and managing infectious diseases."

A young woman living in Recife will not consult WHO bulletins to understand Zika's implications. She will rely first on the same community health workers or primary care nurses and physicians she has always trusted for care. First, for information about the virus and how to prevent its spread. She may want to also understand her contraceptive options so that she may delay pregnancy. If she is lucky, the care she receives will ensure access to affordable, effective quality contraceptives and other reproductive health-related services.

If she is a new mother whose baby has been diagnosed with microcephaly, she will turn once again to these same networks for advice about long-term treatment and care for her infant. A strong health system therefore depends on a supportive primary health care system that is organized around the health needs of individual people, serving as the first point of contact for care and making referrals as necessary. Putting ourselves in her shoes forces us to see that the foundation--and sustainability--of the crisis response depends on the quality of care she receives at that primary entry point. Like Ebola, Zika was not a priority for donors or global health projects. It was not predictable that this would develop in the way it has. But it is predictable that primary care has to cope with whatever problems arise in a community. We need to break out of traditional health sector silos and call for cross-cutting and comprehensive measures that reinforce the importance of integrated primary health care.

Unfortunately, despite the wide-ranging functions of primary health care--immunizations, family planning, diagnostics, antenatal care, maternity services, rehabilitation, counseling, and referrals--it is often underfunded and deprioritized, forcing people to use whatever cash they have for low-quality private services. The volatile Zika outbreak should remind health advocates and policymakers alike that investments in strong comprehensive primary health care systems is the very best precaution for such emergencies. This year in Japan, the G7 will be discussing Universal Health Coverage needs, which is a step in the right direction. In the coming months, we will continue to hear medical experts offering guidelines and weighing in on the global impact of the disease; but to the women directly affected by Zika, the medical advice that will matter the most will be from the local health professionals she already knows.


Suzanne Ehlers is President and CEO of PAI. She leads the organization in its mission to ensure that every person has access to quality, effective and affordable reproductive health care. Ms. Ehlers has worked for the last 15 years to promote women's health, rights and empowerment across the globe, and has been honored as a "40 under 40" International Development Leader by Devex and as a Young Global Leader by the World Economic Forum.

Simon Wright is Head of Child Survival at Save the Children. He has worked in public health and service commissioning in the UK National Health Service. He has worked as an adviser to the UK parliament on HIV and health. He worked for ActionAid leading its HIV campaigning and then establishing the European 
advocacy network, Action for Global Health. He is responsible for Save the Children's global policy and advocacy activities on health and child survival. He is currently a member of the Board of the Global Health Workforce Alliance.