Strengthening primary health care is recognized as an essential step, as early diagnosis and a strong primary care infrastructure are key to earlier treatment and improvement of survival rates. By Farid Fezoua
Universal health coverage is a key priority for World Health Organization and its member states. In order to achieve this important international policy goal, strengthening primary health care (PHC) is recognized as an essential step, as early diagnosis and a strong primary care infrastructure are key to earlier treatment and improvement of survival rates. Also, one target under Sustainable Development Goal 3 is to reduce the global maternal mortality ratio to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average.
However, the delivery of PHC remains insufficient. Today, half the world lacks access to essential health services. Although the maternal mortality ratio has declined by 37 per cent since 2000, approximately 830 women die every day from preventable causes related to pregnancy and childbirth. More than half of these deaths occur in sub-Saharan Africa. The situation remains challenging for infants and newborns. While globally, from 2000 to 2016, the under-5 mortality rate dropped by 47 per cent, and the neonatal mortality rate fell by 39 per cent, 7,000 new-borns still die every day. In sub-Saharan Africa, approximately 1 child out of 13 dies before his or her fifth birthday, while in the world’s high-income countries the ratio is 1 in 189.
In many parts of Africa, PHC is underutilized, and secondary and tertiary referral hospitals are overwhelmed. Primary care often operates in isolation with poor triage or little referral linkage. Healthcare providers in Africa have looked at several models and pilots to address this, but many have so far proven to be un-scalable. Limited budgets at Ministry of Health level, mean that investment tends usually to focus on equipping tertiary level facilities. Further, strategies that tend to be limited to building and equipping, often do not serve as models for sustainable system-wide development.
While very basic health services are available in most communities, health workers in these areas often lack the fundamental skills, with limited access to knowledge of appropriate medical technologies to aid in diagnosis and referral. Where technology does exist, often the local community healthcare infrastructure and equipment service issues prevent optimal technology utilization, leading to potential misdiagnosis and incorrect or lack of referrals for essential care. Another significant issue is often the distance people have to travel and the time they have to spend waiting before they can be served.
As a result, the combination of these issues often acts as a deterrent with many people opting to forego seeking any sort of medical intervention.
In many health systems, due to a lack of trained health workers, relevant technologies and a sustainable local eco-system to support these clinics, the primary and referral care system requires a significant overhaul to improve universal access to quality care for these patients.
Building sustainable healthcare systems requires a clear understanding of the potential gaps in the referral system and continuum of care in the patient journey. To that end, while Governments across Africa are striving to accelerate healthcare transformation at all levels, addressing these challenges requires a collective approach to build the capacity, infrastructure as well as appropriate funding mechanisms essential to increase access to universal front line care.
Governments have realized that to fundamentally strengthen their healthcare referral systems, they need to start at the grass roots level of the health system and work up. Moreover, development agencies are also working to strengthen referral systems, recognizing the direct knock-on effect across the entire eco-system.
Today, in Africa, GE Healthcare’s Primary & Referral Care (P&RC) initiative focuses on reengineering PHC by improving access to quality healthcare across the continent. GEHC together with partners that include governments, funding agencies and NGOs as USAID, Amref Health Africa, JHIPEGO, Pathfinder, Intrahealth, amongst others, designs and implements integrated and affordable PHC delivery models comprised of appropriate medical technologies, training and capacity building of healthcare workers, financing, and regular monitoring and evaluation.
The concept, developed by a dedicated local team in Africa for Africa, provides a wing-to-wing comprehensive, flexible and modular solution aimed at solving the real issues on the ground.
To date, 18 programs are being or have been implemented in 7 countries, over 150,000 expectant women, mothers, and newborns have been directly impacted, and 1,500 healthcare workers, including midwives, nurses, and other primary healthcare workers have been trained, in addition to the increased access to standardized and quality maternal and newborn health care; increased utilization of healthcare services, and improved case management and appropriate referrals.
By strengthening public and private partnerships and stronger collaboration with Government, we can address key gaps in the primary and referral care system by combining all of the following to help achieve long-term and sustainable healthcare outcomes: the right adapted technologies and software; new business model innovation to enhance entrepreneurship and development; education and skills development; public health awareness programs; and access to alternative mechanisms of funding.
Farid Fezoua is President and CEO of GE Africa. This post originally appeared here.
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