Primary Healthcare at 40 – Transition to Universal Healthcare (UHC) Part II

While we looked at the introduction of Primary Healthcare (PHC) as a concept (Alma Ata Declaration of 1978) in the first series of the blog (click here ) let’s take a look at the transition from 1970’s PHC to what is widely used term in the last couple of decades – Universal Health Coverage (UHC)

There is no doubt that PHC initiatives resulted in significant improvements in healthcare infrastructure from 1970’s to early 2000’s – the emerging challenges seen in South East Asia (SEA) were the rise in Non-Communicable Diseases (NCDs) due to increase + ageing population and rapid urbanization. The tangible reforms from PHC was uneven, the health outcomes were unequal within countries and between countries in the SEA region.

Key Demographic & Socio-economic transition in the South East Asia 2000-2018

  1. The elderly population (aged 60 years and above) increased from 111 Mn to 186 Mn from 2000-15 and expected to hit 330 Mn by 2030
  2. NCD’s increased from 40% to 60% of overall disease burden (2000-15)
  3. The % of population living in cities in South East Asia increased from 32% to 41% (2000-18)
  4. Mobile phone users increased from 3% to 75% of the population (2000-16)

While Primary Healthcare (PHC) was perceived to be designed only for the poor, providing cheap and low quality care, focused in rural parts of the developing countries – there was a need felt by the WHO SEARO Expert Group to revitalize the concept of PHC, leading to new definition of “Health for All” or what is termed closer to the more widely used term Universal Healthcare (UHC)

A new definition proposed for UHC (viz a viz PHC) was – “a stage of health development whereby everyone has access to quality healthcare or practices self-care protected by financial security so that no individual or family is experiencing catastrophic expenditure that may bring about impoverishment

There are 2 key changes:

  1. Focus on the need to develop equitable health financing strategy
  2. Focus on the need for linking primary care services to other parts of the healthcare ecosystem and importance of a functioning referral system

The good, the bad and the ugly – where do we stand since 40 years of Alma Ata Declaration of 1978 & the introduction of Primary Healthcare?


The Positives: (Overall health outcomes improving)

  • Maternal & Under-5 mortality rates declined faster in the South East Asia region than in any other WHO region (although neonatal mortality is declining more slowly)
  • Infectious diseases have declined (but still higher compared to other WHO regions)
  • The South East Asia regional average for UHC essential services index is 64% (2018) compared to 44% (2010)

The Areas of concern: (inequality in health access)

  • 800 million people still do NOT have access to full coverage of essential healthcare services
  • 65 million pushed into extreme poverty due to healthcare expenditure every year

In the next series, I intend to look at specific initiatives launched by countries in the South East Asia region and what are some of the success stories, the next steps to realize the dream of “Health for All”

#UniversalHealthcare #PrimaryHealthcare #HealthforAll

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