Universal Health Coverage and primary Health care.

 

The achievement of UHC is fundamentally connected to the realization of a robust PHC system. PHC was first defined in the Alma-Ata Declaration of 1978 as a prerequisite for achieving health for all. Following the WHO definition, PHC provides promotive, preventative, curative, rehabilitative and palliative care to individuals and families throughout their life course. At the same time, one of the main objectives of a system based on PHC is to systematically address Determinants of health, from economic and social to environmental and commercial. Finally, PHC puts individuals and families at the forefront and empowers them to promote and protect their well-being and participate in developing health and social services. A different world in 2018, with the disease burden shifting towards NCDs, an aging population and population growth, resulting in more frequent contacts with the health system, required a renewed commitment by countries on PHC through the Declaration ofAstana, emphasizing the importance of community engagement in the design and delivery of primary health care services and elevating the goal of strengthening PHC in the global health agenda. Quality, affordable and easily accessible health care that is close to the communities is a core aspect ofPHC, which is also The ultimate goal of UHC. Several studies and country experiences have demonstrated the importance of strong PHC services in reducing health expenses, promoting better health outcomes in the population, increasing equity, as well as resulting in better screening, care and follow-up for a wide range of diseases, including those affecting circulatory health. However, a systematic review published in the Lancet highlights that ensuring access to health services through primary care and expanding the range of services covered through UHC are not enough to avert preventable deaths. For instance, poor quality of care was the cause of 84% mortality due to cardiovascular disease. Particularly in LMICs, poor quality represented the main cause of excess mortality that could be averted, followed by not using health services. Because one of the central goals of UHC and PHC is to improve access to health care services withoutfinancial hardship, establishing a well-defined package of health services provided free of charge or at an affordable cost at PHC level is instrumental to achieving UHC. It has been estimated that $200 billion a year of additional investment on PHC will be needed to achieve UHC by 2030. Increasing investments in the health workforce and infrastructure, particularly adding 77,000 PHC facilities in LMICs, are two of the main actions necessary to effectively strengthen PHC. In addition, expanding the number of interventions provided at PHC, including for CVDs, could help avert 60 million deaths between 2020 and 2030. All this evidence suggests the inextricable link between realizing UHC and expanding PHC as the backbone of health systems. As demonstrated, focusing on expanding quality and affordable health services closer to communities, coupled with initiatives to ensure skilled health workers are available, are successful strategies to avert excess mortality due to CVDs.