Focusing on primary care level in resource-constrained settings.

Effective coverage of health services is animportant measure of UHC, and even with significant progress made in improving effective coverage in many countries over the past few decades, UHC is extremely non-uniform not only between countries but also within the same country for different diseases and there is still much work to be done to achieve truly universalcoverage. Despite the availability of a large body of knowledge and evidence on cost-effectiveinterventions that if scaled up at the primary care level would significantly contribute to reducing the health and financial burden of circulatory diseases, UHC packages often do not include interventions to address circulatory diseases. Indeed, the State of UHC Commitment Review found that while countries committed to UHC almost doubled between 2019 and 2021 and the majority of countries state UHC as a clear objective in their national plans and strategies, programs and interventions are generally disease- and service-specific, without addressing issues of financial protection in some cases. The Alma Ata Declaration of 1978 made explicit the link between strengthening Primary Heath Care and attaining the goal of ensuring a level of health for all people that will allow them to “lead a socially and economically productive life.” In the Declaration, PHC is seen as the first point of contact between communities and the formal health system and addresses the main causes of ill health through Promotive, preventive, curative and rehabilitative health services. In this context, the latest report of the WHO High-Level IndependentCommission on Noncommunicable diseases (NCDs) recommends including NCDs and mental healthconditions in UHC plans and urges countries to make PHC the “[...] cornerstone of delivering NCD and mental health services,” ranging from Health promotion and prevention, to Treatment, care and follow-up services. Moreover, in the movement toward UHC, discussion on establishing or expanding the pool of funding necessary to cover health services provide free of charge requires important prioritization efforts, particularly in LMICs. Given financial constraints in the health budgets of LMICs, interventions included in HBPs should be deemed of high value and proven cost-effectiveness. According to Glassman et al., cost-effectiveness analyses (CEA) are increasingly being applied to define what interventions should be included in health benefit packages, based on their cost compared to the additional benefits they would yield. It is therefore evident that tools such as DCP3 and the Appendix 3 of the Global NCD Action Plan become useful in Defining what services for non-communicable and circulatory diseases should becovered at a given budget level. Indeed, Premature mortality from NCDs can be reduced and even avoided by implementing recommendations included in the DCP3 and Appendix 3 of the WHO Action Plan for noncommunicable diseases. A systematic review by Kane et al. (2017) found that passive NCD case finding approaches, in which every consultation represents an opportunity for screening and detection of NCDs, are the most cost-effective in low-income settings. It cites task-shifting to less-specialized health care workers, as well as standardized protocols for diagnosis and treatment of NCDs, as other viable strategies to adopt at primary care level. Useful guidance on implementing such measures and others is included in the WHO PEN Package and the HEARTS technical package, focusing on primary care level in resource-constrained settings.