Make This Time Different. Prioritize Primary Health Care as a 3-for-1 Investment towards Health for All.
An open letter signed by 239 organizations and 157 individuals across 65 countries urging leaders to prioritize a primary health care approach across the 2023 UN High-Level Meetings on Universal Health Coverage and Pandemic Prevention, Preparedness, and Response, and the 2023 midpoint of the Sustainable Development Goals.
Primary health care is ‘primary’ for a reason. We call on national, regional and global actors to prioritize primary health care as a 3-for-1 investment in universal health coverage, health security and better health and well-being. All three of these goals depend on the same health systems, and primary health care is their common foundation.
For more than 40 years, the world has made ambitious commitments to create a healthy future for all – from the Declarations of Astana (2018) and Alma-Ata (1978), to the UN Sustainable Development Goals (SDGs) (2015) to the UHC Political Declaration (2019), which has been referred to as the most comprehensive set of health commitments ever adopted. Along the way, global leaders have repeatedly recognized primary health care (PHC) – an approach that can reach every community and meet the vast majority of people’s health needs throughout their lives – as the foundation of strong health systems and the key to greater well-being, social and economic prosperity, and equity.
Yet for more than 40 years, the reality of these commitments has fallen short of their promise.
Instead of acting on lessons learned to build the health systems people want and need, we keep retreating into patterns of crisis and inaction – leaving millions of lives and livelihoods in the balance. The COVID-19 pandemic and other emerging health threats continue to test the resilience of health systems and prove that we still aren’t prepared to meet the challenge. As a result, additional negotiations have been launched to strengthen pandemic preparedness and response, including calls for a pandemic treaty, reform to the International Health Regulations, and a new fund to help prevent future health emergencies. Efforts are also underway to make up lost ground in the fight against leading infectious and non-communicable diseases.
However, without a strong foundation of primary health care to address growing gaps in essential health services, the most vulnerable communities will remain most susceptible to any threat – whether local or global in scale – to their health and well-being.
It is time for a radical reset. 2023 will see several UN High-Level Meetings – including one on Universal Health Coverage and one on Pandemic Prevention, Preparedness, and Response – as well as the midpoint of the Sustainable Development Goals. All of these moments represent major opportunities to stop repeating history and begin a new chapter of sustained action, recognizing primary health care as the crucial link between these urgent health goals.
Together, we can make this time different by strengthening health systems through a primary health care approach, starting with three overdue shifts:
1. Prioritize people who have been failed by the system, not those who already benefit from it.
Change who has the power to set policy agendas and allocate resources at all levels of government so that the wealthy, privileged, or most vocal few – locally, nationally and globally – are no longer dictating the lives of the many. Teams of decision-makers must reflect the expertise of all the diverse communities that health systems are meant to serve, or else decisions will keep leaving the same people behind.
Require that patients, patient advocates, frontline health care providers (who are predominantly women) and communities be included as equal partners in the leadership and management of health care service delivery. These are some of the people best-positioned to identify crucial gaps and drive solutions that we have missed in the past.
Insist on international agreements and responses – including for matters of global health security – that foster genuine solidarity, equity, and mutual learning across countries, and no longer permit the most powerful donors, leaders, entities and nations to put their priorities above the rest.
2. Give the people what they want: quality health services in their community that work around their needs, preferences, and everyday lives – instead of requiring financial or personal sacrifices to get a trusted standard of care.
Earn people’s trust by consistently delivering primary care services that meet everyone’s needs across the lifespan. Services must be respectful, fully responsive, proactive, and well-managed, with reliable entry points in every community.
Invest in a well-resourced, protected, diverse, and skilled team-based health workforce at community, sub-national and national levels so that health workers can ensure patient satisfaction and meet all essential health needs in times of crisis and calm.
Set measurable targets and report disaggregated data transparently on quality across all pillars of primary health care (e.g., capacity, performance, and impact). This should include external and community-led reviews of how government policies, structures and funds are translating to quality services for all.
Demand systems that guarantee high-quality care for all people and communities. Remove all financial and other barriers to health services so that everyone, particularly the most marginalized groups, can get the quality care, products, and information they need – and entire families, communities, and economies will benefit.
Prioritize human rights, gender equity, and social determinants of health through multisectoral action, and involve communities as partners in their own care, recognizing that good health starts outside of the clinic.
3. Treat primary health care as an investment, not a cost, to build resilience into the foundation of the health system and improve health outcomes for all.
Drive more, better, and localized investments toward health systems based on primary health care, allocating funds according to each community’s and country’s needs and priorities. More public financing is especially key in countries that receive donor support, to lessen dependence on priorities that may not align with national strategic plans.
Instead of diverting resources from one crisis to the next, ensure that every program for pandemic prevention, preparedness, and response includes specific investments for improving primary health care as the foundation of resilient health systems that can adapt to new threats and sustain comprehensive health services, no matter what.
Establish policies and systems of mutual accountability to uphold people’s fundamental right to health, sustain PHC investments, and keep improving population health and well-being even as administrations come and go.
Earmark financing to strengthen health data, surveillance, information systems and community engagement in PHC, and use comprehensive assessments to drive better decision-making. Everyone must be counted and included to leave no one behind.
It is past time to translate the will to achieve Health for All into meaningful benefits for people and communities around the world. The 2023 UN High-Level Meetings on Universal Health Coverage and Pandemic Prevention, Preparedness, and Response, as well as the mid-point of the Sustainable Development Goals, represent major opportunities to take what we have learned and build the world we want.
To make this time different, we urge leaders and Member States to prioritize primary health care in these negotiations as a 3-for-1 investment in universal health coverage, health security, and better health and well-being for all.
Together, we can rise to meet the challenges around us, and turn a corner toward unprecedented times that future generations will thank us for.
Signed by:
Advisors to the Allies Improving PHC
Dr. Lola Dare, Chestrad Global; Dr. Ibtihal Fadhil, Eastern Mediterranean NCD Alliance; Dr. Aminu Magashi Garba, Africa Health Budget Network; Arush Lal, PhD Candidate, London School of Economics & Political Science; Dr. Neda Milevska-Kostova, IAPO Patients for Patient Safety Observatory; Assoc. Professor Shabir Ahmed Hassim Moosa, African Forum for Primary Health Care; Patricia Nudi Orawo, STADA Kenya; Chanthorn Phorng, Khmer HIV/AIDS NGO Alliance
Organizational Signatories
AANI-PAS
Academic and Career Development Initiative Cameroon
Activate Action
Advocacy Network Africa (AdNetA)
Aequitas Consulting Pvt Ltd
AFPDE
AFRAC RDC
Africa Health Budget Network
Africa Islamic Economic Foundation
African Hope Committee Inc
Afrihealth Optonet Association (AHOA) - CSOs Network
AfroPHC
Alliance for Reproductive Health Rights
Americas TB Coalition
Amref Health Africa
Ariadne Labs
Arthritis and Rheumatism Association Malta (ARAM)
ASEAN Institute for Health Development, Mahidol University
Asociación de diabetes en niños y adolescentes del Perú - Adina Perú
Associação de Profissionais Licenciados de Optometria
Associacao Hixikanwe
Associação Santomense para Promoção Familiar ( ASPF)
Association Cedria pou un environnement et un développement durables
Association For Promotion Sustainable Development
Association HERAXXI
Baerbel Jennert Foundation
Banka BioLoo Limited
Best Health Solutions
BOKA HAVEN
Building Capacities for Better Health Africa, Cameroon
CARE
CCM RWANDA
Centre for Accountability and Inclusive Development (CAAID)
Centre for Primary Health Care and Equity, UNSW Sydney
Centre for Sustainable Access to Health in Africa
CHEN - patient fertility association
Christian Fellowship and Care Foundation
Civic and Legal Aid Organization (CILAO)
Civil Society Movement Against TB
Clinique Mobile / Fondation Panzi RDC
Coalition des OSC du Bénin pour la Couverture Universelle en Santé (COBCUS)
Colegio Mexicano de Posgraduados en Medicina Familiar A. C.
Communities at the Heart of UHC
Community AID Transformation Alliance Group (CATAG)
Community Fighte Against GBV and HIV/AIDS
Community Forum (COFO)
Community Health Volunteers
Community Partners International
Community Working Group on Health (CWGH)
Community's Expertise for Development Contributions
Confraternity of Patients Kenya (Cofpak)
Consortium for the Advancement of Right for Key Affected Population (CARKAP)
Construisons Ensemble le Monde
CORE Group
CSYM HUDUMA CHRISTIAN SPIRITUAL YOUTH MINISTRY YLO TANZANIA
Dakshayani and Amaravati Health and Education
Dentalcare Foundation
development Research and Projects Centre
DOM//ECC SUD-KIVU
Dr Uzo Adirieje Foundation (DUZAFOUND)
E-Center for Women's Cancer and Maternal Health
Eastern Mediterranean NCD Alliance
Echovision LLC
Egyptian NCD Alliance
Ergovisão Ponte de Lima
European Forum for Primary Care
Facilitation for Integrated Community Rural Development
Faith Acts Research Support and Training (FARST - Africa)
Family Health International 360 Malawi
Federal University Lokoja Health Services
Focus for the Future Generation
GCFORCB Organisation
Ghana Institute of Management and Public Administration
Global Health Collaborative in the Dept of Family Medicine at Boston University
Global Health Corps
Global Health Strategies
Global Institute for Disease Elimination (GLIDE)
Global Promoters for Community Initiatives
Good Health Community Programmes
Great daughters of Nyakach
Health Action Coordinating Committee
Health and Global Policy Institute (HGPI)
Health and Rights Education Programme, Malawi (HREP Malawi)
Health Campaign Effectiveness Coalition
Health NGOs Network (HENNET)
Health Systems and Policy Research Unit, Community Health Department, University of Uyo
Health Systems Thinkers, LLC
Health, Education and Literacy Programme (HELP)
HealthX Africa
Healthy And Smart Children's Foundation
Heart to Heart Smile
Hellenic Academy of General Practice/Family Medicine & PHC
HelpAge International
HUMAN RIGHT ADVOCACY HEALTHCARE AND REINTEGRATION OF INDIGENT PRISONERS (PERSONS)
Humanity for Orphans, Youth and Widows Initiatives Kenya (HOYWIK)
IAPO Patients for Patient Safety Observatory
Imam Sadr Foundation
Independent Practitioner Association Foundation (IPAF)
Initiative for Integrated Grassroot Empowerment and Support
Innovations for Development (I4DEV)
International Alliance of Patients Organisations (IAPO)
International Diabetes Federation - Saca Region
Intersectoral Forum to Fight NCDs in Brazil (ForumDCNTs)
IntraHealth International
Inuka Success Organization
Jhpiego
Jijenge Youth
Jordan Society of Family Medicine -JSFM
Julie Helping Hands Foundation (JHF)
Kamuzu University of Health Sciences
Kamyk Clinic Limited
KAPOTEC FOUNDATION UG
Kenya Female Advisory Organization
Key Populations Uganda (KPU)
KHANA Center for Population Health Research
Khmer HIV/AIDS NGO Alliance (KHANA)
Kinder Consulting
Kisumu Action for Disability Development Network (KADDNENT)
Kisumu County Community Health Workers Network
Kisumu Medical and Education Trust (KMET)
Kisumu Social Inclusion Network (KSIN)
Kuboresha-Africa
La Ruche Health
LaGray Chemical Co Limited
Lami Fatima Babare Cervical Cancer Foundation
Last Mile Health
Lesotho Network of AIDS Service Organisations (LENASO)
Living Goods
Local Initiatives Development Agency
MAAYGO
Make Me Smile Kenya
Malarialess, Uganda
Management Sciences for Health
Masvingo Association of Residential Care Facilities Trust
Medical Assistance Sierra Leone
Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine
MentorPoint Africa
Millar Institute for Transdisciplinary and Development Studies
Mimbi international school Medical Clinic
Ministerial Committee of Scientific and Technological Cooperation
Ministry of Health - Bhutan
Ministry of Health, Ethiopia
Mumbo International
MWAN PAS
Nasarawa State Ministry of Health
National Advocates For Health
National Disability and Development Forum NDF
Network of Persons Living with HIV/AIDS - GHANA (NAP+ GHANA)
NGOs Network For Dodoma (NGONEDO)
Nigeria Association of Social Workers
NOIPolls Limited
Nuwalege Progressive Movement
Onyibupet Consulting Limited
Options (Evidence for Action-MamaYe)
Options Consultancy Services
Organisation For Health in Sustainable Development (OHISD)
Organization of African Youth
Oromia Regional Health Berou
Outreach Scout Foundation -OSF
PAI
Pandemic Action Network
Pangaea Zimbabwe Aids Trust
Panzi Hospitals
PATH
Pathfinder International
Patient Academy for Innovation and Research
Patient and community welfare Foundation of Malawi
People’s Health Movement Tanzania (PHM Tanzania)
PharmAccess Group
PHM Malawi
PHMUganda
Planned Parenthood Federation of Nigeria
Population Services International (PSI)
Primary Care International (PCI)
Public Health Research Society Nepal
RBM Partnership to End Malaria
Reconciliation and Development Association
Research Center on Health Policies and Systems - International Health, School of Public Health, ULB
Results for Development (R4D)
Riders for Health - Lesotho
Riders For Health - The Gambia
Rural Health Advocacy Project a division of WITS Health Consortium
Rural Women and Girls' Rights Foundation
Safe Island For Women and Children (SIWoC)
Salud para Todos Argentina
Santé et Education pour Tous (SET ONG)
Sauti ya Wanawake Wenye Ulemavu Tanzania (SWAUTA)
Save for Development and Relief Association (SADERA)
Save the Children Indonesia
School of Medicine, University for Development Studies
SEDAP ( Spanish Society of Primary Health Care Managers)
SHAPE CBO
Shift For Change (S4C)
Soc Trang Center For Social Science Engagement (SCSE)
Social Alpha
Society for Conservation and Sustainability of Energy and Environment in Nigeria (SOCSEEN)
SODECA
Speak Up Africa
STADA Kenya
Stage Media Arts
Stessis Digital Medical Systems
Stroke Association Supportnetwork-Ghana (SASNET-GHANA)
Stroke Foundation Uganda (SFU)
Success Capital Organisation
Sukaar Welfare Organization
Support Heal and Purpose to Elevate (SHAPE)
Supporting Girls in Education
Swasti
Tanzania Association of Clinical Officers and Clinical Assistants (TACOCA)
The Access Challenge
The AIDS and Arts Foundation (TAAF Zimbabwe)
The Airlangga Centre for Health Policy
The Botswana Network on Ethics Law HIV AIDS (BONELA)
The George Institute for Global Health
TINADA Youth Organization
Tobacco Free Association of Zambia.
Todos Frente al Chagas /Chagas Disease Alliance
Trans-Plant Cameroon
Tunaweza Organisation (Tanzania)
Uganda Alliance of Patients' Organizations (UAPO)
Uganda Community Based Health Care Association
Uganda National Health Users/ Consumer's Organisation
Ugenya Youth Community Development Project
Ukana West 2 Community Based Health Initiative
Umane
UNICEF
University for Development Studies
VillageReach
West African Institute of Public Health
White Ribbon Alliance
Wider Aid & Development Agency, South Sudan
Winam Chanua Dada CBO (CHADALA)
Women Health Channel Uganda
Women in Media Communication Initiative (WIM)
WONCA ICPC Foundation
World Organization of Family Doctors (WONCA)
YESAM
Zambia Heart and Stroke Foundation
Zambia NCD Alliance
Australia
Mark Burdack
Bangladesh
Harun Maliiha
Md Shah Jalal
Belgium
Jean Macq
Botswana
Sunanda Ray
Brazil
Valentina Martufi
Frida Liane Plavnik
Rita Freitas
Cambodia
Pheak Chhoun
Cameroon
Asanga Zaccheous Achidi
Nkwan Jacob Gobte
Canada
Ishtiaq Bashir
Blessing Adeyemo
Cote d’Ivoire
Rory Assandey
Democratic Republic of the Congo
Buloze Munonge
Jeremie Kasongo
Egypt
Eman Sobh
Ethiopia
Sirak Embibel
Gizew Asres
Bereket Ashenafi
Kadire Geticha Mekengo
Desta Bukulu
Germany
Arthur Onyango
Ghana
Bernice Gyawu
Charles Oduro Owurani
Erasmus Agongo
India
Mudera Cariappa
Bobby John
Asha Jyothi
Nadeem Shaikh
Kareem Karassery
Roma D'silva
Indonesia
Ilham Ridlo
Atikah Adyas
Daniel Tjen
Chandra Laskar
Japan
Joji Sugawara
Hideaki Nakajima
Jordan
Ahmad AlNawafleh
Grace Ojuang
Dr. Mohammed Rasoul Tarawneh
Kenya
Rachel Ndirangu
Mary Ger
Miriam Alvina Achieng
Pauline Irungu
Sylvia Ayon
Brenda Makungu
Shariffa Olima
Samuel Onjolo
Bosse James
Tobias Awalla
Benson Odhiambo Owano
Esther Gikonyo
Dellah Ochieng
Kwameh Daughty
Annet Lucy Achieng Oduory
Danson Maloti
Eric Yogo
Maureen Akeyo Owino
Lavendar Okoth
Fred Misach
Carolyne Amondi Miguna
Byron Otieno
Dennis Obiero Ogot
Daniel Mwangi
Lesotho
Yolisa Mashologu
Nthabeleng Ntsekalle
Malawi
Mabvuto Mndau
Elimase Kamanga
Ellos Lodzeni
Malaysia
Dr. Veronica Lugah
Peter Gan
Uma Ponnudurai
Dr. Saguntala Selvamani
Individual Signatories
Mongolia
Chimeddagva Dashzeveg
Netherlands
Daren Paul Katigbak
Liesbeth Siderius
Nigeria
Fanty Mela
Ebikapaye Okoyen
Louritta Akpelan
Olabisi Adebawo
Kazeem Balogun
Christiana Omelazu
Abdulmujib Dalhatu Abdullahi
Samson Agbo
Adewale Hameed Aderibigbe
Francis Ohanyido
Abraham Shobowale
Zakari Osheku
Shehu Sule
Ayobami Afape
Shehu Muhammad Hassan
Pakistan
Amna Mahmood Islam
Peru
Javier Pablo Anamaria
Philippines
Nancy Brisa Fuentes
Portugal
Raúl Sousa
Rwanda
Frédérique Geron
Vincent K. Cubaka
Sao Tome and Principe
Antonio Luis Dos Santos Amado Vaz
Mafalda Brito
Sierra Leone
Harry Ben Alpha
South Africa
Eliza Malaza
Spain
Borja Cuervo Alonso
Sudan
Mohammed Musa
Almoghirah Abdellah
Nada Mohammed
Nageeb Ibrahim
Switzerland
Brian Li Han Wong
Tanzania
Shaibu Issa
Emmanuel Mush
Edward Mbogo
Monica Tibris
Deus Polepole
Gertruda Keyula
Fredrick Nkona
Thailand
Nirmal Kumar Jha
Tunisia
Abdelkrim Zemzari
Uganda
Samuel Senfuka
John V Amanya
Franco Gabala
Frank Gramsen Kizza
John Vianney Amanya
United Kingdom
Hassan Haghparast Bidgoli
Mamsallah Faal-Omisore
J A Harbottle
Stephanie De Sa Marques Basset
United States
Lakshmi Balaji
Anna McDonald
Jorge Villegas
Cynthia Haq
Nicodemus Soko
Alberto Colorado
Dr. Jean Jose Nzau
Rebecca Fujimura
Samantha Friedmann
Ekpenyong Ekanem
Nida Ali
Lynne Gaffikin
Emily Bigelow
Jeff Markuns
Pattama Ulrich
Gladys Ngeno
Yemen
Dr. Rashad Sheikh
Zambia
Banza Chela
Miriam Chipimo
Zimbabwe
Enock Musungwini
Open Letter published on 20 September 2022