May 2008, id21 insights health, Issue #12

Financing primary health care

Today, millions of people in low- and middle-income countries do not have access to basic, good quality health services. The Alma Ata Declaration in 1978 defined primary health care as basic health care built on technically sound and socially adequate approaches, universally accessible and affordable to all individuals. This issue of id21 insights explores the challenges facing donors and national governments in providing and financing primary health care for all.

Enrolled Nurse Miriam Chisizwa takes the blood pressure of a patient in Bwalia Hospital in Lilongwe, Malawi, where she has worked for seven years. Her salary is 28,000 Kwacha (£100 per month). She works 24 hour shifts and says "I feel very tired." Abbie Trayler-Smith, Panos Pictures, 2007. See Tackling Malawi's human resources crisis.

Other articles in this issue:

Skilled delivery care in Indonesia

Providing adequate access to maternal health care is a test of the entire health system. Care for most women before, during and after delivery can be provided within a well equipped primary care setting. Where complications arise there is the need for speedy referral to higher level facilities. Primary care is thus a main care provider as well as a crucial link to more specialist forms of care.

The story of primary health care

The idea of primary health care (PHC) emerged in the 1960s, in recognition of the shortcomings of the health systems inherited by developing countries after independence. Such urban, centralised and curative-oriented health systems were poorly matched to the needs of their people.

Contracting out health services

Contracting out public services is a way for governments to complement their own delivery of services. It is particularly effective for high risk or hard-to-reach populations that can be more effectively served by private groups. It can also contribute to more efficient delivery of primary health care (PHC).

Better access to effective antimalarials

Malaria is one of the main reasons why people use health services in sub-Saharan Africa, placing a considerable burden on primary health care.

Efficiency and equity through a sector-wide approach in Uganda

Financing Uganda's health care services used to be based on a minimum package which cost more than the financial resources available. Donor aid contributed between 40 to 50 percent of these costs. Financial allocations were also biased towards national level hospitals and wages.

Tackling Malawi's human resources crisis

The achievement of the Millennium Development Goals (MDGs) by 2015 will only be possible if we can successfully strengthen the capacity of health systems in middle and low-income countries.

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