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This post addresses the importance of primary healthcare in first contact healthcare availability and accessibility, and what investments are required to achieve effective and sustainable primary healthcare. It is part of the blog series for the collaboration project between SDG 1: No Poverty and SDG 3: Good Health and Well-Being working groups at Springer Nature, “Is the future of healthcare affordable and sustainable?”.
We have introduced the United Nations Sustainable Development Goal of universal health coverage (UHC) as part of SDG 3: Good Health and Well-Being in the previous post. Meeting UHC targets would ensure that all people would have access to quality health services and care they require without financial hardship. This goal is far from being met, due to the need for high investments, planning and organisation, diversion of resources and effective execution of policies.
Healthcare is a large investment for any country. It constitutes everything from policy planning, training and mobilising healthcare professionals, building and running of healthcare facilities, production and procurement of medication, healthcare equipment and supplies, and dissemination of healthcare information and services. For countries of low or middle income, it can be difficult to divert funding to healthcare when there are more pressing needs such as hunger.
At the core of healthcare availability, primary healthcare (PHC) is the most inclusive, efficient and cost-effective approach to attaining universal health coverage. Not only does it provide on-the-ground care and monitoring to populations that may be limited by socio-economic and demographic barriers, but it also plays a crucial role in early detection of crises such as epidemics and provide quick response to natural disasters.
The World Health Organisation (WHO) has proposed a monitoring conceptual framework, which breaks down what needs to be invested to achieve effective and sustainable PHC. Structural determinants such as governance, consideration of population health needs and financing set the precedence for resilient health systems. These determine the inputs required for investments including physical infrastructure, a trained health workforce, medicines and supplies, health reporting systems and digital technologies (e.g. electronic health records). Downstream service delivery to populations consists of planning and executing different models of care, such as appropriate service packages, service design to ensure accessibility and traceability, care facility management and community empowerment by engagement and collaboration. Having available systems for improving healthcare service delivery and resilience for absorbing shocks of natural disasters and pandemics without disruption to essential care are also important considerations.
Ultimately, the aim of PHC is to ensure healthcare accessibility, affordability and acceptability to the population. This takes into account geographical access, barriers such as distance, cost or socio-cultural reasons, and availability of emergency services. The services provided should be available and ready to offer the required services, with established facilities compliant to meet minimum standards, and offer a range of services including outpatient, emergency unit and hospital stays. Finally, the delivery of quality care to the population meeting core PHC functions such as first contact and continued care, comprehensive and coordinated case investigation and reporting centred on the patient experience help to build people’s perceptions of health systems and services. The effectiveness of delivery depends on diagnostic accuracy and provider knowledge and training and traceability for adherence to clinical standards and hospital readmission rates. Safety in appropriate prescription practices, efficiency of the healthcare provider in handling cases numbers and timely access to diagnosis and treatment options are significant factors in ensuring quality care.
An effective and resilient PHC system would thus actuate UHC by promoting service coverage and financial protection. Out-of-pocket (OOP) healthcare costs are a large expenditure for vulnerable populations whose income matches the household discretionary budget, and PHC policies need to anticipate and address this equity gap.
With a clear framework laid out, why is it so difficult for low- and middle-income countries (LMICs) to attain UHC and keep up with healthcare costs? Subsequent posts in the series will discuss economic and socio-demographic barriers that fundamentally affect health policy decisions and healthcare spending.
Sources and further reading:
World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF), (2022). Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens.
https://iris.who.int/server/api/core/bitstreams/01195433-c326-4d03-ba77-a64e5462a8ef/content
World Health Organization. (2025). Tracking universal health coverage: 2025 global monitoring report. https://www.who.int/publications/i/item/9789240117808
Related Sustainable Development Goals:
SDG 1: No Poverty
SDG 3: Good Health and Well-being
SDG 3.8: Universal health coverage (UHC)
SDG 3.8.2: Financial hardship in health
Keywords: health equity, primary healthcare, universal health coverage, out-of-pocket, healthcare affordability and accessibility