Delivering Quality Care to Patients Who Need it Most: Exploring Health Strategies at the Global Conference on Primary Health Care

This blog post was written by Maia Olsen, Program Manager, NCD Synergies at Partners In Health (PIH). PIH’s mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair. They are a 2018 Global Health Council member.

Maia Olsen (second from the left) joins PIH colleagues in Astana, Kazakhstan – including PIH Liberia’s Executive Director Patrick Ulysse, PIH Haiti’s Co-Executive Director Loune Viaud, and PIH’s Senior Director of Strategic Partnerships Leslie Flinn – in a surprise photo with WHO Director General Tedros Adhanom Ghebreyesus, who was between commitments amid a busy conference schedule. Photo Credit: Eric Hansen / Partners In Health

Last week, Partners In Health (PIH) came together in Astana, Kazakhstan with Ministries of Health and colleagues representing institutions throughout the world for a historic and inspiring week of meetings on primary health care and strategies to achieve Universal Health Coverage (UHC). The week was in honor of the 40th Anniversary of the Declaration of Alma-Ata, as well as in recognition of how much is still left to be achieved on the 1978 call to action so many years ago.

On Wednesday 24th October, PIH held a one day pre-meeting to the global conference entitled “Health Systems and Delivery Strategies to Achieve Universal Health Coverage” in collaboration with the Ministry of Health of Kazakhstan and the Global Financing Facility. At this meeting, PIH looked to generate energy and critical discussion around pathways to expand quality care delivery to patients who need it most, across all levels of the health system. A common theme throughout the day’s discussion was how imperative it is that we – as the implementing community in low- and middle-income countries – encourage donors and support governments to invest in comprehensive health systems strengthening that addresses what our patients need across the full disease spectrum, rather than centering prevention and care delivery solely around “low-hanging fruit”, vertical programs, or a more minimal and selective primary care package.

Over 150 participants attended PIH’s sessions, representing peer organizations such as PIVOT, Muso, Possible, Last Mile Health, Integrate Health, Amref, and many members of the Frontline Health Workers Coalition and Civil Society Engagement Mechanism for UHC2030, prominent stakeholders including the WHO, World Bank, Global Fund, USAID, GAVI, and Global Health Council, and more than ten Ministry of Health delegations across countries as diverse as Liberia, Madagascar, Kazakhstan, and Nepal. Throughout the day, discussions were forward-looking, social justice focused, and rooted in asking hard questions regarding how to provide increased access to quality care to the world’s most vulnerable populations.

As Dr. Joia Mukherjee, PIH’s Chief Medical Officer, stated in an opinion piece coinciding with last week’s conference:

“Provision of high quality care is attainable in some of the hardest to reach and least-resourced settings when patient-centered approaches are prioritized […] Universal health coverage is an ideal whose benefits are clear, whose time has come, and whose expense is nothing compared to the cost of continued delays.”

As someone representing the NCD community through my role with the NCD Synergies program at PIH and who has closely collaborated with partners like the Global Health Council, NCD Roundtable, and the Women and NCDs Taskforce in advocacy efforts leading up to the 2018 UN High-Level Meeting on NCDs, it was inspiring to be – just over a month later – in a room where NCDs, mental health, and injuries fit squarely in a broader conversation around how to achieve universal health coverage and health financing in the poorest settings where PIH works.

As we have demonstrated through PIH’s work and partnership across the Program in Global NCDs and Social Change at Harvard Medical School and the Lancet Commission on Reframing NCDs and Injuries among the Poorest Billion, there are proven strategies to address gaps in care for NCDs, mental health, and surgically-amenable conditions, which often extend beyond primary care, such as the PEN-Plus packagefor integrated management of severe, complex, and chronic NCDs such as rheumatic heart disease and type 1 diabetes at first-level hospitals.

For those that have seen or experienced the struggles of young patients like Babesh Tumang and Sheila Chipenge living with NCDs like neuroblastoma and type 1 diabetes, it is immediately clear why severe NCDs that impact the world’s youngest and poorest patients must be included as an essential part of the global UHC agenda. Their voices are why our NCD Synergies team made the call to action we did on behalf of PIH at the July 5th United Nations Interactive Hearing on NCDs alongside our colleagues at Global Health Council and other civil society institutions.

Their voices are also why we were so honored to be in Astana to come together around such an ambitious call to action to support governments to progressively achieve universal coverage to quality care spanning the health system and inclusive of all conditions – from cholera to multi-drug resistant tuberculosis to rheumatic heart disease.

We ask our colleagues throughout the world to join forces with us in advocating for increased funds for integrated health systems strengthening to achieve UHC. Let’s work together to realize the commitments in the Astana Declaration – and throughout the UHC agenda – in a way we didn’t following Alma Ata in 1978.