Exploring the Challenges for Universal Health Coverage: A Call to Africa by AfroPHC.

Abstract

The primary health care (PHC) system in Africa faces many challenges AND opportunities. To date, human resources for health in PHC are grossly insufficient in number, often inefficiently and inequitably distributed, lacking adequate training for delivering fully responsive and comprehensive frontline care and are treated inequitably within the health system. There has been a lack of solidarity among key role players in healthcare to create adequate PHC funding in Africa. Resources do not appropriately or adequately reach the frontline PHC service platform due to outdated service delivery and payment models. Patients experience PHC as numbers in a queue, with poor comprehensiveness, continuity, and coordination. Health workers are also treated like numbers in a bureaucracy that fragments and undermines training and service for integrated care around patient and population needs. However, opportunities abound with global PHC milestones, increasing political will for investment in PHC, and proven mechanisms for achieving a stronger workforce such as community health workers, clinical task-sharing, and the integration of family doctors into PHC. The African Forum for PHC (AfroPHC) has a vision for PHC and UHC that is team-based with skills mix appropriate to Africa, including family doctors, family nurse practitioners, clinical officers, community health workers and others that are empowered to take care of an empaneled population in high-quality people centred PHC. AfroPHC is making a call on stakeholders to develop and implement a regional forward-looking plan to 1) build robust PHC systems, 2) train, recruit and maintain a sufficient frontline PHC workforce, and 3) support PHC with appropriate financing. This can all come together easily in a nationally defined PHC contract using risk-adjusted blended capitation payment to decentralised PHC teams empanelled to enrolled populations, coordinated by district health services and easily administered at national or sub-national level for empowered public and private providers.