Opinion: 4 lessons for primary health care from the global response to HIV

A health worker conducts an HIV awareness training for patients at a women's hospital in El Fasher, North Darfur. Photo by: Albert González Farran / UNAMID / CC BY-NC-ND

Last month, alongside the International AIDS Conference in Amsterdam, the International AIDS Society-Lancet Commission launched a groundbreaking report on the future of global health and the HIV response.

While acknowledging that HIV-specific efforts have achieved remarkable success, the authors call for “a new era of global health,” focused on strengthening health systems and reaching universal health coverage as an essential strategy to maintain and further success in the fight against HIV and AIDS. The authors recognize that this effort will succeed only if everyone can access quality integrated health care without financial hardship.

At the Primary Health Care Performance Initiative, we couldn’t agree more. We too believe that health systems must be better supported to provide high quality, integrated, person-centered care accessible to everyone in order to achieve the Sustainable Development Goals for health — and this begins with robust primary health care.

There is no more powerful, foundational step toward universal health care than strengthening primary health care, which can meet more than 80 percent of people’s diverse health needs throughout their lives. Robust primary health care will be critical to the future of the HIV response, as just last year, 36.9 million people globally were living with HIV and 1.8 million became newly infected. Primary health care is also best positioned to provide the type of integrated, co-located services necessary for those people living with HIV and contending with various diseases both related and unrelated to HIV.

Reflecting on the decades of successes and setbacks in the global HIV response, we see four key lessons from the new Lancet-IAS Commission report to guide future efforts toward strengthening primary health care and achieving health for all.

1. Integrating health services saves lives and money

For a long time, HIV/AIDS programs focused on controlling the epidemic and treating as many people as possible. Now, these programs are increasingly trying to focus on prevention and aligning with programs geared toward issues including maternal and newborn health, immunization, and noncommunicable diseases. According to The IAS-Lancet Commission report, integrated approaches — the same that underpin a strong primary health care system — are generally more effective and affordable.

From the patient perspective, it also makes sense. When a pregnant woman visits a clinic, she should be able to receive an antenatal check-up, get tested for HIV, and pick up antimalarial treatment for her family. When a young boy goes to the doctor, he should be able to receive treatment for his fever and life-saving vaccinations. Comprehensive primary health care delivers the integrated health services people need.

Put simply: People don’t experience illness in siloes, and health systems should follow suit.

2. People should always be at the center

One of the hallmarks of the HIV response has been its dedication to putting people first by advocating for patients’ rights and reducing stigma. This focus on social justice has helped marginalized people around the world access key prevention, treatment and care services they need and deserve. But there is a great deal more to be done.

Enhanced primary health care can build on this momentum, bringing better health to even more people, especially the vulnerable. By working across the HIV prevention, treatment and care continuum, strong primary health care can help reach the most marginalized communities to further break down health inequities.

3. Low-income doesn’t have to mean low-impact

With a combination of domestic and donor funding, low- and middle-income countries have made extraordinary progress in combating HIV. Low-resource countries such as Botswana, Senegal, and Uganda have all made strides in reducing new infections and expanding access to treatment. In 2015, Cuba became the first country to eliminate mother-to-child transmission of HIV.

Coupling these efforts with primary health care can accomplish even more. Countries across the income spectrum can be trailblazers in primary health care — especially because it is a “best-buy” investment that can meet the majority of people’s diverse health needs in a cost-effective way through reliable delivery of basic health services.

Consider Brazil: Through its family health program, which provides primary health care free at the point of service, Brazil ensured that at least 64 percent of its population has access to essential health services. Namibia scaled up access to essential health services and cut maternal and child mortality by investing in mobile primary health care clinics. Thailand — even in the face of financial crises in the 80s and 90s — was able to make essential health services available to all its citizens for free or at very low cost. Though each of these countries still has a way to go, they have made marked improvements in a variety of health outcomes because of efforts to strengthen primary health care.

4. More and better data makes a difference

Without clear targets to track gaps and progress, HIV/AIDS advocates would not have been able to raise funds, mobilize support, and demand policy change. From UNAIDS to the Global Fund to PEPFAR and national health ministries, efforts to quantify the magnitude of the problem and use data to drive solutions have led to transformative progress against the pandemic.

Unfortunately, when it comes to strengthening health systems and primary health care, our data is still severely lacking.

At PHCPI, we are working to improve the availability and use of data on primary health care around the world, helping to shine a light on what’s working and what isn’t, and ensuring decision-makers have the information they need to strengthen these systems. But we can’t do this alone. Advocates for primary health care and universal health care should continue to push for more and better data, so that we can leverage these metrics to achieve major global health goals, including continued progress on HIV.

As we seek this ambitious goal of health for all, those of us working on primary health care and universal health care must continue to broaden our coalition and build bridges with others. The right to health belongs to everyone, and our movement must too.

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About the authors

  • Beth

    Beth Tritter

    Beth Tritter is the executive director for the Primary Health Care Performance Initiative, a partnership dedicated to transforming the global state of primary health care. Previously, Beth was the vice president for the Department of Policy and Evaluation at the Millennium Challenge Corporation, where she directed the MCC’s policy development, economic analysis, program evaluation and learning, and Threshold Program. She was also a managing director at the Glover Park Group and a legislative director for New York Congresswoman Nita Lowey.
  • Jmarkuns

    Jeffrey Markuns

    Jeffrey Markuns is the deputy director of the Primary Health Care Performance Initiative and executive director for the Boston University Family Medicine Global Health Collaborative. As a practicing family physician and faculty educator in both family medicine and general medical education, Jeff has worked to improve primary health care around the world, including in Cambodia, Laos, Lesotho, Myanmar, the Philippines, Saudi Arabia, and Vietnam.