![]() The change also requires good information about PHC resource levels and flows so that this reorientation can be effectively managed and monitored. Changing the ways in which PHC is financed requires support from a wide range of stakeholders, and deliberate political strategies, to determine and then stay the course. Political, social, and economic factors are therefore as important as technical design elements when it comes to enacting efficient and equitable primary health-care financing reform. Improving PHC financing can occur in response to bottom-up advocacy, top-down policy or, most likely, through a combination of grassroots and technocratic approaches. ![]() This Commission recognises that, depending on the context, the evolution of an effective primary health-care financing system in some countries might occur through incremental changes, whereas others can implement comprehensive reforms. The four attributes outlined both represent goals and present a guide for working towards those goals. Focus on financingĮach country is at a different point along its path towards the goal of effective financing for PHC. This action deprives PHC of funding, and the lack of resources further exacerbates the problems that have driven patients elsewhere. Therefore, many people bypass primary health-care facilities to seek out higher-level specialist care. A vicious cycle has undermined PHC: underfunded services are unreliable, of poor quality, and not accountable to users. Public funding for PHC is insufficient, access to PHC services remains inequitable, and patients often have to pay out of pocket to use them. In many places across the globe, PHC does not meet the needs of the people-including both users and providers-who should be at its centre. Yet in most low-income and middle-income countries (LMICs), PHC is not delivering on the promises of these declarations. More recently, the 2018 Astana Declaration on PHC made a similar call for universal coverage of basic health care across the life cycle, as well as essential public health functions, community engagement, and a multisectoral approach to health. PHC was famously set as a global priority in the 1978 Alma-Ata Declaration. The Lancet Regional Health – Western Pacific. ![]()
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