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

Area of Science:

• Health Policy and Systems Research
• Global Health
• Primary Health Care Delivery

Background:

• Primary health care (PHC) in Africa is hampered by insufficient, inequitably distributed, and inadequately trained human resources.
• Inadequate funding and outdated service delivery/payment models prevent resources from reaching frontline PHC services.
• Patients and health workers experience fragmented care and bureaucratic inefficiencies within the current PHC system.

Purpose of the Study:

• To highlight the challenges and opportunities facing PHC systems in Africa.
• To advocate for a strengthened, team-based PHC workforce and improved financing mechanisms.
• To propose a regional plan for robust PHC system development and implementation.

Main Methods:

• Analysis of the current state of PHC human resources, funding, and service delivery in Africa.
• Review of global PHC milestones and successful workforce strengthening mechanisms.
• Proposal of a new PHC contract model utilizing risk-adjusted blended capitation payments.

Main Results:

• Significant deficiencies exist in PHC human resources, funding, and service delivery across Africa.
• Opportunities for improvement include global PHC initiatives, increased political will, and proven workforce strategies like community health workers and task-sharing.
• A vision for team-based PHC with an appropriate skills mix, including family doctors, is presented.

Conclusions:

• A concerted regional effort is needed to build robust PHC systems, train and retain a sufficient frontline workforce, and secure adequate financing.
• Empowered, team-based PHC providers caring for empanelled populations can improve health outcomes.
• A nationally defined PHC contract with risk-adjusted blended capitation is proposed for efficient administration and delivery of quality, people-centered PHC.