Prevention of Tropical Diseases

¶ … World Health Organization

Advocating Universal Access to Primary Care

One major goal of primary health care is better health for all. Furthermore, the major international initiative to foster this goal is from the World Health Organization who has advocated since the late seventies to improve global public health by improving access. The WHO has created a coalition calls for a (WHO, N.d.):

"A new global coalition of more than 500 leading health and development organizations worldwide is urging governments to accelerate reforms that ensure everyone, everywhere, can access quality health services without being forced into poverty. The coalition emphasises the importance of universal access to health services for saving lives, ending extreme poverty, building resilience against the health effects of climate change and ending deadly epidemics such as Ebola."

The statement calls something other than common conceptions of what is referred to as "universal healthcare" in the West. However, "access" to healthcare in the developing world is typically thought of along three dimensions (Evans, Hsu, & Boerma, 2013)

Physical accessibility. This is understood as the availability of good health services within reasonable reach of those who need them and of opening hours, appointment systems and other aspects of service organization and delivery that allow people to obtain the services when they need them.

Financial affordability. This is a measure of people's ability to pay for services without financial hardship. It takes into account not only the price of the health services but also indirect and opportunity costs (e.g. the costs of transportation to and from facilities and of taking time away from work). Affordability is influenced by the wider health financing system and by household income.

Acceptability. This captures people's willingness to seek services. Acceptability is low when patients perceive services to be ineffective or when social and cultural factors such as language or the age, sex, ethnicity or religion of the health provider discourage them from seeking services.

It is important to note that the concept of universal healthcare, as it is often thought of in the West, does not necessarily imply a single payer system such is found in nearly all developed countries. Rather, according to the UN, the system must be affordable and accessible in a variety of different ways. Although, countries such as the UK and France, guarantees coverage to all its citizens, there are many other ways to expand access as well. For example, the U.S. could expand access to many population segments by helping to reduce costs or subsidizing fees. The Affordable Care Act (ACA) expanded the system to millions of Americans however there are still significant portions of the population that do not have adequate access to primary care. Further expanding the system has become the base for a national discussion on the role of government in increasing access to healthcare. Other initiatives such as nurse managed clinics have also shown promise in regards to providing basic primary services to many underprivileged populations.