From dysfunctional gatekeeping to quality, comprehensive care for all

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First, guaranteeing universal coverage of high quality, comprehensive PHC will require governments to raise adequate funding through prepaid, pooled financing, while making explicit efforts to remove financial barriers to care for the entire population. This investment must be guided by clear plans and explicitly defined PHC benefits packages that prioritize prevention and timely treatment at the appropriate level of care, thereby avoiding unnecessary hospitalizations or complications. Second, the shift to effective team-based care models requires innovations in the way providers are paid, accompanied by investments in data and information systems that facilitate closer coordination. Third, financing can address persistent inequities and facilitate accountability through inclusive decision-making processes, explicit removal of financial barriers on both the supply and demand sides, better measurement, and transparent planning and budgeting. Fourth, as demonstrated by COVID-19, countries require agile financing arrangements to adapt to shocks, build resilient systems, and protect spending on essential PHC services during emergencies. Finally, beyond direct health benefits, PHC also offers a best-buy to progress toward many nonhealth SDGs by targeting the social determinants of health across areas including education, housing, transport, and the environment (Anaf et al. 2014; Public Health Agency of Canada 2007; Public Health Agency of Canada and WHO 2008).However, leveraging these synergies will require new models of cross-sectoral prioritization and financing.

PHC investment should draw from general government revenues

Significant investments, not just adjustments at the margins, are needed to put PHC at the center of health systems. Substantial resources are required to finance a set of guaranteed services that gives adequate weight to health promotion and disease prevention and encompasses core public-health and health security functions, including disease surveillance, outbreak response, infection prevention and containment, and monitoring and evaluation. Modeling suggests that an estimated additional US$200 billion per year would be required from 2020 to 2030 for 67 LMICs to cover basic preventive and outpatient PHC services. Mobilizing these sums would require LMICs (in aggregate) to at least double their total health expenditure. The more ambitious vision described in this report, including a broad PHC package and cross-sectoral investments, would raise the overall price tag in these