What will the World Bank do?

platforms and/or ensure their interoperability. Any support donors provide to health management information systems (HMIS) should respect the longterm agenda for a single integrated or interoperable health information platform in each country. In the immediate term, donors should “walk the talk” by ensuring that any vertically organized data collection platforms are made interoperable with the national HMIS—such that national HMIS systems can access all donor-supported data (while respecting patient privacy).

3. Align with a WHO-endorsed international standard for community-based medical education. The international community should work collaboratively to raise international recognition of community-based medical education and qualifications. One practical step would be to align with a set of WHO-endorsed standards and guidelines for community-based medical education and certification. Like existing medical and nursing degrees, these qualifications would be broadly recognized across borders and hold equal prestige—ultimately including earning power—with traditional medical education.

4. Fund country-led multidisciplinary medical education reform. Developing new norms, content, and pedagogy for multidisciplinary medical education will require investment. Existing institutions will work together in new ways, while in some cases new institutions or facilities will be created.

In addition to supporting the normative aspects of reforms, international partners may contribute financial resources to accelerate critical phases of the process. Capital investments in new medical education institutions may be a particularly good fit for multilateral development banks.

COVID-19 has opened a new era of global uncertainty and risk. Precisely for that reason, now is the time to advocate for, invest in, and work with countries to deliver reimagined PHC—the cornerstone of the health system transformations that the pandemic has shown are needed in countries at all income levels.

The World Bank is working with its partners to meet this challenge. Through its COVID-19 Multiphase Programmatic Approach (MPA) financing facilities, the World Bank has accelerated support to countries to tackle the pandemic while strengthening health systems fundamentals. Now, in a Strategy Refresh for the post-COVID world, the World Bank’s Health, Nutrition and Population (HNP) Global Practice has prioritized ensuring universal and equitable access to affordable, people-centered, and integrated quality care with reimagined PHC. This agenda goes hand in hand with strengthening public health

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functions, including pandemic preparedness, and investing in health beyond health care under a whole-of-government approach (World Bank 2007).

In the years ahead, the World Bank will use three main mechanisms to help countries deliver the promise of reimagined PHC. These mechanisms match the World Bank’s principal areas of added value in health, as identified in the 2021 Strategy Refresh: Lending, Learning, and Leadership. These priorities also underscore the World Bank’s commitment to partnerships that have proven their value for countries, including the Global Action Plan PHC Accelerator, Primary Health Care Performance Initiative (PHCPI), Joint Learning Network (JLN), and others (WHO 2019).1,2 As countries and partners continue to grapple with the health and economic “double shock” of COVID-19 (Tandon et al. 2020), the World Bank’s approach is parsimonious. It does not aim to create new structures that might duplicate what already exists. Instead, it seeks to work within existing structures and alliances in more effective ways.

1. Lending: ease access to funding for PHC reforms. The World Bank will work with the Global Finance Facility (GFF) and other partners to make it easier for countries to quickly access the funds they need for

PHC-oriented system reforms. Before COVID-19, investment in health system strengthening and public health-enabled PHC was constrained by the difficult transition to domestic health financing in some countries, together with the continued appeal of donor funding for disease-specific programs. COVID-19 has underscored the limits of such models and the need for new solutions. However, the crisis has also complicated resource mobilization for ambitious PHC-centered system reforms. The

World Bank is well-positioned to help shift this dynamic, drawing lessons from financing and technical support innovations under the COVID-19

Multiphase Programmatic Approach (MPA) (World Bank 2020). As was the case of COVID-19, the World Bank can combine financial backing for

PHC reforms with policy and technical advice that will inform leaders on emerging options and equip them to select, finance, and deliver the best approaches for country needs. The World Bank can move quickly to initiate conversations with its International Development Association (IDA) and

International Bank for Reconstruction and Development (IBRD) clients and to raise the profile of PHC. Advancing PHC assertively in COVID-19 health system strengthening operations and GFF Essential Services Grants will be a “win-win” for countries and for the World Bank’s programs, as both can achieve desired results more efficiently through PHC.

2. Learning: mobilize practice-relevant PHC knowledge. Together with analytic and financial partners, the World Bank will strengthen global knowledge hubs for PHC and ensure that they are equipped to deliver the actionable information that countries need in formats they can use.

Since PHCPI’s creation in 2015, the initiative’s databases and PHC improvement tools have advanced PHC learning and practice.3 This and other PHC knowledge hubs, such as that maintained by JLN,4 can achieve even more in the years ahead. More can be done to share PHC knowledge in user-friendly forms and to tailor information for policy makers and implementers facing specific challenges on the ground. Through collaboration in these efforts, the World Bank will capture and disseminate learning around PHC “hardware” (for example, digital technology, technology-equipped PHC workers) and “software” (for example, team-based organizational care models, risk pooling, value-based purchasing). It will help compile and assess country experiences and facilitate their dissemination through tailored global, regional, and country-specific training courses and other activities. World Bank technical assistance to countries will support the integration and operationalization of PHC knowledge in policies and programs. Recently, a new PHC performance framework from WHO and the United Nations Children’s Fund (UNICEF) and the Organisation for Economic Co-operation and Development’s (OECD) Patient-Reported Indicator Surveys (PaRIS) have advanced PHC performance measurement (OECD n.d.). The World Bank will work with these and other partners on a country-friendly measurement toolbox for PHC-related inputs, outputs, and outcomes. The World Bank will also expand the place of PHC in its learning platforms, such as flagship courses.

3. Leadership: develop policy options in dialogue with ministers. To support national leadership in PHC reform and facilitate a whole-of-government approach, the World Bank HNP Global Practice will establish a dedicated platform for policy dialogue, advice, and technical assistance to ministries of health and ministries of finance. The platform will include high-level policy seminars on country-selected topics, linked to the World Bank/

International Monetary Fund Annual Meetings. Flagship courses will be tailored to senior decision-makers. The platform’s initial agenda will focus on analyzing the political economy dynamics of PHC reform in the post-

COVID-19 era, capturing the range of country experiences and emerging solutions. Platform dialogue will identify entry points and strengthen relationships for subsequent country-level technical collaboration and financial support.This initiative builds on and further leverages the GFF country leadership program that aims to bolster country leadership to drive transformational changes for health system reforms, as well as partner alignment with government priorities.

As the World Bank works with countries to build high-performing, equitable, and resilient PHC systems, it is not about creating new administrative structures, logos, and hashtags. Rather, it is about concretely “upping our game” with trusted partners and within structures that are largely in place,

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