• The COVID-19 pandemic pushed many primary healthcare systems to breaking point.
  • The rise of noncommunicable diseases and increasing life expectancy is adding to the pressure.
  • Encouraging more robust primary healthcare for all calls for decisive action.

It is more than 40 years since a global declaration on primary healthcare (PHC) called for world governments to take urgent action. Since then, according to the World Bank there has been plenty of talk but not enough action.

In its report Walking the Talk: Reimagining Primary Health Care After COVID-19, the World Bank says: “For nearly half a century, countries have struggled to walk the talk on PHC. We have not built health systems anchored in strong PHC where they were needed most.”

The consequences of that failure to deliver robust healthcare services were revealed by the COVID-19 pandemic, according to the report: “PHC was often the weakest link in the national and community response, despite its critical importance as a backstop to ‘flatten the curve’ and prevent hospital saturation.”

Likening the pandemic to a day of reckoning for PHC implementation, the report highlights some of the wider health-related challenges and details how systemic PHC failures could be overcome.

Healthy life expectancy matters

Life expectancy at birth is frequently used as an indicator of health status. In 1990, it was 65.4 years. By 2018, that had risen to 72.6 years. People in low-income countries have a lower average life expectancy at birth, however. High rates of maternal and child mortality, conflict and violence, and the HIV pandemic are among the reasons why.

But the World Banks says another measure could provide a clearer picture of overall population health – healthy life expectancy (HALE).

HALE takes into account a wider set of health outcomes, including non-fatal. It also shows an income-based disparity. “The average HALE in high-income countries exceeds the global average by almost 7 years,” the report says.

What that means is that some people aren’t just living longer. Sometimes, they’re living longer in poor health, which can have implications for their ability to work and further jeopardize their overall circumstances.

a chart showing how more people are living longer, but in poor health.
More people are living longer, but in poor health.
Image: Walking the talk: Reimagining primary healthcare after COVID-19

Preventable and noncommunicable diseases are a significant problem in developing countries. In low- and middle-income countries, the World Bank says: “Over three-quarters of diabetes patients and 90% of individuals with hypertension receive zero or inadequate care to control their conditions.” Poor quality PHC is thought to be responsible for around 60% of all healthcare-preventable deaths in these countries, the report continues.

a chart showing the effect of COVID on fighting noncommunicable diseases with weak healthcare systems
Fragile healthcare systems have been stretched during COVID-119.
Image: Walking the talk: Reimagining primary healthcare after COVID-19

Rebuilding post-pandemic PHC

This is, the World Bank says, a “once-in-a-generation chance for structural health-system change.” It is calling for reforms and a reassessment of goals to make the delivery of robust healthcare for all a priority. This will create a more equitable distribution of healthcare, and should mean the world is better prepared to cope with any future pandemics or similarly large public health calamities.

But, the World Bank says: “The walk has to finally match the talk.”

coronavirus, health, COVID19, pandemic

What is the World Economic Forum doing to manage emerging risks from COVID-19?

The first global pandemic in more than 100 years, COVID-19 has spread throughout the world at an unprecedented speed. At the time of writing, 4.5 million cases have been confirmed and more than 300,000 people have died due to the virus.

As countries seek to recover, some of the more long-term economic, business, environmental, societal and technological challenges and opportunities are just beginning to become visible.

To help all stakeholders – communities, governments, businesses and individuals understand the emerging risks and follow-on effects generated by the impact of the coronavirus pandemic, the World Economic Forum, in collaboration with Marsh and McLennan and Zurich Insurance Group, has launched its COVID-19 Risks Outlook: A Preliminary Mapping and its Implications - a companion for decision-makers, building on the Forum’s annual Global Risks Report.

The report reveals that the economic impact of COVID-19 is dominating companies’ risks perceptions.

Companies are invited to join the Forum’s work to help manage the identified emerging risks of COVID-19 across industries to shape a better future. Read the full COVID-19 Risks Outlook: A Preliminary Mapping and its Implications report here, and our impact story with further information.

To that end, the World Bank will focus its efforts in three key areas – lending, learning, and leadership – to help bring improved PHC to fruition in countries where it is most needed.

Lending: accelerate access to funding for PHC reforms

Focusing on making it easier for countries in need to access funds for PHC-oriented system reforms.

Learning: mobilize practice-relevant PHC knowledge

Strengthening global knowledge hubs, and offering help to support the integration of PHC knowledge into policies and programmes.

Leadership: develop country-specific policy options through dialogue

Supporting national leadership in PHC reform efforts and working to establish a platform for policy dialogue, advice, and technical assistance to Ministries of Health and Ministries of Finance around the world.

"A life-course approach to healthy ageing is ever more important now life expectancy has increased globally," says Sofiat Akinola, Project Lead, Shaping the Future of Health and Healthcare at the World Economic Forum. "We must ensure that the years gained is lived in good health, focus on prevention and ensure that our health system is sustainable in meeting the demands of present and future generations."