Financing primary health care in Low-Middle-Income Countries

The 2022 report from the Lancet Global Health Commission on Financing Primary Health Care highlights key financing functions and the “political economy,” crucial for an increased focus on primary health care (PHC) and progress towards universal health coverage.

The report’s main recommendations are that:

1. Public resources should provide the bulk of PHC funding.
2. Pooled funds should cover PHC, enabling all people to receive PHC that is provided free or nearly free at the point of service use.
3. Resources for PHC should be allocated equitably across levels of service delivery and geographic areas.
4. Properly designed PHC provider payment mechanisms should be implemented, with capitation at its core.

The symposium critically examined this attempt to revive PHC, particularly whether the recommendations are realistic in country contexts. Potential obstacles could be that the population might view their needs differently from what the traditional PHC approach implies. Furthermore, the political and economic elite may have other interests in relation to the health system and services than prioritising PHC.

The political, economic perspective, which is emphasised in the Commission’s report as well as by the World Health Organization’s recent “how to guide” on Political Economy Analysis for Health Financing, is a relevant though challenging aspect, and rarely addressed because discussions are mostly dominated by “technicians”, like public health specialists and health economists, with little interest in and understanding of the political aspects of the problems faced.

With an outset in the recommendations by the Lancet Commission’s report, this symposium examined the complex landscape of financing PHC and best ways forward.