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What impact has COVID-19 had on primary health care (PHC) systems, and what are the opportunities to overcome barriers and make “PHC for UHC” a reality? This blog looks at experience in Kenya.
This week, participants at the African Health Agenda International Conference 2021 are discussing how to accelerate progress towards universal health coverage (UHC), in the wake of the COVID-19 pandemic and other pressing health challenges on the African continent. At the same time, one million doses of the AstraZeneca-Oxford COVID-19 vaccine will arrive in Nairobi through the COVAX facility, prioritized for Kenyan frontline health workers. This historic moment offers an opportunity to review current policies and reimagine how to build back stronger than before, laying the foundation for more equitable and resilient health systems.
COVID-19’s impact on PHC
When the first case of COVID-19 was reported in Kenya in March 2020, immediate control measures were taken by the newly formed Multi-Agency Taskforce. Flights were halted, quarantine was enforced, curfews, lockdowns and social distancing were implemented, all in an effort to curb the spread of the novel virus. At the onset of the pandemic, the Ministry of Health ordered hospitals across the country to postpone non-emergency surgeries, in an effort to direct all available resources towards fighting the pandemic, and many clinics halted services for non-communicable diseases.
Unfortunately, pandemic control measures had a significant impact on the utilization of PHC services. Movement was restricted at night, reducing access to emergency health services during night hours. Public and private facilities closed, as several facilities were designated as COVID isolation wards, and others due to lack of adequate PPE. There was also a lack of awareness among the public that services were still available, and, for those who were aware, the high cost of utilizing the limited public transport available also contributed to the drop in the number of people able to access health services.
Utilization of many essential and routine health services dropped considerably, including routine immunization of children, out-patient services for the general population, antenatal care of pregnant women, vitamin A supplementation, management of NCDs, and screening for cervical cancer. In addition, the identification and treatment of communicable diseases - malaria and TB in particular - and the enrollment of new HIV patients for ART treatment also experienced a significant decrease. However, some primary health care services were more resilient than others. For example, HIV programs for existing patients were able to continue with minimal disruption, since program models were already in place to ensure uninterrupted patient-to-provider communication.
While COVID demanded the reallocation of time and services, the Ministry made it a top priority to maintain access to essential health services. The Technical Working Group to Maintain Essential Services - a newly-formed subcommittee of the COVID-19 taskforce at the Ministry of Health - focused on identifying solutions to ensure people could continue to access the health care they needed, by resuming some elective procedures and highlighting certain services to prioritize, such as antenatal care, immunizations, and child health services. Health workers found innovative ways to coordinate private transport, allowing emergency vehicles to travel during curfew hours to respond to emergencies. Care teams also implemented innovations with regards to our service delivery models - employing a modern communication system to ensure that patients were contacted several times via text message and telephone, urging them to come back to their next appointment. Like many other countries around the world, the ability to provide telehealth services has been transformational, enabling remote care, while not overwhelming the health system.
Kenya implemented a call center for the public to seek information and advice, as well as a home-based care model to treat asymptomatic and mild COVID-19 cases. Health workers, with the support of the community health workers provided support to patients in their homes rather than in hospitals. As community transmission surged, these interventions helped reduce the number of contacts and costs associated with care that would have typically been incurred in a hospital setting.
#PHC4UHC in Kenya
Since 2018, University Health Coverage has been a national priority in Kenya, with the Government of Kenya committing to make strategic investments in health to ensure that all residents of Kenya can access the essential health services they require by 2022. This bold commitment has helped the government to focus on identifying and tackling challenges within the health system.
As a PHCPI Trailblazer country, Kenya has committed to strengthening primary health care and battling COVID-19 has further highlighted the critical role of PHC to meet the needs of the community in crisis and in calm. Kenya leveraged PHC and community health workers, which are crucial to a country's ability to respond to health security threats, in its response to COVID-19. The pandemic showed how resilient health systems are critical to respond to outbreaks, and investment in primary health care is imperative to ensuring this resilience.
Aspirations to reality
Over the past few years, the global community has galvanized attention around the critical role of PHC. From the 2018 ratification of the Declaration of Astana, to the 72nd World Health Assembly PHC resolutions and UN High-level meeting on UHC, a renewed interest was built around the reality that PHC can drive our shared aspirations.
As leaders and advocates convene at AHAIC2021 this week to consider priorities for both the ongoing COVID-19 response and recovery, we hope to see them keep a focus on PHC for UHC. COVID-19 has shown us how fragile health systems can be in many countries, and reminded the world of the critical importance of health for all. The crisis has reinforced why we must leave no one behind, and that investing in PHC can provide the cornerstone for health systems that protect us all
About the authors
Dr. Agatha Olago is the Head of the Primary Health Services and Family Medicine Division at the Ministry of Health in Kenya. Twitter: @AgathaOlago
Maisoon Chowdhury, MPH, is the Senior Program Associate at the Primary Health Care Performance Initiative, a partnership of the Bill & Melinda Gates Foundation, the World Health Organization, the World Bank, and UNICEF, in collaboration with Ariadne Labs and Results for Development. As a UHC2030 Related Initiative, PHCPI is dedicated to transforming the global state of primary health care, starting with better measurement. Learn more about PHCPI here. Twitter: @ImprovingPHC
This blog from the Primary Heath Care Performance Initiative is part of a curated blog series from the UHC2030 Health Systems Related Initiatives. The UHC2030 Related Initiatives promote collective action for stronger health systems that protect everyone. Find out more.
Photo: WHO / Light in Captivity