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Case study

Primary Health Care as an avenue to respond to national and regional needs: Lessons from the World Bank’s analytical work to facilitate consistent access to care

A key challenge for people living with NCDs is having consistent access to care. Such care can be delivered equitably through health systems based on primary health care (PHC). PHC represents an important, and often first, point of care for patients. It is also an avenue through which health systems can find cases and detect diseases, identify individuals with high-risk status, and provide psychosocial interventions with long-term follow-up and regular monitoring. As NCDs continue to rise, adding pressure on health systems, especially at secondary and tertiary levels of care, it is essential that primary health care is strengthened.

The World Bank is acutely sensitive to the importance of primary health care and several projects funded by Access Accelerated support this first point of care. For example, the World Bank developed a rapid assessment tool of NCD management best practices to identify actions that improve national investments in NCD management. The tool is being deployed in Ghana, Dominica, St. Vincent and the Grenadines, and Gujarat state in India. The World Bank leverages its analytical capacity to collate a series of examples that integrate NCD management into PHC systems. These will support the identification of best practices and models for countries seeking to strengthen PHC.

In Chile, the World Bank supports the universalization of PHC so that all people, regardless of their health insurer, can access PHC services free of charge and in a timely manner. The project emphasizes the expansion of effective access to preventive care and evidence generation for the management of NCDs. It works in a phased approach to test the operational and organizational aspects covering regulatory, resource, and coordination aspects of the healthcare network. The World Bank leverages its analytical capacity to assess municipalities’ capacities to expand PHC services, identifying strengths and barriers for progressive implementation and assessing the feasibility of pilot projects. The analysis supports the national strategy to consolidate comprehensive, person-centered care, especially in the context of multimorbidity. In addition to working with the Chilean Ministry of Health to prepare the first level of health care to respond to needs derived from the universalization of access to PHC, the World Bank works with selected communities to identify how PHC services can be made socially pertinent and acceptable. The full diagnosis approach of assessing the enabling environment, as well as the social dialogue and plan for a phased implementation, represents a responsive, bottomup approach to expanding PHC services.

By strengthening PHC services, health systems can leverage existing infrastructure to respond to emerging needs. With COVID-19, it became evident that access to uninterrupted care is a necessity for people living with chronic conditions. Improving the efficiency of procurement systems and financing mechanisms and expanding access and use of transformed PHC services will lead to a better quality of care and quality of life for people living with NCDs. The World Bank’s work in PHC also offers lessons on the relevance of leveraging different analytical capacities to address one health systems entry point through varied and context-specific ways, rather than in a siloed approach. The World Bank is uniquely positioned to do this well as its reach and technical know-how enable it to address changing needs. By strengthening PHC services, health systems can leverage existing infrastructure to respond to emerging needs. With COVID-19, it became evident that access to uninterrupted care is a necessity for people living with chronic conditions.

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