Strengthening Primary Health Care in the Americas

Insights for WONCA and Family Medicine from a PAHO/ABFM Embassy Series Event at the Brazilian Embassy, Washington DC, June 2024.

The COVID-19 pandemic crisis clearly exposed the weaknesses of health systems throughout the Americas, underscoring the urgent need to move forward boldly with investments in Primary Health Care (PHC) as the foundational component of resilient health systems. In response, the Pan-American Health Organization (PAHO) launched the Alliance for Primary Health Care in the Americas in Uruguay at the end of 2023, with leadership from the World Organization of Family Doctors (WONCA) in attendance to discuss how primary healthcare is providing effective care for our populations. To address these pressing issues and discuss the impacts of this initiative, PAHO and the American Board of Family Medicine Foundation/Center for Professionalism & Value in Healthcare, with support and advisement from WONCA, hosted a special Primary Care "Embassy Series" Event on June 25th, 2024, at the Brazilian Embassy in Washington D.C. Intentionally timed to take advantage of the presence of Ministers of Health and senior staff from countries across the region, this event highlighted the Alliance and turned attention to the critical role of PHC in building and sustaining robust health systems. WONCA President-elect Dr. Viviana Martinez-Bianchi attended to ensure that the voices of North American and Ibero American Family Medicine were heard, crucial contacts across the regional ministries were made, and the prospects for future collaborations between WONCA and PAHO were advanced.

Greetings and Opening Remarks

The event began with welcoming remarks from H.E. Maria Luiza Ribeiro Viotti, Ambassador of Brazil to the United States. She emphasized the importance of international collaboration in healthcare and the shared goal of enhancing PHC systems across the Americas. Jarbas Barbosa da Silva Jr., Director of the Pan American Health Organization (PAHO), followed with opening comments on the essential role of primary health care in the region, particularly in the aftermath of the pandemic. Director Barbosa highlighted how, the Declaration of Alma Ata, was a revolution that located health not just in the hospitals, but in the communities, and yet it had only focused on maternal and child health, which are still very important for Latin America and the Caribbean, but “if we want the primary healthcare that is providing effective care for our population we need to cover much more than just maternal and child health, we need to provide health promotion, prevention surveillance, the first line for early detection and first response, a primary health care that can deal with the persistent communicable diseases that are prevalent in the region (TB, Malaria, Dengue, etc), and to also respond to the new burden represented by new communicable diseases and mental health.” “When we talk about this renewed and strengthened primary health care, we are talking about health centres that can have training for a health care workforce, and connectivity to improve the quality of care… a new era for primary health care to provide a better use of the limited resources you have in the health sector, and also to identify the barriers to developing a primary health care strategy and transform universal health coverage into a reality in our region.”

Primary Health Care: The Foundation of the Brazilian Health System

H.E. Alexandre Pena Ghisleni, Head of the Special Office for International Affairs, Ministry of Health, Brazil, provided an overview of Brazil's health system with a focus on primary health care. He discussed how PHC serves as the bedrock of Brazil's health system, is well-financed, and able to address challenges posed by a complex and evolving epidemiological context, an aging population, increased mental health needs, and the impact of climate change. Loyce Pace, Assistant Secretary for Global Affairs at the U.S. Department of Health and Human Services and past CEO of the Global Health Council, shared insights on the U.S. perspectives on global health partnerships and the vital role of equitable and community-engaged primary health care in fostering a resilient health system.

Guided Discussion on PHC and Resilient Health Systems

The event featured a guided discussion moderated by Dr. Robert Phillips, Executive Director of the Center for Professionalism & Value in Healthcare and representative of the American Board of Family Medicine Foundation. Dr. Phillips emphasized how the COVID-19 pandemic has reinforced the need for robust PHC investments, necessitating sustained commitment from both countries and the international community. He highlighted how the recent establishment of the Alliance for Primary Health Care in the Americas offers a unique opportunity for the United States Department of Health & Human Services to craft strategic partnerships to enhance PHC resilience and cooperation across our hemisphere. A roundtable conversation among panelists followed, starting with Dr. James Fitzgerald, Director of Health Systems and Services at PAHO, who highlighted the importance of PHC in health promotion, prevention, surveillance, and care for prevalent health conditions. He stressed that PHC is the first wall of defense in emergency situations, crucial for early detection and response to disease outbreaks.

Dr. Juan Pablo Uribe, Global Director for Health Nutrition and Population and the Global Financing Facility for Women, Children, and Adolescents at the World Bank, discussed financing mechanisms for primary health care. He emphasized the role of the Alliance for Primary Health Care in the Americas, established in December 2023, in advancing PHC through strategic partnerships and quality investment plans.

Dr. Ferdinando Regalia, Manager of the Social Sector Department at the Inter-American Development Bank, offered perspectives on the social determinants of health and the necessity of investment in primary health care. He pointed out that expanding PHC enhances capacity for early disease detection and community-level responses, forming the cornerstone of resilient health systems.

Comments and Broader Discussion

The comments and discussion segment began with a reaction from Mag. Gabriela Gomez Castillo, Director of the Department of External Relations and Cooperation at the Ministry of Health, Uruguay. She discussed the importance of the Initiatives in Uruguay, a country that has long embraced Community-Oriented Primary Care. Like her Brazilian counterpart, Director Gomez Castillo noted the centrality of primary health care in the Uruguayan health care system. She cited the importance of investing 25-30% of their federal budget for health into primary health care. For comparison, the U.S. invests 5-7% of its health care budget into primary care. She also outlined a series of structural advantages that allow Uruguayan primary care to be flexible and adaptive to community and pandemic demands.

Questions and comments from the audience highlighted the importance of integration and collaboration across sectors, and the need for generating data informing effective primary health care workforce and delivery.

Conclusion and Call to Action

The event concluded with a summary of key takeaways from the initiative’s successes and its future utilization in U.S. policy work, underscoring the critical need for international collaboration in strengthening primary health care systems. The panelists emphasized the transformational changes required to embed resilience within societies and national health systems, with PHC at the core. They also highlighted the role of the Alliance for Primary Health Care in the Americas in facilitating these changes. WONCA will play a clear role in promoting the importance of postgraduate training in Family Care.

In closing, participants were encouraged to continue engaging in global health partnerships and collaborative efforts to enhance PHC. PAHO representatives shared planned next steps for the Alliance, inviting stakeholders to remain active in these crucial discussions.

The Embassy Series Event at the Brazilian Embassy showcased the vital importance of PHC as the foundation of resilient health systems, offering a roadmap for renewed and expanded efforts through strategic partnerships and sustained commitment from countries and the international community.

Submitted to WONCA news by Emma Bazemore, Robert Phillips, Andrew Bazemore and Viviana Martinez-Bianchi.