Against a background of major demographic shifts and increasing health impacts of climate change, the importance of comprehensive primary health care is greater than ever.
What We Are Advocating For
We are seeking increased emphasis on comprehensive primary care within US global health assistance. To maximize the chance of success in the legislative process, we are not requesting a funding increase or a new line item for comprehensive primary health care. Rather we are focusing on the existing funding line items for Global Health Security and for Nutrition, whose purposes can be accomplished in large part by comprehensive primary health programs. Within these programs we are advocating that US assistance should include $100 million for comprehensive primary health care programs.
Quality primary care is fundamental to reaching all major health goals as well as detecting new threats in a timely fashion.Over the past few decades, large scale disease-specific health interventions, such as those addressing TB, HIV/AIDS and malaria, have been extremely successful in reducing mortality. Supporting these interventions must continue to be a priority. However, other health needs, for example the rise of non-communicable diseases, are being given too little attention due to a lack of effective and accessible comprehensive primary health care in many parts of the world. The World Health Organization reports that roughly 400 million individuals still have no access to primary care, though the real figure could be much higher.
The Nutrition and Global Health Security programs would greatly benefit if comprehensive primary health care were included as part of these programs.
Nutrition: In order to effectively address malnutrition, programs need to address basic health problems since they play a major role in causing malnutrition. Incorporating comprehensive primary health care into nutrition programs would substantially reduce malnutrition. Some examples of basic health problems which cause malnutrition are summarized below.
INFECTION: Infection causes malnutrition (1) by increasing energy needs and (2) by reducing nutrient uptake due to loss of appetite, decreased nutrient absorption and/or loss of nutrients in stool. The effect of infection on malnutrition is so substantial that a short course of antibiotics has been shown to dramatically reduce malnutrition-related mortality and improve recovery from malnutrition.
DIARRHEAL DISEASE: Diarrhea leads to malnutrition, including stunting, and wasting, especially if episodes are frequent. During diarrhea, the mucosal layer is shed from gut leading to an inability to absorb nutrients.Basic primary health measures including rotavirus vaccine, zinc supplementation, and oral rehydration are extremely cost-effective interventions that effectively address diarrheal disease.
TUBERCULOSIS:There is a two-way link between malnutrition and TB, with each condition making the other worse. Routine screening and treatment for TB as part of primary health care allows for early detection and will generally result in cure of the disease and prevention of the resulting malnutrition.
HIV/AIDS: HIV infection, even prior to symptoms of AIDS, often results in problems in the absorption of carbohydrates, fat and protein. Screening and treatment for HIV is a key part of comprehensive primary health care, and is important not only in terms of the underlying disease but also in terms of the associated malnutrition.
Global Health Security: Providing comprehensive primary health care addressing the major health issues of a population plays a key role in improving global health security for a number of reasons. First comprehensive primary care is vital in detecting new and emerging diseases in timely fashion. Second it is the best way to determine early on if there is a danger of an epidemic of an existing disease. Third, it serves as a test bed for developing new health delivery approaches that protect health security.
Trehan I, Goldbach HS, LaGrone LN, et al. Antibiotics for Uncomplicated Severe Malnutrition. New England Journal of Medicine. 2013;368(25):2435-2437. doi:10.1056/nejmc1304407. https://www.nejm.org/doi/full/10.1056/NEJMoa1202851
Fuentes R, Pfutze T, Seck P. A Logistic Analysis of Diarrhea Incidence and Access to Water and Sanitation. United Nations Development Programme: Human Development Reports.
Okafor CE, Ekwunife OI. Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model. PLoS Negl Trop Dis. 2017;11(12):e0006124. Published 2017 Dec 19. doi:10.1371/journal.pntd.0006124. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752040/.
Duggal S, Chugh TD, Duggal AK. HIV and Malnutrition: Effects on Immune System. Clinical and Developmental Immunology. 2012;2012:1-8. doi:10.1155/2012/784740. https://www.hindawi.com/journals/jir/2012/784740/cta/.