Health systems and primary health services
Each year, 9 million people in low and lower middle income countries (LMICs) die from conditions that should have been managed by the health systems in the countries. About 60 per cent of these deaths are attributed to poor quality care and 40 per cent to limited access to services. COVID-19 demonstrated the importance of protecting the population against infections, responding to outbreaks and also ensuring and maintaining services. Norway works to strengthen health systems, primary health services and achieve universal health care (UHC) in developing countries.
What
Weak health systems result in limited access to health services and weak capacity for the prevention of illness and death. Key barriers include lack of funding, equipment and medicines, data and information and, not least, challenges associated with access to adequate, qualified healthcare professionals. Another challenge is people not seeking out health services, either due to a lack of confidence in the health service or due to financial, cultural or other reasons.
Norway works to strengthen health systems with an emphasis on the primary health services to achieve universal health care (UHC). UHC means that everyone should have access to fundamental health services without any serious financial strain.
According to the WHO, the COVID-19 pandemic led to most low and middle income countries experiencing major challenges in maintaining fundamental services in areas such as vaccinations, maternity and children’s health, sexual and reproductive health, nutrition and non-communicable diseases (NCD). In order to avoid similar situations in future, it is necessary to ensure:
- Strong and credible political leadership
- More sustainable and resilient health systems
- This includes fundamental public health functions for preparedness
- A integrated approach to public health based on equality, fairness and rights.
Why
Health systems in poor countries must be strengthened to manage the challenges associated with infectious and non-communicable diseases. Non-communicable diseases are expected to increase as a country’s income increases and it transitions to a lower middle income level. By 2030, the World Bank anticipates that more than 75 per cent of deaths in these countries will be caused by non-communicable diseases. Health systems must also deal with changes to the progression of disease due to climate change, conflict, demographic developments and, not least, concurrent outbreaks of disease.
The challenges are many. Most poor counties do not have adequate health infrastructure when it comes to the quantity and quality of healthcare facilities and medical devices. In sub-Saharan Africa, there are only 2.3 doctors and 10.4 nurses and midwives available per 10,000 residents. The World Health Organization recommends a minimum of 23 healthcare professionals per 10,000 residents.
Poor countries face significant challenging in financing health systems and spend, on average, only USD 41 per person per year, compared to USD 3,915 in high income countries.
The availability of basic medicines in poor countries is estimated to be only 50-60 per cent compared to 80-90 per cent in high income countries. Many countries lack basic birth and death registries, which is a prerequisite for ensuring the fundamental right to identity. Along with good health information systems (HMIS) and monitoring systems for outbreaks of disease, this is also crucial in planning and governing the sector.
How
For a long time, Norwegian health aid has focused on achieving quick results in relation to specific health challenges such as HIV/aids, tuberculosis and malaria, increased access to vaccines and access to safe childbirth.
In order to ensure long-term results and sustainability, Norway is in the process of focusing health aid on strengthening national health systems so that these become more resistant to changes such as crises, conflict or climate change. Norway contributes to the development of capacity at national institutions in order to plan, finance and offer fundamental health services, including prevention and monitoring of the development of disease and implementation of actions.
Norad organises these efforts through a separate portfolio with the objective of strengthening national health systems. The effort includes strong prioritisation of programmes that contribute to strengthening the health system as a whole or individual components within the health system that cover different diseases and health challenges. There is a particular focus on the first line of defence (primary health service).
Norad also contributes through dialogue and influence in various forums such as boards, committees in large global funds and multilateral organisations.
Who/Where
The majority of Norwegian health aid is channelled through global health initiatives, fund mechanisms and multilateral organisations. Although the organisations are global, their efforts target countries.
Nevertheless, Norad also supports institutions that undertake more targeted efforts in individual countries, such as the strengthening of health information systems, capacity for knowledge-based priorities and the development of capacity for public health initiatives.
Links:
Mortality and global health estimates (who.int)
Burden of Disease - Our World in Data
Integrated health system strengthening (who.int)