Of all the forms of inequality, injustice in health is the most shocking and inhumane, said Martin Luther King Jr. This thought was further emphasized during the Covid-19 pandemic when disparities in the provision of health services across socioeconomic sections came to the fore. To bridge the gap, countries have realigned their focus towards providing basic healthcare services to ensure the well-being of their populations.
According to the World Health Organization (WHO), primary health care (PHC) addresses most people’s health needs throughout their lifetime, including physical, mental, and social well-being. PHC is vital in making health systems more resilient and prepared for crisis situations. Good management and well-trained teams make it more efficient. High-functioning PHC systems are essential for achieving all 17 Sustainable Development Goals (SDGs) of the 2030 Sustainable Development Agenda.
With Asia being home to more than half of the world’s population, the region has experienced an increasing rise in non-communicable diseases such as heart disease, stroke, cancer, diabetes, mental illnesses, and injuries and outbreaks of infectious diseases that stall progress on health indicators. Though the private health sector has expanded rapidly, public health services continue to be under-financed and over-burdened to meet the needs of the patients.
For example, In Japan, the number of medical facilities with surgical and pediatric departments is declining along with shortages of doctors in emergency, obstetrics and gynecology, internal medicine, and anesthesia departments. The region’s uneven geographical distribution of health workers is a serious concern. This leads to poor availability of health services, particularly for the vulnerable population. Pakistan is the fifth most populous country in the world but has 0.5 primary care centers per 10,000 population with a life expectancy of 66.5 years. Though there is an elaborate network of nearly 200,000 Government Primary Health Care Facilities (GPHCFs) in rural and urban areas in India, there are significant disparities in the quality and availability of PHCs between different regions. Most PHC centers do not have essential infrastructure and facilities like a well-equipped operation theatre, labor room, observation ward, generator, drinking water, ambulance, and lady doctor, which are basic requirements. Rural India comprises 70% of the population but has only 40% of the beds in the country.
Public health measures in Asia
A strong public health system plays a vital role in the status and stability of national and regional economies. It is the primary driver for achieving UHC. In the post-pandemic world, Asian countries have realized the importance of establishing the right policies and financing arrangements to support the development of a people-oriented PHC. As a result, many have started to strengthen the basic structure of the healthcare system. For instance, the challenge of a weak PHC network has been increasingly recognized and acknowledged by the Indian government. The National Health Policy (NHP) 2017 proposed strengthening PHC systems and investing two-thirds or more government health spending in PHC centers. The Ayushman Bharat Program (ABP), launched in 2018, offers holistic and integrated healthcare services and insurance facilities to the poor at all levels. All the schemes launched under NHM are available free of cost at all public health facilities at district and sub-district levels.
Meanwhile, Malaysia has regarded health system development as an integral component of national development. The government-funded PHC sector is the main service provider. Similarly, Singapore has achieved universal health coverage through a hybrid financing system. To further strengthen PHC, the government focuses on one doctor, one resident, and general practitioners as a driver of preventive care and long-term chronic care. It is working towards shifting acute hospital funding to a capitated regime to concentrate on healthcare outcomes. The government has also created Individual Health Plans emphasizing regular screenings, immunizations, lifestyle adjustments, and linking acute and primary care health records to common IT and data backend.
Hong Kong aims at early detection, prevention, and health promotion, emphasizing primary care. Like Singapore, the Hong Kong government has also opted for one resident and one doctor and general practitioner rule to provide attention to preventive and long-term chronic care. It is also planning to personalize health records that are universally accessible. In China, population health, prevention, and health promotion has been the main agenda for developing the healthcare sector. It has emphasized chronic disease prevention and management through increased healthcare service delivery capacity.
Building a pan-Asian ecosystem
An efficient PHC system must leverage all the services offered by digital technologies, including telemedicine, EHR system, and home monitoring, among others, to support health outcomes. We need to focus on early diagnosis and better lifestyle management to reduce the burden on tertiary care. There is also an underlying need for strong collaboration and knowledge-sharing beyond borders to strengthen PHC in the region. Asian countries should prioritize enhanced regional cooperation in the health sector to rationalize operations, thereby achieving quality, equitable, and cost-effective care for their diverse populations. They must also harness their talent collectively to address immediate health priorities and contribute to ongoing research and development efforts.
Asian countries have already started leveraging their expertise and networks to design solutions tailored to improve domestic PHCs. As large sections of the population in the region still lack access to consistent and effective primary care, building a pan-Asian ecosystem could be a significant step in the right direction.
