The Primary Health Care Approach: Rhetoric or Policy? - A Review of National Health Policies in 8 Countries in Southern Africa

Abstract

INTRODUCTION: The Primary Health Care approach (PHC) can contribute towards universal health coverage (UHC). However, implementing the PHC approach in Africa remains suboptimal. One way to ascertain political commitment to the PHC approach is its reflection in the national health policies (NHP). Several PHC initiatives have helped define and guide the PHC definition, implementation, and evaluation. These include the Alma Ata PHC conference, the Ouagadougou Declaration on PHC in Africa, and the Astana conference. The aim of this paper is to explore to what extent the guidance and characteristics of the PHC approach have been reflected and integrated into the National Health Policies (NHPs) in countries in the Southern African Development Community (SADC). METHODS: The READ approach was undertaken to analyze eight publicly available NHPs. A 12-point checklist was developed to extract relevant data from the policy documents.  The WHO Health Systems building blocks are used as the analytical framework to understand the key features of the PHC approach mentioned in the policies. RESULTS: All the NHPs were developed after the Alma Ata conference in 1978. Six of the eight NHPs reviewed were updated after the Ouagadougou declaration on PHC in Africa in 2008. None of the NHPs were updated after the 2018 Astana PHC conference. Based on the checklist, Lesotho had the most integrated PHC elements (n=12), while Eswatini had the least (n=4). Based on the policy review, there seems to be commitment and priority placed on leadership, governance, and access to essential medicines. However, more still needs to be done to improve service delivery in terms of integrated patient centered care (only included in 3 out of the 8), health financing for primary care, integrated health information systems and the community health workers as part of the health workforce. CONCLUSION: In conclusion, NHPs should guide implementation, and the NHP is a reference document for many organizations wishing to partner with the government in improving health care services. As such, it should be updated in line with the new evidence and learning and reflect the country’s priorities to help align development actors.