Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda

Palagyi, Anna; Dodd, Rebecca; Jan, Stephen; Nambiar, Devaki; Joshi, Rohina; Tian, Maoyi; Abimbola, Seye; Peiris, David

A central feature of the universal health coverage (UHC) agenda is strengthening primary health care (PHC). 1 High-functioning PHC systems are considered essential to achieving all 17 goals (Sustainable Development Goals, SDGs) of the 2030 Sustainable Development Agenda; not just the health-specific SDG3. 2 Yet, decades after the Alma-Ata Declaration on PHC in 1978, many communities in low-and middle-income countries (LMIC) still experience limited access to safe, effective and affordable PHC. The growing burden of non-communicable diseases (NCD), combined with an intensifying risk of infectious disease outbreaks, presents a 'double threat' to fragile health systems of LMICs of the Asia-Pacific region. Here, NCDs account for 80% of all deaths and 50% of premature deaths, 3 4 a result of longevity, increasing urbanisation, economic growth and lifestyle factors. At the same time, outbreaks of emerging diseases such as severe acute respiratory syndrome (2003), 5 Influenza A (2009) 6 and Zika (2016) 7 are likely to continue. A robust PHC system underpins a nation's ability to promote population health, and remain resilient in times of crisis. Yet PHC systems in many Asia-Pacific LMICs are the 'poor cousins' of the hospital system. 8 Designed primarily to provide episodic care for acute disease management, they often struggle to manage long-term conditions, deliver preventive health activities or to integrate care across diseases. [9] [10] [11] BMJ Global Health Figure 1 Framework of primary health care (PHC) system inputs and outcomes used to guide the coding of evidence on the organisation of PHC service delivery in the Asia-Pacific region.