Rethinking how development assistance for health can catalyse progress on primary health care.

Global campaigns to control HIV, tuberculosis, malaria, and vaccine-preventable illnesses showed that large-scale impact can be achieved by using additional international financing to support selected, evidence-based, high-impact investment areas and to catalyse domestic resource mobilisation. Building on this paradigm, we make the case for targeting additional international funding for selected high-impact investments in primary health care. We have identified and costed a set of concrete, evidence-based investments that donors could support, which would be expected to have major impacts at an affordable cost. These investments are in: (1) individuals and communities empowered to engage in health decision making, (2) a new model of people-centred primary care, and (3) next generation community health workers. These three areas would be supported by strengthening two cross-cutting elements of national systems. The first is the digital tools and data that support facility, district, and national managers to improve processes, quality of care, and accountability across primary health care. The second is the educational, training, and supervisory systems needed to improve the quality of care. We estimate that with an additional international investment of between US$1·87 billion in a low-investment scenario and $3·85 billion in a high-investment scenario annually over the next 3 years, the international community could support the scale-up of this evidence-based package of investments in the 59 low-income and middle-income countries that are eligible for external financing from the World Bank Group's International Development Association.
Competing Interests: Declaration of interests TK, GY, SD, KKMcD, JL, CL, MMD, OO, PP, CS, AT, AZ, and CB declare grant funding from the Bill & Melinda Gates Foundation to support this work. TK declares consulting fees in the past 36 months from WHO Eastern Mediterranean Regional Office on models of care for primary health care and from the World Bank Group on integration of primary health care and pandemic prevention, preparedness, and response. KKMcD and GY declare other grants for global health research in the past 36 months from WHO, the Bill & Melinda Gates Foundation, The Carnegie Corporation of New York, the United Nations Economic and Social Commission for Asia and the Pacific, the Alliance for Health Policy and Systems Research, and the New Venture Fund. OO declares other grants for global health research in the past 36 months from WHO, the Bill & Melinda Gates Foundation, the National Institutes of Minority Health and Disparities, Duke REACH Equity, and the Alliance for Health Policy and Systems Research. LNA declares funding from SEEK Development to support this work; in the past 36 months he reports consulting fees from the World Bank to support country-level non-communicable disease (NCD) policy implementation, and consulting fees from WHO to support international and country-level NCD policy implementation. CS declares grants in the past 36 months from WHO and the Medicines for Malaria Venture (MMV) for various strategy consulting projects relating to global health, and consulting fees from the Bill & Melinda Gates Foundation, WHO, and MMV for various strategy consulting projects related to global health. CL and SD declare consulting fees in the past 36 months from the Bill & Melinda Gates Foundation for various strategy consulting projects related to global health. BT declares that she was previously Executive Director of the Primary Health Care Performance Initiative, funded by the Bill & Melinda Gates Foundation, while this work was being conducted. She works at the United States Agency for International Development, which has broad interest in development assistance for health/primary health care (she is co-authoring this paper in her personal capacity). DJ is supported by the London School of Hygiene & Tropical Medicine Takeda Chair in Global Child Health and declares grant funding from WHO and UKRI Innovation Fund. RN declares grant support from WHO for NCD implementation science research in association with a WHO Technical Advisory Group and from the World Bank for NCD research and policy development in the Europe and Central Asia (ECA) and sub-Saharan Africa (SSA) regions. DS declares that employment as Chief Digital Officer for the international NGO PATH supported the opportunity and ability to contribute to this article (PATH has a PHC programme and works to strengthen PHC in countries around the world). DS also declares board membership of Medic (governance role, uncompensated). DS is Co-Chair of the Leadership and Governance Committee (advisory role, uncompensated) for Transform Health Coalition. PB declares that he is currently the Global Director of Policy Advocacy and Communication at the Bill & Melinda Gates Foundation. He did not review or approve the grant that supported this work. He was a member of the international expert advisory group. All other authors declare no competing interests.
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