Galvanizing Action on Primary Health Care: Analyzing Bottlenecks and Strategies to Strengthen Community Health Systems in West and Central Africa

Abstract

In West and Central Africa, “leaving no one behind” requires strengthening community health systems by increasing health financing, improving supply chain system, and fostering community ownership and partnerships in all settings. Countries with high child mortality rates should improve service delivery through better integration. Galvanizing context-specific country actions is fundamental to improve primary health care services and move toward universal health coverage.

Abstract

Key Findings

• Challenges with health financing, essential medical products and technology, and community ownership and partnerships emerged as the severe or very severe health system bottlenecks that hampered the strengthening of community health systems, irrespective of mortality context.

• Country-led progress is possible. Potential strategies to overcome bottlenecks include increasing domestic allocation and leveraging innovative funding mechanisms for primary health care (PHC), integrating supply chain systems, and strengthening policy implementation with communities and local governments.

• Countries with high child mortality rates should improve service delivery through better integration.

Key Implications

• Countries must seize the opportunities to systematically strengthen community health systems in their efforts to achieve universal health coverage.

• We must galvanize efforts to mobilize resources for effective PHC, which is reliant on strong community health systems to expand access to services and live no one behind.

• Community-based integrated programming should be reinforced to strengthen resilience, disease surveillance, and rapid responses to health crises, including infectious diseases like COVID-19.

ABSTRACT

Introduction:

The renewed commitment to primary health care (PHC) presents an opportunity to strengthen health systems in West and Central Africa (WCA). Though evidence-based cost-effective interventions that are predicted to prevent up to one-third of maternal, newborn, and child health complications and deaths with universal coverage have been identified, more than 50% of people living in rural areas or from poor families still do not have access to these interventions in resource-constrained settings.

Methods:

We conducted a multicountry systematic analysis of bottlenecks and proposed solutions to strengthen community health systems through a series of collaborative workshops in 22 countries in WCA. Countries were categorized by their under-5 mortality rate (U5MR) to assess specificities related to reported challenges. We also reviewed existing data on selected health system tracer interventions to analyze country profiles.

Results:

The bottlenecks identified as severe or very severe were related to health financing (19 countries, 86%), essential medical technology and products (16 countries, 73%), integrated health service delivery (14 countries, 64%), and community ownership and partnerships (self-reported by 14 countries, 64%). Only the integrated service delivery was self-reported as a severe challenge by countries with high U5MR. The issue of human resources for community health was one of the least reported challenges.

Conclusion:

In WCA, strengthening community health systems as part of PHC revitalization efforts should focus on increasing health financing and innovative investments, strengthening the logistics management system, and fostering community ownership and partnerships. Countries with high U5MR should also reinforce integrated service delivery approaches through innovation. Government actions galvanized by global and regional ongoing initiatives should be sustained to ensure that no one is left behind.