top of page

Tackling Key Determinants of Primary Care

In the past century, there has been a transition in healthcare from focusing on diseases and their pathology to focus instead on a variety of socio-environmental factors that influence health outcomes, especially primary care. Barbara Starfield, a leading American pediatrician and champion of primary care defined primary care as

“the level of a health service system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and co-ordinates or integrates care provided elsewhere by others.”

The transition called for a comprehensive primary care approach that provided services in a continuous and coordinated manner in order to meet the health needs of the population. As evidenced by the table below, health outcomes globally have generally improved over the decades but data in sub-Saharan Africa (SSA) remain a decade behind the world. Even with increased investments in health, difficult to measure outcomes such as equity and quality remain questionable, while cost of care continues to price out those unable to pay on the continent ensuring SSA trails behind in achievement of the SDGs and UHC.

Though SSA governments are mandated to provide primary healthcare services to their population, they are inundated with numerous challenges making it a difficult task to accomplish. As a result of the inconsistent service delivery, pharmacy stock-outs and many other recurring challenges with public sector providers, many people opt to receive care from private sector providers. Unfortunately, private sector providers are often unregulated allowing them to charge high premiums, limiting access to individuals who can afford it and excluding the poor.

Other key challenges to public sector provision of primary health care are:

  • Antiquated infrastructure that are poorly staffed causing them to be incapable of providing high quality care at the global standard of care to high volumes of patients

  • Technological inertia in low and middle-income countries, which exacerbates the above challenge and limits drastic improvements in delivery

  • Accessibility to care for individuals in hard-to-reach areas as a result of geography preventing individuals in crucial need from access to it

Hence, innovators in both the formal and informal private sector are engaging in ‘out-of-the-box thinking’ to improve access to primary healthcare, essentially challenging conventional methods of service delivery, with the key goal of promoting wellness and preventing diseases in the community.


B. Starfield, Primary Care: Balancing Health Needs, Services and Technology, Oxford University Press, New York, NY, USA, 1998.


Triple transition
bottom of page