The World Health Organization (WHO) is partnering with development banks to help support efforts to strengthen primary health care in low-income and middle-income countries.
Experts have welcomed a new funding mechanism to strengthen primary health-care services in low-income and middle-income countries, but say additional measures are needed to address current care challenges.
The Health Impact Investment Platform, launched by WHO and three multilateral development banks, will initially make US$1·5 billion available in concessional loans and grants to eligible countries, starting before the end of 2023.
The funds will go towards expanding the reach and scope of primary health-care services, especially for the most vulnerable and underserved populations and communities. The loans will have favourable terms for the borrower such as repayment grace periods and below-market interest rates.
The Platform was launched during the Summit for a New Global Financing Pact in Paris, France, in late June, by WHO and the African Development Bank, European Investment Bank, and Islamic Development Bank. The Inter-American Development Bank is also considering joining the partnership.
WHO’s goal for the Platform is to support countries worldwide, but in the first phase the eligible low-income and middle-income countries will be from Africa, Asia, Latin America, and the Middle East. Countries will be agreed by the participating development banks, whose considerations will include those with the greatest need and whether there is willingness to join the effort.
Azeem Majeed, Professor of Primary Care and Public Health at Imperial College London, UK, welcomed the new initiative. “The launch of the Health Impact Investment Platform will provide much-needed funding that could make a significant contribution to improving primary healthcare and universal coverage in low-income and middle-income countries.
Primary health care is crucial in health systems, for example, in promoting health, preventing diseases and managing long-term conditions, thereby reducing health inequalities and improving health outcomes”, he commented.
Mit Philips, Coordinator of Health Politics at Médecins Sans Frontières, agreed that the prioritisation of primary health-care investments by WHO and major development banks was a positive development, but highlighted the “urgent need for action on the existing financial barriers that force people to forego essential care, including suspending user fees and reducing patients’ out-of-pocket expenses for health.
This means that financial and other support needs to go towards specific measures (at facility and community level) that ensure people’s access to services, in particular for the most vulnerable and for people who may already be neglected by the state or society.” She added: “Support to effective referral to hospital, emergency services, wound care, transfusions, and other life-saving care should complement primary care.”
WHO is the Platform’s policy coordinator and will host its Secretariat.
“WHO will serve as a system catalyst to drive new investments in primary health care at country level. This will be done by identifying health service delivery gaps in countries and coming up with investment plans, convening capital providers, supporting mutual accountability and solidarity processes, and monitoring impact”, Catharina Boehme, WHO Assistant Director-General, External Relations, explained to The Lancet.
The Platform’s work has two pillars.
Pillar 1’s main roles include guiding investments according to gaps and needs and monitoring and reporting implementation. However, Philips noted that communities and patients should be involved in “determining priorities, plans, and independent monitoring” of the Platform.Pillar 1 will also manage paid-in donor contributions that can be used for technical assistance from WHO to governments, as grant contributions, or as interest rate subsidies to allow any financing provided under Pillar 2 to be highly concessional.
Pillar 2 covers loans for large-scale investments. “A major benefit of the platform will be the potential to scale-up necessary investments with lending. It is expected that this will be mainly for public sector financing, but it could also include private sector transactions. There will be a minimum of 50% concessional lending, while the remainder of a project will involve investment grants or similar concessional lending instruments”, said Boehme.
Although Philips believes the Platform is “potentially a step in the right direction for long-term solutions”, she noted that the universal health coverage and primary health care agendas “need to address the issues that people are facing today” including “effective and reliable short-term responses, especially for those with special health needs or vulnerabilities and those affected by emergencies”.
