Abstract:
After the eight Millennium Development Goals
that have shaped progress in the past 15 years,
17 Sustainable Development Goals (SDGs) were adopted
by governments at the UN General Assembly in
September, 2015. SDG3 explicitly relates to health—to
“Ensure healthy lives and promote well-being for all at all
ages”. This goal is translated into 13 targets: three relate
to reproductive and child health; three to communicable
diseases, non-communicable diseases, and addiction; two
to environmental health; and one to achieving universal
health coverage (UHC). Four further targets relate to
tobacco control, vaccines and medicines, health fi
nancing
and workforce, and global health risk preparedness.
When supported by strong public health policies
and with aligned eff
orts across social, economic, and
political domains, primary health care has a central role
in achievement of sustainable development. Although
diff
erences are inevitable between countries in the
organisation of primary health care and the human
resources available, many of the challenges outlined
in SDG3—related to reproductive and child health,
communicable diseases, chronic illnesses (including
multimorbidity), addiction, and other mental health
problems—can be addressed through a person-centred
and population-based approach to primary health care.
1–5
Delivery of vaccines and drugs needs a functioning
primary care system. Well integrated and prepared
primary health care has a key role in health emergency
responsiveness, and it is essential for the achievement of
UHC equitably and cost-eff
ectively.
6–8
Moreover, primary health care can contribute to
the achievement of many of the 16 other SDGs; for
example, its role in addressing the social determinants
of health was underlined in the report
Closing the Gap
in a Generation
. Primary care teams worldwide can
provide examples from daily practice that illustrate
their contribution across the SDGs, including helping
to end poverty, improve nutrition, provide health
education and promote lifelong learning, empower
individuals and communities to reduce inequities
and promote justice, enable access to safe water and
sanitation, encourage productive and sustainable
employment, foster innovation, advocate for healthy
and sustainable living environments, and promote
peaceful communities.
Yet investment in realising the full potential of primary
health care still seems
elusive to many governments,
policy makers, funders, and health-care providers.
Therefore, 7 years after the World Health Report and
The
Lancet
Series on primary health care, and 37 years
since the Alma-Ata declaration, the absence of reference
to primary health care in the SDGs and their targets
seems a serious oversight. Two conclusions could be
drawn: fi
rst, that
primary health care
is dispensable and
peripheral to achieving sustainable development; or,
second, that primary
health care is so integral to the
path towards the SDGs that reference in a goal or target
would undermine its cross-cutting role.
We opt for the second conclusion, yet do so with
apprehension, because one of the contributing factors to
the documented failure of primary health care in many
settings since the Alma-Ata declaration was “the scarcity
of a proposed strategy for implementation and its
monitoring for accountability and scale-up purposes”.
9
This issue needs to be addressed in the development of
implementation strategies for the SDGs. If the agenda is
not explicit about how health systems with good-quality
comprehensive primary care can be achieved, or how to
measure progress towards this goal, we risk repeating
the failures of the past.
National governments and other stakeholders need
to be ambitious in measuring progress towards delivery
of primary health care that will address the SDGs. This
monitoring includes the use of indicators that can capture