Strengthening Primary Health Care: Lessons from WHO’s South-East Asia Region

This article covers the WHO’s 2024 report on positive practices in developing primary health care systems across the South-East Asia Region. The report shares 20 case studies from countries like India, Thailand, Bhutan, and Indonesia, focusing on workforce development, public-private partnerships, and community engagement. The lessons drawn from these stories show the importance of innovative approaches to improving health systems and achieving Universal Health Coverage (UHC).

Primary Health Care (PHC) is the backbone of any health system, ensuring equitable access to essential services. Across the WHO South-East Asia Region, countries have been navigating through the challenges of delivering comprehensive PHC to their populations. The 2024 WHO report, Positive Practices in Developing Primary Health Care-Oriented Health Systems – A Collection of Case Stories from the WHO South-East Asia Region, presents 20 case studies showcasing innovative approaches to transforming health care systems. These stories highlight the region’s commitment to achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) despite facing demographic, economic, and health-related crises.

Workforce Development and Innovation

A key focus of the report is the development and optimization of the PHC workforce. Countries like India and Bhutan are leading the way in reskilling health workers and deploying mid-level providers to expand health service delivery. In India, the introduction of Community Health Officers (CHOs) has revolutionized care at the subcenter level. CHOs have helped provide services to previously underserved populations, especially in rural and remote areas. A six-month training program for nurses and traditional medicine practitioners has enabled them to deliver a comprehensive set of 12 essential health services.

In Bhutan, reskilling health assistants to take on broader roles has been essential in expanding PHC coverage. Previously, health assistants were trained only in selective areas, such as reproductive and child health. However, as the burden of noncommunicable diseases (NCDs) rises, it has become crucial to integrate a more comprehensive approach to care. This initiative has not only improved access to healthcare services but also empowered healthcare workers with new skills and responsibilities.

Public-Private Partnerships in Urban Health

Urban health settings pose unique challenges, particularly in terms of overcrowded public health facilities and the need for more decentralized services. Thailand provides a compelling example of how public-private partnerships (PPP) can bridge this gap. In Bangkok, the Universal Coverage Scheme (UCS) has successfully integrated private providers into the PHC system. Pharmacies, private clinics, and even digital health services are now part of Thailand’s broader strategy to ensure urban populations have easy access to essential health services.

By contracting with private pharmacies, the UCS allows patients to access free consultations and medications for common conditions such as headaches, coughs, and skin infections. This partnership not only alleviates pressure on public hospitals but also enhances access to timely care. The program’s success has paved the way for a planned expansion across other regions of Thailand, showing how innovation in service delivery models can greatly improve health outcomes.

Community Engagement and Empowerment

Community engagement has been a cornerstone of successful PHC systems, as seen in case studies from Indonesia and Nepal. Indonesia’s Healthy Cities initiative has focused on involving elderly community members in promoting health and well-being. The Usia Lanjut Masih Aktif (ULAMA) program in Wajo Regency mobilizes retirees as active participants in community health, turning an often-overlooked demographic into key players in urban health promotion. Their involvement has increased community participation and strengthened the link between local governance and health service delivery.

Similarly, Nepal has focused on the role of local governments in promoting PHC. By empowering village-level committees to take ownership of health initiatives, Nepal has improved healthcare access, especially in hard-to-reach areas. These community-driven approaches have demonstrated the power of local engagement in achieving sustainable health outcomes.

Lessons Learned

The WHO South-East Asia report emphasizes several key lessons from these case studies. First, workforce development is critical. Whether through reskilling, capacity building, or team-based approaches, having a well-trained and versatile health workforce is essential to delivering comprehensive PHC. Second, public-private partnerships offer practical solutions to gaps in urban health systems, particularly where public sector capacity is limited. By integrating private providers into the PHC model, governments can increase access and reduce the burden on public facilities.

Moreover, community engagement is not just a supporting factor—it is a central component of PHC success. Empowering communities to take part in their health systems leads to greater ownership and better outcomes. Finally, the use of data systems and monitoring frameworks has proven critical in improving health system accountability and performance.

The report from the WHO South-East Asia Region serves as a valuable resource for health policymakers, managers, and practitioners. The successful implementation of innovative practices across a variety of contexts shows that even in the face of major challenges, progress can be made. By sharing these stories, the WHO hopes to inspire other regions to adopt and adapt these practices to their health systems.

As the world continues to push toward universal health coverage, the lessons from the Southeast Asia Region highlight the importance of investment in workforce development, public-private partnerships, community engagement, and data-driven decision-making. By prioritizing these areas, countries can create health systems that are more resilient, efficient, and accessible for all.