Improving the frontline of health care services post COVID-19: A key agenda for resilient health systems

Colombia is one of the beacons of universal health coverage in Latin America, with 97% of the population covered through its national health insurance program. Yet, there are disparities in access to services, quality and outcomes  that show that effective universal health coverage – not access only to care but access to quality care that protects and improves the health of populations – remains an unfinished agenda. 

For example, in Colombia, over 30% of people that reported a need to use health services for a recent illness, who did not seek care reported this was due to a lack of trust, negative previous experience or perception of low quality of care. This barrier to access created by a perception of limited quality of care is compounded by large inequalities across departments where in wealthier ones (Quindío, Risaralda) nearly all pregnant women receive 4 or more Antenatal care consultations, only one in three women in poorer departments (Vichada, Guainía) receive the same care.

Additionally, while 90% of women and children in Colombia from households where the mother has completed high school or a higher level of education, receive a complete package of interventions that ensure basic aspects of their health, only 71% of women and children of households where the mother did not complete primary education receive this same package of interventions.  According to 2019 data, one person out of five in Colombia with hypertension will develop kidney disease, an aggravated condition leading to poor health outcomes. 

Such examples of gaps in care and outcomes illustrate the importance of strengthening health systems through high-quality primary health care. This is the main conclusion of two recent World Bank reports , part of an effort by the Primary Health Care Performance Initiative – a coalition of major multilateral organizations, philanthropy and research organizations – to scale up high performing Primary Health Care in Low and Middle-Income countries. 

A first study presents the results of an evaluation of the performance, equity and capacities of the PHC system to ensure the provision of services to the Colombian population. A second study presents an in-depth analysis of the first three months of the Colombian Health System's response to the COVID-19 pandemic and the degree of preparedness and dependence of the PHC system.

The main recommendations of these two in-depth analyses offer a road map for health sector transformation in Colombia: 

1. Implement a new model of care delivery focused on PHC, which offers a comprehensive package of services to the population. This recommendation would be carried out by adapting the current health care model to local health needs in order to improve the health outcomes of the population. To complement the new model, it would be necessary to ensure that local governance is strengthened and includes citizens and patients in defining local priorities.
2. Prepare the next generation of front-line primary health care professionals to work in multidisciplinary teams. To achieve this, it will be necessary to strengthen and implement the National Policy on Human Resources in Health, with a vision towards strengthening multidisciplinary PHC. It is also recommended to develop a greater number of training programs in Medicine, Family and Community Health, and to implement and adopt a basic curriculum for these disciplines and for the training of community health workers. Within the new care model, PHC professionals should work increasingly in multidisciplinary teams, offering comprehensive prevention, health promotion, and curative services to families and individuals.
3. Use PHC as a strategy to reduce inequalities in health. This would require implementing a new care model that promotes equity and should be complemented with efforts to reduce access barriers and a proactive approach that promotes the participation and relationship between patients and citizens in better planning of health services. Better public reporting and accountability will be essential in reducing health inequalities.

A health system that is more resilient, more effective and more sustainable is also one that is squarely focused on strong primary health care in Colombia . When primary health care works, people and families are connected with trusted health workers and supportive systems throughout their lives, have access to comprehensive services ranging from family planning and routine immunizations to treatment of illness and management of chronic conditions. 

The ongoing COVID-19 pandemic and its unprecedented human, economic and social costs have shown that health systems are essential to save lives and protect human capital and economic prosperity. Improving the quality of primary health care in Colombia is at the heart of the next generation of health reforms, reforms which will better meet the needs of Colombians , will ensure the financial sustainability of the sector and will strengthen its capacity to respond to and withstand future public health crises such as COVID-19.