Make This Time Different. Prioritize Primary Health Care as a 3-for-1 Investment towards Health for All.

An open letter signed by 239 organizations and 157 individuals across 65 countries urging leaders to prioritize a primary health care approach across the 2023 UN High-Level Meetings on Universal Health Coverage and Pandemic Prevention, Preparedness, and Response, and the 2023 midpoint of the Sustainable Development Goals.

Primary health care is ‘primary’ for a reason. We call on national, regional and global actors to prioritize primary health care as a 3-for-1 investment in universal health coverage, health security and better health and well-being. All three of these goals depend on the same health systems, and primary health care is their common foundation.

For more than 40 years, the world has made ambitious commitments to create a healthy future for all – from the Declarations of Astana (2018) and Alma-Ata (1978), to the UN Sustainable Development Goals (SDGs) (2015) to the UHC Political Declaration (2019), which has been referred to as the most comprehensive set of health commitments ever adopted. Along the way, global leaders have repeatedly recognized primary health care (PHC) – an approach that can reach every community and meet the vast majority of people’s health needs throughout their lives – as the foundation of strong health systems and the key to greater well-being, social and economic prosperity, and equity. 

Yet for more than 40 years, the reality of these commitments has fallen short of their promise. 

Instead of acting on lessons learned to build the health systems people want and need, we keep retreating into patterns of crisis and inaction – leaving millions of lives and livelihoods in the balance. The COVID-19 pandemic and other emerging health threats continue to test the resilience of health systems and prove that we still aren’t prepared to meet the challenge. As a result, additional negotiations have been launched to strengthen pandemic preparedness and response, including calls for a pandemic treaty, reform to the International Health Regulations, and a new fund to help prevent future health emergencies. Efforts are also underway to make up lost ground in the fight against leading infectious and non-communicable diseases. 

However, without a strong foundation of primary health care to address growing gaps in essential health services, the most vulnerable communities will remain most susceptible to any threat – whether local or global in scale – to their health and well-being. 

It is time for a radical reset. 2023 will see several UN High-Level Meetings – including one on Universal Health Coverage and one on Pandemic Prevention, Preparedness, and Response – as well as the midpoint of the Sustainable Development Goals. All of these moments represent major opportunities to stop repeating history and begin a new chapter of sustained action, recognizing primary health care as the crucial link between these urgent health goals.


Together, we can make this time different by strengthening health systems through a primary health care approach, starting with three overdue shifts:

1. Prioritize people who have been failed by the system, not those who already benefit from it.

  • Change who has the power to set policy agendas and allocate resources at all levels of government so that the wealthy, privileged, or most vocal few – locally, nationally and globally – are no longer dictating the lives of the many. Teams of decision-makers must reflect the expertise of all the diverse communities that health systems are meant to serve, or else decisions will keep leaving the same people behind. 

  • Require that patients, patient advocates, frontline health care providers (who are predominantly women) and communities be included as equal partners in the leadership and management of health care service delivery. These are some of the people best-positioned to identify crucial gaps and drive solutions that we have missed in the past. 

  • Insist on international agreements and responses – including for matters of global health security – that foster genuine solidarity, equity, and mutual learning across countries, and no longer permit the most powerful donors, leaders, entities and nations to put their priorities above the rest.

2. Give the people what they want: quality health services in their community that work around their needs, preferences, and everyday lives – instead of requiring financial or personal sacrifices to get a trusted standard of care.

  • Earn people’s trust by consistently delivering primary care services that meet everyone’s needs across the lifespan. Services must be respectful, fully responsive, proactive, and well-managed, with reliable entry points in every community. 

  • Invest in a well-resourced, protected, diverse, and skilled team-based health workforce at community, sub-national and national levels so that health workers can ensure patient satisfaction and meet all essential health needs in times of crisis and calm.

  • Set measurable targets and report disaggregated data transparently on quality across all pillars of primary health care (e.g., capacity, performance, and impact). This should include external and community-led reviews of how government policies, structures and funds are translating to quality services for all.

  • Demand systems that guarantee high-quality care for all people and communities. Remove all financial and other barriers to health services so that everyone, particularly the most marginalized groups, can get the quality care, products, and information they need – and entire families, communities, and economies will benefit. 

  • Prioritize human rights, gender equity, and social determinants of health through multisectoral action, and involve communities as partners in their own care, recognizing that good health starts outside of the clinic.

3. Treat primary health care as an investment, not a cost, to build resilience into the foundation of the health system and improve health outcomes for all.

  • Drive more, better, and localized investments toward health systems based on primary health care, allocating funds according to each community’s and country’s needs and priorities. More public financing is especially key in countries that receive donor support, to lessen dependence on priorities that may not align with national strategic plans. 

  • Instead of diverting resources from one crisis to the next, ensure that every program for pandemic prevention, preparedness, and response includes specific investments for improving primary health care as the foundation of resilient health systems that can adapt to new threats and sustain comprehensive health services, no matter what. 

  • Establish policies and systems of mutual accountability to uphold people’s fundamental right to health, sustain PHC investments, and keep improving population health and well-being even as administrations come and go.

  • Earmark financing to strengthen health data, surveillance, information systems and community engagement in PHC, and use comprehensive assessments to drive better decision-making. Everyone must be counted and included to leave no one behind.

It is past time to translate the will to achieve Health for All into meaningful benefits for people and communities around the world. The 2023 UN High-Level Meetings on Universal Health Coverage and Pandemic Prevention, Preparedness, and Response, as well as the mid-point of the Sustainable Development Goals, represent major opportunities to take what we have learned and build the world we want.

To make this time different, we urge leaders and Member States to prioritize primary health care in these negotiations as a 3-for-1 investment in universal health coverage, health security, and better health and well-being for all. 

Together, we can rise to meet the challenges around us, and turn a corner toward unprecedented times that future generations will thank us for.

Signed by:

Advisors to the Allies Improving PHC

Dr. Lola Dare, Chestrad Global; Dr. Ibtihal Fadhil, Eastern Mediterranean NCD Alliance; Dr. Aminu Magashi Garba, Africa Health Budget Network; Arush Lal, PhD Candidate, London School of Economics & Political Science; Dr. Neda Milevska-Kostova, IAPO Patients for Patient Safety Observatory; Assoc. Professor Shabir Ahmed Hassim Moosa, African Forum for Primary Health Care; Patricia Nudi Orawo, STADA Kenya; Chanthorn Phorng, Khmer HIV/AIDS NGO Alliance

Organizational Signatories

AANI-PAS

Academic and Career Development Initiative Cameroon

Activate Action

Advocacy Network Africa (AdNetA)

Aequitas Consulting Pvt Ltd

AFPDE

AFRAC RDC

Africa Health Budget Network

Africa Islamic Economic Foundation

African Hope Committee Inc

Afrihealth Optonet Association (AHOA) - CSOs Network

AfroPHC

Alliance for Reproductive Health Rights

Americas TB Coalition

Amref Health Africa

Ariadne Labs

Arthritis and Rheumatism Association Malta (ARAM)

ASEAN Institute for Health Development, Mahidol University

Asociación de diabetes en niños y adolescentes del Perú - Adina Perú

Associação de Profissionais Licenciados de Optometria

Associacao Hixikanwe

Associação Santomense para Promoção Familiar ( ASPF)

Association Cedria pou un environnement et un développement durables

Association For Promotion Sustainable Development

Association HERAXXI

Baerbel Jennert Foundation

Banka BioLoo Limited

Best Health Solutions

BOKA HAVEN

Building Capacities for Better Health Africa, Cameroon

CARE

CCM RWANDA

Centre for Accountability and Inclusive Development (CAAID)

Centre for Primary Health Care and Equity, UNSW Sydney

Centre for Sustainable Access to Health in Africa

CHEN - patient fertility association

Christian Fellowship and Care Foundation

Civic and Legal Aid Organization (CILAO)

Civil Society Movement Against TB

Clinique Mobile / Fondation Panzi RDC

Coalition des OSC du Bénin pour la Couverture Universelle en Santé (COBCUS)

Colegio Mexicano de Posgraduados en Medicina Familiar A. C.

Communities at the Heart of UHC

Community AID Transformation Alliance Group (CATAG)

Community Fighte Against GBV and HIV/AIDS

Community Forum (COFO)

Community Health Volunteers

Community Partners International

Community Working Group on Health (CWGH)

Community's Expertise for Development Contributions

Confraternity of Patients Kenya (Cofpak)

Consortium for the Advancement of Right for Key Affected Population (CARKAP)

Construisons Ensemble le Monde

CORE Group

CSYM HUDUMA CHRISTIAN SPIRITUAL YOUTH MINISTRY YLO TANZANIA

Dakshayani and Amaravati Health and Education

Dentalcare Foundation

development Research and Projects Centre

DOM//ECC SUD-KIVU

Dr Uzo Adirieje Foundation (DUZAFOUND)

E-Center for Women's Cancer and Maternal Health

Eastern Mediterranean NCD Alliance

Echovision LLC

Egyptian NCD Alliance

Ergovisão Ponte de Lima

European Forum for Primary Care

Facilitation for Integrated Community Rural Development

Faith Acts Research Support and Training (FARST - Africa)

Family Health International 360 Malawi

Federal University Lokoja Health Services

Focus for the Future Generation

GCFORCB Organisation

Ghana Institute of Management and Public Administration

Global Health Collaborative in the Dept of Family Medicine at Boston University

Global Health Corps

Global Health Strategies

Global Institute for Disease Elimination (GLIDE)

Global Promoters for Community Initiatives

Good Health Community Programmes

Great daughters of Nyakach

Health Action Coordinating Committee

Health and Global Policy Institute (HGPI)

Health and Rights Education Programme, Malawi (HREP Malawi)

Health Campaign Effectiveness Coalition

Health NGOs Network (HENNET)

Health Systems and Policy Research Unit, Community Health Department, University of Uyo

Health Systems Thinkers, LLC

Health, Education and Literacy Programme (HELP)

HealthX Africa

Healthy And Smart Children's Foundation

Heart to Heart Smile

Hellenic Academy of General Practice/Family Medicine & PHC

HelpAge International

HUMAN RIGHT ADVOCACY HEALTHCARE AND REINTEGRATION OF INDIGENT PRISONERS (PERSONS)

Humanity for Orphans, Youth and Widows Initiatives Kenya (HOYWIK)

IAPO Patients for Patient Safety Observatory

Imam Sadr Foundation

Independent Practitioner Association Foundation (IPAF)

Initiative for Integrated Grassroot Empowerment and Support

Innovations for Development (I4DEV)

International Alliance of Patients Organisations (IAPO)

International Diabetes Federation - Saca Region

Intersectoral Forum to Fight NCDs in Brazil (ForumDCNTs)

IntraHealth International

Inuka Success Organization

Jhpiego

Jijenge Youth

Jordan Society of Family Medicine -JSFM

Julie Helping Hands Foundation (JHF)

Kamuzu University of Health Sciences

Kamyk Clinic Limited

KAPOTEC FOUNDATION UG

Kenya Female Advisory Organization

Key Populations Uganda (KPU)

KHANA Center for Population Health Research

Khmer HIV/AIDS NGO Alliance (KHANA)

Kinder Consulting

Kisumu Action for Disability Development Network (KADDNENT)

Kisumu County Community Health Workers Network

Kisumu Medical and Education Trust (KMET)

Kisumu Social Inclusion Network (KSIN)

Kuboresha-Africa

La Ruche Health

LaGray Chemical Co Limited

Lami Fatima Babare Cervical Cancer Foundation

Last Mile Health

Lesotho Network of AIDS Service Organisations (LENASO)

Living Goods

Local Initiatives Development Agency

MAAYGO

Make Me Smile Kenya

Malarialess, Uganda

Management Sciences for Health

Masvingo Association of Residential Care Facilities Trust

Medical Assistance Sierra Leone

Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine

MentorPoint Africa

Millar Institute for Transdisciplinary and Development Studies

Mimbi international school Medical Clinic

Ministerial Committee of Scientific and Technological Cooperation

Ministry of Health - Bhutan

Ministry of Health, Ethiopia

Mumbo International

MWAN PAS

Nasarawa State Ministry of Health

National Advocates For Health

National Disability and Development Forum NDF

Network of Persons Living with HIV/AIDS - GHANA (NAP+ GHANA)

NGOs Network For Dodoma (NGONEDO)

Nigeria Association of Social Workers

NOIPolls Limited

Nuwalege Progressive Movement

Onyibupet Consulting Limited

Options (Evidence for Action-MamaYe)

Options Consultancy Services

Organisation For Health in Sustainable Development (OHISD)

Organization of African Youth

Oromia Regional Health Berou

Outreach Scout Foundation -OSF

PAI

Pandemic Action Network

Pangaea Zimbabwe Aids Trust

Panzi Hospitals

PATH

Pathfinder International

Patient Academy for Innovation and Research

Patient and community welfare Foundation of Malawi

People’s Health Movement Tanzania (PHM Tanzania)

PharmAccess Group

PHM Malawi

PHMUganda

Planned Parenthood Federation of Nigeria

Population Services International (PSI)

Primary Care International (PCI)

Public Health Research Society Nepal

RBM Partnership to End Malaria

Reconciliation and Development Association

Research Center on Health Policies and Systems - International Health, School of Public Health, ULB

Results for Development (R4D)

Riders for Health - Lesotho

Riders For Health - The Gambia

Rural Health Advocacy Project a division of WITS Health Consortium

Rural Women and Girls' Rights Foundation

Safe Island For Women and Children (SIWoC)

Salud para Todos Argentina

Santé et Education pour Tous (SET ONG)

Sauti ya Wanawake Wenye Ulemavu Tanzania (SWAUTA)

Save for Development and Relief Association (SADERA)

Save the Children Indonesia

School of Medicine, University for Development Studies

SEDAP ( Spanish Society of Primary Health Care Managers)

SHAPE CBO

Shift For Change (S4C)

Soc Trang Center For Social Science Engagement (SCSE)

Social Alpha

Society for Conservation and Sustainability of Energy and Environment in Nigeria (SOCSEEN)

SODECA

Speak Up Africa

STADA Kenya

Stage Media Arts

Stessis Digital Medical Systems

Stroke Association Supportnetwork-Ghana (SASNET-GHANA)

Stroke Foundation Uganda (SFU)

Success Capital Organisation

Sukaar Welfare Organization

Support Heal and Purpose to Elevate (SHAPE)

Supporting Girls in Education

Swasti

Tanzania Association of Clinical Officers and Clinical Assistants (TACOCA)

The Access Challenge

The AIDS and Arts Foundation (TAAF Zimbabwe)

The Airlangga Centre for Health Policy

The Botswana Network on Ethics Law HIV AIDS (BONELA)

The George Institute for Global Health

TINADA Youth Organization

Tobacco Free Association of Zambia.

Todos Frente al Chagas /Chagas Disease Alliance

Trans-Plant Cameroon

Tunaweza Organisation (Tanzania)

Uganda Alliance of Patients' Organizations (UAPO)

Uganda Community Based Health Care Association

Uganda National Health Users/ Consumer's Organisation

Ugenya Youth Community Development Project

Ukana West 2 Community Based Health Initiative

Umane

UNICEF

University for Development Studies

VillageReach

West African Institute of Public Health

White Ribbon Alliance

Wider Aid & Development Agency, South Sudan

Winam Chanua Dada CBO (CHADALA)

Women Health Channel Uganda

Women in Media Communication Initiative (WIM)

WONCA ICPC Foundation

World Organization of Family Doctors (WONCA)

YESAM

Zambia Heart and Stroke Foundation

Zambia NCD Alliance

Australia

Mark Burdack

Bangladesh

Harun Maliiha

Md Shah Jalal

Belgium

Jean Macq

Botswana

Sunanda Ray

Brazil

Valentina Martufi

Frida Liane Plavnik

Rita Freitas

Cambodia

Pheak Chhoun

Cameroon

Asanga Zaccheous Achidi

Nkwan Jacob Gobte

Canada

Ishtiaq Bashir

Blessing Adeyemo

Cote d’Ivoire

Rory Assandey

Democratic Republic of the Congo

Buloze Munonge

Jeremie Kasongo

Egypt

Eman Sobh

Ethiopia

Sirak Embibel

Gizew Asres

Bereket Ashenafi

Kadire Geticha Mekengo

Desta Bukulu

Germany

Arthur Onyango

Ghana

Bernice Gyawu

Charles Oduro Owurani

Erasmus Agongo

India

Mudera Cariappa

Bobby John

Asha Jyothi

Nadeem Shaikh

Kareem Karassery

Roma D'silva

Indonesia

Ilham Ridlo

Atikah Adyas

Daniel Tjen

Chandra Laskar

Japan

Joji Sugawara

Hideaki Nakajima

Jordan

Ahmad AlNawafleh

Grace Ojuang

Dr. Mohammed Rasoul Tarawneh

Kenya

Rachel Ndirangu

Mary Ger

Miriam Alvina Achieng

Pauline Irungu

Sylvia Ayon

Brenda Makungu

Shariffa Olima

Samuel Onjolo

Bosse James

Tobias Awalla

Benson Odhiambo Owano

Esther Gikonyo

Dellah Ochieng

Kwameh Daughty

Annet Lucy Achieng Oduory

Danson Maloti

Eric Yogo

Maureen Akeyo Owino

Lavendar Okoth

Fred Misach

Carolyne Amondi Miguna

Byron Otieno

Dennis Obiero Ogot

Daniel Mwangi

Lesotho

Yolisa Mashologu

Nthabeleng Ntsekalle

Malawi

Mabvuto Mndau

Elimase Kamanga

Ellos Lodzeni

Malaysia

Dr. Veronica Lugah

Peter Gan

Uma Ponnudurai

Dr. Saguntala Selvamani

Individual Signatories

Mongolia

Chimeddagva Dashzeveg

Netherlands

Daren Paul Katigbak

Liesbeth Siderius

Nigeria

Fanty Mela

Ebikapaye Okoyen

Louritta Akpelan

Olabisi Adebawo

Kazeem Balogun

Christiana Omelazu

Abdulmujib Dalhatu Abdullahi

Samson Agbo

Adewale Hameed Aderibigbe

Francis Ohanyido

Abraham Shobowale

Zakari Osheku

Shehu Sule

Ayobami Afape

Shehu Muhammad Hassan

Pakistan

Amna Mahmood Islam

Peru

Javier Pablo Anamaria

Philippines

Nancy Brisa Fuentes

Portugal

Raúl Sousa

Rwanda

Frédérique Geron

Vincent K. Cubaka

Sao Tome and Principe

Antonio Luis Dos Santos Amado Vaz

Mafalda Brito

Sierra Leone

Harry Ben Alpha

South Africa

Eliza Malaza

Spain

Borja Cuervo Alonso

Sudan

Mohammed Musa

Almoghirah Abdellah

Nada Mohammed

Nageeb Ibrahim

Switzerland

Brian Li Han Wong

Tanzania

Shaibu Issa

Emmanuel Mush

Edward Mbogo

Monica Tibris

Deus Polepole

Gertruda Keyula

Fredrick Nkona

Thailand

Nirmal Kumar Jha

Tunisia

Abdelkrim Zemzari

Uganda

Samuel Senfuka

John V Amanya

Franco Gabala

Frank Gramsen Kizza

John Vianney Amanya

United Kingdom

Hassan Haghparast Bidgoli

Mamsallah Faal-Omisore

J A Harbottle

Stephanie De Sa Marques Basset

United States

Lakshmi Balaji

Anna McDonald

Jorge Villegas

Cynthia Haq

Nicodemus Soko

Alberto Colorado

Dr. Jean Jose Nzau

Rebecca Fujimura

Samantha Friedmann

Ekpenyong Ekanem

Nida Ali

Lynne Gaffikin

Emily Bigelow

Jeff Markuns

Pattama Ulrich

Gladys Ngeno

Yemen

Dr. Rashad Sheikh

Zambia

Banza Chela

Miriam Chipimo

Zimbabwe

Enock Musungwini

Open Letter published on 20 September 2022