By Ngo Bibaa Lundi Anne
A renewed commitment to Primary Health Care (PHC) has Just been adopted by UN member states. This commitment which is termed “The Astana Declaration” comes in 40 years after the Alma Ata Declaration was signed (WHO 2018,). The Astana Declaration reawakens our consciousness to the shortcomings of our health systems in meeting the health needs of everyone. Health systems which in most countries are inequitable, hospital centred, and impoverishing for the population (Kruk et al 2018). PHC is said in the declaration to be an all-encompassing societal centred approach geared towards the attainment of the highest level of health and well-being, including the equitable distribution on the needs and preferences of people from health promotion, disease prevention, treatment, rehabilitation, and palliative care which takes into consideration people’s context (WHO, 2018).
PHC as embeded in the Alma Ata declaration over the years in many countries saw so many interpretations (Rifkin, 2018). some of which led to successes in improving health outcomes which served as best practices for other countries, and others which only increased inequality, and reduced access to health. With less than 4000 days left for the Sustainable Development Goals to be met, coupled to the challenges in accessing quality health care in the 21st century, there was need to rethink on how best each stakeholder can contribute towards achieving health for all. This declaration which now serves a footprint for countries to implement based on contexts, needs appropriation from all stakeholders. It is important thus for Cameroon to commit towards developing a stronger, inclusive, efficient and effective primary health care as key in the implementation of its universal health coverage program which is currently under development.
Civil Society organisations and Primary Health care in Cameroon
Evidence since Alma Ata (1978) supports a multisectoral and comprehensive approach to PHC; an approach which is people centred. Civil society organisations have been and continue to be great contributors to advancing global health agendas. The very presence of CSOs within affected communities gives them the impetus to influence grassroots transformations for the well-being of all. Examples could be seen in the early years of the AIDS pandemic when CSO activists fought to increase access to generic medicines for People Living with HIV to access antiretrovirals at affordable costs. Advocacy actions will not only push governments to re-organise PHC but also ensure that quality is ensured for everyone. CSOs in Cameroon have an opportunity to orientate the current Universal Health Coverage (UHC) policy which is under development to ensure that PHC is at the centre and CSOs as key partners in the implementation. For PHC to be strengthened at community level in Cameroon, there is need to engage community health workers and traditional rulers in ‘community dialogues’ to involve communities in owning their health, train and map out existing CHWs, advocate to government and international funding bodies to equip health centres and district hospitals (which serve as the first point of contact), and deploy general practitioners (family doctors) to work within health centres. CSOs must also commit to raising awareness on the economic benefit for households to utilise health centres within communities to avoid the heavy reliance on secondary and tertiary hospitals by the population.
Further, with the increasing number of internally displaced persons in Cameroon, there is even a stronger need for CSOs in Cameroon to be even more involved in primary health care to ensure these communities have access to basic health services. CSOs who are already actively involved in humanitarian response projects for IDPS will have to think of innovative ways of providing quality health care services to IDPs living the bushes, rural and urban areas.
The Astana Declaration and Cameroonian youths
Although the Astana declaration does not explicitly mention youths as key stakeholders to the achievement of health for all, youths are indispensable to the realisation of this vision. The voices of youths came out very strong and clear on their commitment to advancing the Primary Health care agenda as seen in the Youth statement published during the global conference on PHC in Astana 2018. Cameroonian youths will have to join this global youth PHC movement and push the government in rolling out a UHC policy which is centred on PHC and has youths as key stakeholders during its implementation. Faced with a health system that is not readily accessible for most youths due to structural challenges like; high unemployment rates, bad road, long walking hours to health centres, poor communication systems, shortages in human resources, lack of youth friendly services within health centres and insecurity, Cameroonian youth start-ups and youth advocates will need to think of innovative ways of increasing access to health information for youths, ways of linking their peers to service providers, ways of delivering and receiving quality care and ways of holding the government accountable to the commitment of Astana Declaration.
Ngo Bibaa Lundi Anne is a civil society advocate working with Reach Out Cameroon. She is also a member of WHO Primary Health Care young leaders network from Cameroon. Her career has been focused on Strengthening community health systems for underprivileged and marginalised communities.