Primary Health Care Financing and Payment: Lessons and Best Practices from the COVID-19 Pandemic

Globally, countries are grappling with unprecedented social and economic challenges posed by COVID-19. More than 6 months after COVID-19 was declared a pandemic, the Joint Learning Network for Universal Health Coverage (JLN) Primary Healthcare (PHC) Financing and Payment Collaborative, has taken a step back to reflect on countries’ COVID-19 experiences’ coordinating the pandemic response, and financing and paying for services at PHC level. This brief consolidates common lessons from six countries from the collaborative – Bangladesh, China, Kenya, Nigeria, the Philippines, and South Korea. While experiences are often contextual and unique to each country, the objective remains the same: to better prepare health systems to respond to future epidemics and pandemics.

Bangladesh was able to overcome the pandemic by creating localized solutions – a necessity given the reality of their population density, informal economy, and inter-generational families. Bangladesh used data to identify clusters for transmission, to target different levels of restrictions and safety precautions depending on new cases, recoveries, and deaths. Download the Bangladesh brief.

Officials developed a strategy, dubbed the “Four Early’s”, that sought to minimize infection by identifying, addressing, and conducting contact tracing for infections as soon as possible. This strategy was bolstered by a triaged approach for different regions based on the level of risk identified, which allowed policymakers to direct resources more efficiently to where they were most needed. Officials also recognized the importance of access to high quality health services in curbing the pandemic. The priorities that guided China’s response, timeliness, and access, proved to be largely effective. Download the China brief.

Kenya’s response prioritized the efficient process of incoming data, collected, and synthesized at both the national and county level, to ensure timeliness, completeness and accuracy. This approach allowed the Kenyan government to stay abreast of the rapidly evolving situation, monitoring human resources, test kits, drugs, and personal protection equipment levels to more effectively direct resources to where they are needed. Download the Kenya brief.

Nigeria’s systems-based response not only helped reduce the burden of morbidity and mortality in the immediate term but has also helped prepare Nigeria to better handle a resurgence of COVID-19—or any other pandemic of similar magnitude. Care was taken to minimize the impact of the pandemic on critical social, economic and health infrastructure systems and speed-up post-pandemic recovery and rehabilitation. Download the Nigeria brief.

The Philippines Health Insurance Corporation (PhilHealth) administers the National Health Insurance Program to provide health insurance coverage and ensure accessible and affordable healthcare services for all Filipinos. At the onset of the COVID-19 pandemic, PhilHealth played a pivotal role in financing healthcare services. This brief documents actions taken by PhilHealth and how it has leveraged existing systems to quickly respond and contribute to the pandemic response. Download the Philippines brief.

Republic of Korea
The Republic of Korea’s preemptive and transparent public health response was instrumental to slowing the spread of the virus and flattening the curve of new infections. In the aftermath of the Middle East Respiratory Syndrome outbreak in 2015, policy changes that were implemented to boost pandemic preparedness and response provided a crucial foundation for the COVID-19 response and became investments that were quickly leveraged, and supported a faster and more effective response. Download the Korea brief.

These country briefs revealed several lessons about how policymakers and practitioners may bolster pandemic preparedness and response in the future, including the following:

Strategic purchasing for COVID-10
Strategic purchasing is a lever to achieve UHC goals, by using limited resources most efficiently to achieve equitable access to quality health services. Policymakers in all six countries coupled incentives for patients to access care with assurances to providers that they will receive the appropriate reimbursement for services, providing a concrete foundation for health system responsiveness.

Leveraging Primary Healthcare and Community Health Systems
PHC and community health are the first point of entry into formal health systems in many countries. Although many investments for the pandemic focused on “surging hospital capacity” with more intensive care beds and ventilators, and “flattening the curve”, the reality is that many cases remain mild or asymptomatic, and PHC and community health systems remain the backbone to support contact tracing, testing and home-based care.

Governance and coordination across sectors and between levels of government
The pandemic response goes beyond the health sector – all six countries have pandemic national coordination units that bring together all sectors such as immigration, security, finance, transport, trade, education, hospitality including – state and non-state actors – to develop multi-sectoral strategies addressing the multiple facets of community life affected by COVID-19 and enforce their implementation.

Evidence-based strategies
Data is a vital component in helping governments, researchers, and policymakers battle the COVID-19 pandemic. With accurate, timely and complete data, governments can make informed decisions to ensure the safety of the population.

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