Correspondance

Universal health coverage is currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues for analysing lessons learned from different country experiences, but we believe there is a crucial element neglected within the ongoing universal health coverage debate.

Health-care system development requires more than financing and human resource considerations. Although essential, these components must be integrated into an overall framework for organising and delivering care that best meets population needs. Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality^. Strong orientation towards primary health care and its core principles (often outlined as first contact, continuous, comprehensive, and coordinated care) is shown to be stable over time and was often incorporated in the early days of many health-care systems that have a strong primary health-care orientation today. This observed stability makes the lack of focus on primary health care within the current universal health coverage debate an urgent issue.

This is where universal health coverage should be reconnected with primary health care. To aim for universal health coverage and better population health should not remain a laudable intention. People living in countries presently moving towards universal health coverage—irrespective of their income level—should not suffer for decades because of an avoidable failure to secure a strong primary health-care orientation from the very beginning. We believe that the time to move the universal health coverage debate towards primary health care is now.