Ayoung mother living in a rural area of a low-income country struggles to access basic health services for herself and her children. Her country’s high rate of HIV and AIDS has drawn the attention of international donors who have channeled resources into critical investments to bring the latest advancements in HIV detection and treatment to a newly built clinic nearby. Fortunately for her, she and her children don’t have HIV. However, what are her options for postpartum care for herself, and for monitoring her children’s nutrition, growth, and routine immunizations as well as her hypertension?

What she and many of her neighbors need is affordable access to essential health care, which could be available should the health authorities adopt primary health care (PHC) as the mainstay of their health sector strategy. Defined by the World Health Organization as  “focusing on people’s needs as early as possible along the continuum from health promotion to treatment, rehabilitation and palliative care,” PHC is considered an essential component of achieving universal health coverage (UHC), but requires sustained investments.

Although there are few assessments of what low- and middle-income countries (LMICs) need to implement basic elements of PHC, there is a huge financing gap for UHC, estimated to reach $371 billion or $58 per person annually by 2030. Countries are struggling to finance the health of their populations amid a myriad of challenges, including high debt servicing and other fiscal pressures compounded by shifts in demographics and disease burdens. For example, with 2024 gross domestic product (GDP) estimated to be about $2.8 billion and average health expenditure 5 percent of GDP, Africa has the lowest health spending across the globe. A projected growth in GDP over the next two and half decades is not expected to lead to growth in public health spending if current trends remain the same.