Mortality due to low-quality health systems in the universal health coverage era (5) Universal health coverage (13)

17 October, 2018

Dear HIFA colleagues,

On the topic of Universal Health Coverage, which implies both expanded access to AND quality of care, it occurs to me that there’s much hand-wringing over the absence of it, and not enough dissemination of information about the examples where it is succeeding, especially in LMICs. Aside from a handful of highly publicized and well-funded programs like Last Mile Health in Liberia, we hear very little about the good work of small organizations working toward optimizing primary health care in their given contexts--like Integrate Health in Togo, Muso in Mali, PIVOT in Madagascar, and Wild4Life Health in Zimbabwe. Most of these programs work on both the facility and community sides to expand access and improve quality, through some combination of intensive clinical mentoring, remote outreach services, organization and training of community health workers, community accountability, facility renovation and supply-chain management, among other necessities of a high-functioning health system.

For example, at Wild4Life, which I recently left as Zimbabwe Program Director after eight years, we implemented a package of five facility- and community-based interventions to address a wide spectrum of primary care service gaps and quality concerns—many of the same concerns noted in The Lancet Global Health Commission’s recent report, High-quality health systems in the Sustainable Development Goals era: time for a revolution ( The Wild4Life results speak to the gains that can be achieved from highly integrated and contextualized approaches to building capacity in primary care. To cite a few diverse examples: After two years of implementation across 17 rural clinics and a population of 65,000, overall HIV testing doubled (and tripled for children), thus increasing the number of patients on treatment by 38.4%; the number of TB suspect cases grew by 93.4%; the number of pregnant women visiting ANC early (before 16 weeks gestation) grew nearly 53%; and the proportion of appropriately classified and treated pneumonia cases in children under five surged by 91%. All of these results, achieved at economical cost, were very substantial improvements over a group of nearby non-intervention comparison sites. My colleagues and I recently posted a working paper describing the Wild4Life program and results ( , which we welcome you to read and comment on. On this 40th anniversary of the Alma Ata Declaration on Primary Care, our hope is that by disseminating this information, we and other organizations like Wild4Life might provide ministries of health the evidence needed to scale up these models, and to inspire similar solutions in additional countries. Looking forward to your comments.

Warm regards,

Jonathan Levine

Former Zimbabwe Program Director

Wild4Life Health

HIFA profile: Jonathan Levine is former Zimbabwe Program Director at Wild4Life Health in the USA. Professional interests: Program strategy development, quality of healthcare service delivery in Africa, HIV/AIDS (pediatric), community health workers, program impact evaluation. jblevine100 AT