Primary Health Care and Health  Infrastructure Development: Lessons From China

By Salim Abila Asuman

Attention; in the relentless pursuit of progress, a nation teeters on the brink of stagnation when its healthcare infrastructure falters. As the sickly grip tightens, the nation’s capacity to evolve, innovate, and propel itself forward dwindles.

An ailing healthcare system is not merely a burden, it is an indication of systemic decline, casting a dark shadow over the promise of a brighter future.

In the pursuit of progress and economic advancement, nations often overlook a fundamental pilar of development: healthcare infrastructure. However, the consequences of neglecting this vital aspect of society are dire and far-reaching, threatening the prospects of a nation’s growth and prosperity.

As the heartbeat of a nation’s well-being, healthcare infrastructure serves as the backbone upon which the health and productivity of its citizens rely. And, failure to invest in this critical foundation can unleash a torrent of devastating effects, reverberating through every facet of society.

First and foremost, inadequate healthcare infrastructure leads to a stark reality of inaccessibility to essential medical services for a significant portion of the population.

I assure you, without proper facilities, resources, and personnel, individuals are left vulnerable to the ravages of preventable diseases and untreated conditions, and as a result it becomes a heavy toll on both human lives and economic vitality.

The economic burden of poor health outcomes is profound, draining off resources and stifling growth at every turn. Skyrocketing healthcare costs, coupled with the loss of productivity due to illness, place immense strain on household finances and national budgets alike. Scares resources that could fuel progress in education, infrastructure, and innovation are diverted to address health crises, perpetuating a cycle of stagnation and underdevelopment.

The neglect of healthcare infrastructure strikes at the heart of human capital development, the cornerstone of sustainable progress. A populace plagued by poor health is one deprived of its full potential, with reduced life expectancy, compromised cognitive abilities, and diminished educational attainment stifling the aspirations of generations to come.

On the global stage, the repercussions of neglecting healthcare infrastructure echo far beyond national borders. In an interconnected world where investment and talent flow freely, nations with robust healthcare systems emerge as beacons of stability and opportunity. On the contrary, those marred by neglect face dwindling prospects for foreign investment and skilled labor.

For a nation like Uganda, the consequences of a deficient healthcare system reverberate across every aspect of society, profoundly impacting its development trajectory.

Without adequate access to medical care, preventable illnesses become barriers to productivity, leading to increased absenteeism and diminished economic output.

A robust healthcare infrastructure is indispensable for nurturing human capital and enhancing productivity, accessible healthcare services ensure that individuals remain healthy and productive, minimising absenteeism due to preventable illnesses and enabling workforce participation. Healthy individuals, in turn, contribute to higher levels of productivity, driving economic growth and prosperity.

The warning bell tolls loudly for African nations that turn a blind eye to the imperative of healthcare infrastructure. To ignore this call is to gamble with the future of the nation, as we stand at the crossroads of progress let us heed to this warning.

In the archives of healthcare evolution, China’s journey stands out as a fascinating tale of transformation and triumph. And it offers lessons for Uganda and all African countries aspiring to leap into a brighter future.

The completion of iconic projects like the Shanghai Pudong New Area People’s Hospital within a mere two years, underscores the importance of prioritising infrastructure investment. The lesson to learn here is that by channeling resources into building hospitals and clinics, aiming to enhance accessibility and quality of healthcare services within a defined timeline Uganda can emulate this success.

Embracing healthcare technology by China, including telemedicine and electronic health records (EHRs), has revolutionised healthcare delivery, particularly in remote areas. To replicate this success, Uganda must leverage technology to bridge geographical gaps in healthcare access, and set a target for nationwide coverage at least within two years.

By China collaborating with private entities, such as Alibaba Group’s healthcare initiatives the potential of public-private partnerships has been highlighted in driving healthcare innovation and expansion. Uganda can harness the resources and expertise of private sectors partners to accelerate healthcare projects, aimed to launch joint initiatives within a defined timeframe.

Strengthening primary care infrastructure is a cornerstone of China’s Health policy, by investing in community health centers and promoting primary care services, aimed at providing a comprehensive and preventive healthcare closer to where people live has reduced the burden on tertiary care facilities and improves overall health outcomes.

China acknowledges regional disparities in healthcare infrastructure, highlighting the need for Uganda to implement targeted initiatives to improve rural and remote areas for equitable healthcare access. This is evidenced by China’s support to our health sector with China funded Naguru hospital also known as China-Uganda Frienship Hospital being a key example.

China’s construction of emergency hospitals, such as the Huoshenshan Hospital in Wuhan, in a matter of days demonstrated its ability to rapidly scale up healthcare infrastructure to respond to the crisis, providing critical care to COVID-19 patients while reducing strain on existing facilities. Uganda should learn from China’s example by prioritising proactive and coordinated actions while investing in strong healthcare infrastructure.

A reminder; in the tapestry of international relations, amidst the dynamic currents of global cooperation, one remarkable alliance that emerges is China’s unwavering commitment to Africa’s infrastructure advancement.

It is a symphony of solidarity, a testament to mutual respect, and a beacon of hope for progress.

China’s support in establishment and construction of the Africa Centre for Disease Control and Prevention is a reminder of a reliable partner when it comes to Africa’s efforts in building a strong health system. Today, the centre is playing a leading role in supporting public health initiatives of member states and strengthening capacity of their health institutions to deal with disease threats. The Addis Ababa Fistula Hospital and the China-Angola Friendship Hospital in Luanda are monuments of this unwavering dedication to African’s healthcare advancement, these are tangible testaments to a commitment to fostering progress and prosperity across the continent.

Another paramount reminder is that development hinges on the strength of its human capital. A thriving populace, kept afloat by robust healthcare and wellness initiatives, is the catalyst for transformation growth. China’s remarkable progress stands as a testament to this principle.

Let us embrace this powerful reminder of unity, recognising its potential to reshape landscapes, empower communities, and foster a brighter future for generations to come.

Salim Abila Asuman is a research fellow at the Sino-Uganda Research Centre.


Creating a functioning health system for all: Lessons from China.

By Joseph Nyero

A heath system comprises all organisations, institutions and resources that produce actions whose purpose is to achieve good health. Its building blocks include; governance, human resource, health information, health finance, service delivery, medicines, vaccines and appropriate technology.

All these components work together interrelatedly with an intrinsic goal of providing good health. A breach in one of them make lead to the collapse of the whole system. Take for instance, if there is not health finance, the medicine will not be bought and the service delivery will be poor. It is therefore vital to develop the system as a whole and to do a full systems analysis if there is need to fix any problems in a health system.

Several studies have confirmed that having well-functioning health systems is a forward in eliminating unnecessary and controllable deaths.

While it is not like a picnic to build a strong and good health system, we can borrow a leaf from some of developing countries that have succeeded in this aspect.  China for example had its first health system reform in 1996. The effectiveness and efficiency of the reform was questioned after a couple of years because people still had the same problems, they had in the first place.

They still had high out of the pocket expenditure, most of them didn’t have health insurance. A large proportion of the people couldn’t afford the health that they needed. In a closer look, these are almost the same problems faced by the health system in developing countries like Uganda.

People at times have to sell off their assets just to afford medical care which pushes them right to poverty even if they had escaped the poverty line. It is important that we look not only at prescription drugs but also make sure that health care is a major focus.

Following a failure from a top research institute, the former reform of 1996 had failed. China then embarked on planning another reform in 2007 where they consulted and worked with very many of their ministries. In 2009, the central committee of the communist party of china issued a policy. Its major aim was universal health coverage by 2020 through strengthening health care delivery, health security and provision of essential medicines. This policy reform is a long-term endeavor but the returns are worth the investments. Even when it is quite challenging for the African setting, we ought to start on our own reforms. Like the Chinese say, a journey of 1000 miles starts with a single step.

In order to get the job done, the state council set up a state council health systems reform office where the activities of the reform would be coordinated. The following were the policy reforms.

Under social health security, the social health insurance package was extended, medical aid was extended to the eligible poor and those with catastrophic medical expenditure.

The payment system was also reformed. Through this, 95% of the population has been covered by health insurance schemes by the end of 2017 and catastrophic health insurance introduced in all provinces.

Such a system in Uganda would reduce the burden of out of the pocket health expenditure. Often a times I have seen families who just take their patients back home because they can’t afford any more bills.

These people die from cases that could have been well managed if they had some form of insurance. Such a policy in Uganda would thus reduce mortality.

For the essential drugs, the new policy promoted rational use of antibiotics, removing price mark ups of drug and reforming the drug procurement system. This decreased the unnecessary use of anti-biotics and also made the drugs more accessible to the public. One of the issues in Uganda is over use of antibiotics which will eventually lead to resistance.

It bothers me a lot when I see how a wonder drug like ceftriaxone is used in cases where a milder antibiotic would work just fine. Antibiotic resistance is real and a day can come when a drug that did magic can no longer do a thing. A good example is penicillin. When it was discovered in 1928, it greatly improved mortality. Right now, bugs can have it for lunch! Such a policy in Uganda would not only reduce unnecessary bills on antibiotics but also delay the incidence of resistance.

As a doctor, sometimes I have had to walk through the pharmacies in Kampala to determine their prices. This is because I know that’s the first question patients ask upon presenting to them the treatment options. And from the search, the prices are shockingly different. I then send my patients to the cheapest pharmacy for the respective drugs. If we had a policy like the one China put up where the prices are controlled, medical care would be cheaper.

People even opt for traditional medicine that ends up messing their livers and kidneys the more. This is worse if the patient presented with a liver or kidney failure and they add on herbs to the problem. The people actually don’t want the herbs, they just can’t afford the modern medicine.

On the policy for primary health care, the Chinese government increased the capacity for training and created contracting systems for general practitioners. This was able to increase the number of doctors and improve health care. One of the major challenges in the developing countries like ours is few doctors and poor recruitment by governments. Having such a policy would increase the number of training institutes and ensure more doctors while also providing new jobs to the staff in the institutes. Another reason patients avoid government hospitals in Uganda is the long waiting time. This would provide a solution to this as there would be many doctors seeing the patients.

The other policy introduced by the Chinese to strengthen its health system was basic public health package. Here the government provided subsidies and promoted programs that control the main public health concerns. This made the bills cheaper and reduced the occurrence of non-communicable diseases. As indicated earlier, high bills are still a problem for Uganda. Non-communicable diseases are also on the rise in developing countries.

The last policy was about public hospitals. Through this, they encouraged the creation of consortium or alliances of healthcare providers. They also established a tiered health system where every healthcare provider knew exactly what its functions are. They also encouraged the use of clinical guidelines. This created an organized system with a standard of care that is uniform and a regulatory body. We have a clinical guideline in Uganda but it is not yet widely used and every doctor manages patients their way.

This makes some of the patients to get substandard care. In the Ugandan system, health center IVs are supposed to carryout surgeries but there are those which don’t. such a system would make every health center offer healthcare to the best of its abilities thereby helping reduce congestion at reginal and national health facilities where many tend to run even with cases that could be managed at health centers.

Upon emulation of such policies in to our setting, Uganda shall have tremendous health benefits. More people will visit and afford hospitals, poverty levels will drop, patient waiting time will decrease etc. the end result will be a good sustainable health system for all.

The writer is a research fellow at Development Watch Centre, a Foreign Policy Think Tank, and a fourth-year medical student at Makerere University.



Development Watch Centre

Kampala - Uganda


Plot 212, RTG Plaza,3rd Floor, Office Number C7 - Hoima Road, Rubaga


+256 703 380252

© DWC - All rights reserved - Cookies Policy - Privacy Policy