Strengthening Mauritius’ Primary Health Care approach to improve the population’s health and well-being

By providing affordable access to quality health services, Primary Health Care (PHC) forms the cornerstone for advancing towards universal health coverage (UHC) and ultimately for improving people’s health and well-being across the life-course.

In a nutshell, it is about patient-centered care which is a fundamental human right. PHC was identified as the key to the attainment of the goal of Health for All in 1978 through the milestone declaration of Alma-Ata in 1998. Mauritius was one among the leading countries in the African region to embrace the spirit of PHC and Alma Ata with the establishment of Area and Community Health Centres. Through the Astana Declaration of 2018, which Mauritius adopted, PHC was revamped to ensure that everyone everywhere is able to enjoy the highest possible attainable standard of health.

Mauritius boasts a UHC service coverage index of 66, which is significantly higher than the WHO African Region (AFRO) average of 44 and only a couple of percentage points lower than the global average of 68. One of the main reasons for its strong UHC performance is the vast network of health facilities offering basic free PHC to the majority of the population within a distance of less than five kilometers. 

The Ministry of Health and Wellness (MOHW) identified Integrated Primary Health Care Services as the first priority of its Health Sector Strategic Plan 2020-2024. The MOHW thus requested that WHO assess the current status of the PHC approach in Mauritius and provide recommendations to ensure that the rapidly expanding network of health facilities can effectively maximize the level and equitable distribution of health and well-being among the Mauritian Population.

Indeed, the PHC approach aims to offer at the earliest possible stage people-centered, integrated and essential health services which are of high quality, as well as being accessible and affordable. It covers the continuum of care, from health promotion and disease prevention to treatment, rehabilitation and palliative care, and aims to shift efforts from a reactive biomedical approach to illness towards a more holistic and proactive approach focusing on people’s health needs and well-being across the life span.

Since November 2023, a team of WHO experts has been working with the MOHW to prepare the Scoping Mission which took place in May 2024 to: conduct a deep dive into Mauritius’ PHC approach; identify its strengths and weaknesses, opportunities and challenges; propose high level recommendations for improvement; and develop a roadmap for the operationalization of these recommendations. 

The Director of Health Services at the Ministry of Health and Wellness, Dr Prithviraj Ramputty, explains the rationale behind the mission: “It was time for us to take a fresh look at our journey as the demands on the PHC system in Mauritius have evolved significantly since independence in 1968.”

To achieve these objectives, the who team of experts performed a systematic review of primary and secondary data, previous assessments, current health policies, legislation and strategies. They also conducted extensive stakeholder consultations along with visits of health facilities and interviews of key informants. “The interaction with the consultants was very frank and open. They shared their views and experience from other countries. It was clear from very outset that we had to contextualize the process and the drafting of the roadmap for the coming five to 10 years,” Dr Prithviraj Ramputty explains.

The mission’s preliminary findings were presented to the Minister of Health and Wellness, Dr Kailash Jagutpal, and senior officials during a final stakeholder meeting in Port Louis on 24 May 2024.

Introduced by WHO expert Dr Benson Droti, the key recommendations include: i. refining the Package of Health Services and interventions at the various levels of service delivery; ii. revising staffing norms to match these services and interventions; iii. establishing and institutionalizing quality management systems; iv. digitalizing health care; v. enhancing the availability and utilization of data to inform decision making; vi. private sector engagement; vii. decentralizing health service management at sub-national level (including devolution to scale-up delegation of authority for greater autonomy in decision making); and viii.  strengthening the national regulatory framework for pharmaceuticals and lifting up of health promotive and preventative interventions.

In his allocution, the Minister of Health and Wellness, Dr Kailesh Jagutpal, noted that Mauritius possesses an impressive 200 health care points before remarking that the public health sector still needs to improve in terms of accessibility, making health care services more acceptable from the patients’ perspectives, quality of care, health equity, community engagement and health financing, among others. “This mission comes at the right time as we are in the process preparing the second Health Sector Strategic Plan (HSSP).

The WHO Representative, Dr Anne Ancia, also emphasized the timeliness and importance of the mission’s recommendations: “Elevating Mauritius’ PHC approach will ensure that the necessary health system reorganization matches the expanding health facility network and the services on offer, to effectively improve the health and well-being of all Mauritians.”

Distributed by APO Group on behalf of World Health Organization (WHO) – Mauritius.

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