Abstract

Organisation of health services for the delivery of primary health care in the WHO African region: a future perspective

Karamagi, H. Mamo, A. Droti, B. Tsofa, B. Sy, S. Kidane, S. Cabral, N. Nabyonga, J. Tumusiime, P.
Lancet Prim Care. 2026; 2None

Permanent descriptor

https://doi.org/10.1016/j.lanprc.2026.100122

Despite decades of investment in health systems across the WHO African region, population health outcomes remain suboptimal. The region faces evolving challenges, including demographic shifts, emerging health threats, and persistent inequalities. Current health-service delivery models are misaligned with anticipated future health demands, necessitating a reimagined operational framework grounded in a revitalised primary health-care approach. In this Viewpoint, we draw on expert consensus from professionals across 19 countries using the nominal group technique and Delphi-style rounds. Experts were organised into thematic "policy laboratories" focusing on primary care, hospitals, and oversight. Expert insights were collected through structured questionnaires, thematic analysis, and iterative validation, culminating in a 5-day consensus workshop. Three key constructs emerged for future health-service organisation: (1) primary care units as integrated networks delivering first point-of-care interventions; (2) hospitals redefined to include training, research, and clinical governance roles; and (3) oversight structures with decentralised, participatory, and evidence-informed decision-making capacities. The proposed model emphasises person centredness, functional integration, and digital innovation to enhance system responsiveness and resilience. The future of health-service delivery in Africa lies not in replacing existing structures, but in repurposing and realigning them to meet population health needs. Incremental reforms, supported by digital tools, essential health packages, and rationalised service-provision modalities, can enable countries to build resilient, people-centred health-care systems. National and subnational leadership, supported by regional and global partners, is essential for driving this transformation.