Health services are free, easy to access geographically and have high utilisation rates. However, quality, equity, outcomes and user experience and satisfaction are not adequately measured. This may imply certain population groups may be ‘left behind’, but not picked up by current routine monitoring – making a case for stronger measurement of these aspects of care. While public health sector services remain free of user charges, a series of NHA reports show increasing out-of-pocket spending on health, chiefly driven by increasing utilisation of private health services.

The two seminal global conferences on primary care (Alma-Ata, 1978, and Astana, 2018) have emphasised the importance of primary care as the key vessel to deliver quality health services to all, to improve everyone’s health and wellbeing. In recent years, UHC (defined in Box 1) has been the flagship approach of the WHO (and the wider United Nations) for improving health and wellbeing within the Sustainable Development Agenda 2030 framework48. A strong recent high-level political commitment to UHC was achieved, through a UN general assembly resolution49.

The principle aims to expand the range of health services provided, at high quality, to the whole population, with maximum financial protection. The ideals of achieving and improving UHC through strengthening primary care, are well aligned with both the global health goals (SDG 3) and the National Vision for Health.

Primary care and the achievement of UHC are intricately linked to public health (aimed at prevention), health promotion (aimed at prevention and promotion), and health systems strengthening (provides the supports to improve the platform through which UHC services are delivered).

Seychelles has a relatively high UHC index of 7150. WHO criteria and targets are, however, generally not tailored for high-income contexts, and do not accurately reflect changes to UHC in the Seychelles context. As such, particularly in the context of an economic crisis, there is risk for erosion of past gains in UHC, which may go  undetected in the annual standard UHC index measurements, hinting at a need for more tailored criteria and thresholds. There are also a need to measure equity and quality of health
services.