Overview of Primary Health Care
Primary Health Care (PHC) is a foundational approach to health that has been discussed and refined since the Alma-Ata Declaration of 1978. Despite its long history, the term “primary health care” is often misunderstood. To address this, a clear and concise definition has been established by the World Health Organization (WHO): Primary Health Care is “a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment.”
This definition highlights that PHC is not just about basic medical services. It’s a comprehensive strategy that encompasses three interconnected components working together to create a robust health system. These components are:
- Integrated Health Services: This includes a wide range of services, from essential primary care to broader public health functions. Primary care acts as the central point of contact, but it’s complemented by public health initiatives to ensure population-wide health improvements.
- Multi-sectoral Policies and Actions: Recognizing that health is influenced by factors beyond the healthcare sector, PHC advocates for collaboration across different sectors. This involves addressing the social, economic, and environmental determinants of health through coordinated policies and actions.
- Engaged and Empowered Individuals and Communities: PHC emphasizes the active participation of individuals, families, and communities in their own health and healthcare decisions. Empowering people to take charge of their health through self-care and community involvement is crucial for sustainable health improvements.
At its core, PHC is driven by principles of social justice, equity, solidarity, and participation. It is based on the fundamental human right to health, ensuring that everyone, regardless of their background, has access to the highest attainable standard of health. This approach requires a shift from disease-centered health systems to people-centered systems, focusing on the holistic needs of individuals throughout their lives. Governments at all levels are urged to look beyond the traditional health sector and adopt a “whole-of-government” approach, embedding health considerations into all policies to promote equity and well-being across the entire life course. PHC addresses not only physical health but also the interconnected aspects of mental and social well-being, providing comprehensive care that spans from health promotion and disease prevention to treatment, rehabilitation, and palliative care, all within people’s daily environments.
Why Primary Health Care Matters
Primary Health Care is not just a concept; it is the cornerstone of a sustainable and effective health system. Member States globally have committed to renewing and implementing PHC as the foundation for achieving Universal Health Coverage (UHC), the health-related Sustainable Development Goals (SDGs), and global health security. PHC serves as the operational engine for these ambitious global health agendas. This commitment is firmly established in landmark declarations such as the Declaration of Astana, World Health Assembly Resolution 72/2, and United Nations General Assembly high-level declarations on UHC. While UHC, SDGs, and health security goals are ambitious, they are achievable, and PHC provides the most effective pathway to accelerate progress.
Investing in PHC is the most inclusive, equitable, cost-effective, and efficient way to improve the physical and mental health and social well-being of populations. Growing evidence from around the world demonstrates the wide-ranging positive impacts of PHC investments, especially during crises like the COVID-19 pandemic.
Globally, investments in PHC lead to:
- Improved Equity and Access: PHC reduces health disparities by ensuring services are accessible to everyone, regardless of their location or socioeconomic status.
- Enhanced Health-care Performance: Strong PHC systems improve the overall efficiency and effectiveness of healthcare delivery.
- Increased Accountability of Health Systems: PHC strengthens the responsiveness and accountability of health systems to the needs of the population they serve.
- Better Health Outcomes: By focusing on prevention and early intervention, PHC contributes to significant improvements in overall health outcomes and life expectancy.
It’s important to recognize that health and well-being are shaped by a multitude of factors beyond just healthcare services. Social protection, food systems, education, and environmental factors all play crucial roles. PHC’s multi-sectoral approach addresses these broader determinants of health, leading to more comprehensive and lasting improvements.
Furthermore, PHC plays a vital role in building resilient health systems capable of withstanding crises. It strengthens health systems to be more proactive in early epidemic detection and better prepared to respond to surges in service demand. As the “front door” of the health system, PHC is essential for strengthening core public health functions and effectively managing public health emergencies like the COVID-19 pandemic.
WHO’s Role in Strengthening Primary Health Care
The World Health Organization (WHO) is actively supporting countries in reorienting their health systems towards PHC as a crucial strategy for achieving UHC, SDG3 (Good Health and Well-being), and health security. WHO’s vision is for health systems to be fit for people, fit for context, and fit for purpose. Strengthening health systems through PHC involves improvements across various domains, including: health governance and financing, health workforce development, addressing gender and equity issues, ensuring human rights, strengthening health information systems, improving quality and patient safety, promoting maternal, newborn, child, and adolescent health through healthy aging, advancing sexual and reproductive health, ensuring access to essential medicines and medical supplies, enhancing emergency preparedness and response, and tackling both communicable and non-communicable diseases.
To strengthen PHC globally, WHO has identified three strategic areas of focus:
- Providing Tailored Implementation Support: WHO offers a centralized mechanism to support Member States in PHC implementation. This support is customized to each country’s unique context and priorities. It includes putting the Operational Framework for PHC into action and leveraging investment opportunities arising from the COVID-19 response to rebuild and strengthen PHC-based health systems during recovery. This core function is driven by and builds upon existing successful practices and experiences from countries and regions worldwide.
- Generating Evidence and Innovation: WHO is committed to producing PHC-oriented evidence and fostering innovation, with a particular focus on reaching underserved populations. This work leverages existing implementation evidence, best practice guidelines, successful implementation solutions, and published research to drive innovative approaches. Key outputs include monitoring and measurement guidance to assess PHC progress in countries, leading to a global report on PHC progress, and an innovative capacity-building initiative through the WHO Academy.
- Promoting PHC Renewal through Leadership and Partnerships: WHO champions PHC renewal through policy leadership, advocacy, and strategic partnerships. This involves collaboration with governments, non-governmental organizations, civil society organizations, development partners, UN agencies, donors, and other stakeholders at global, regional, and national levels. Initiatives under this area include establishing an external Strategic Advisory Group on PHC to advise WHO, creating a PHC award to recognize global excellence, and fostering new PHC partnerships and collaborative networks involving diverse stakeholders such as young health leaders, parliamentarians, and civil society.
By focusing on these strategic areas, WHO is playing a critical role in guiding and supporting the global movement towards stronger, more equitable, and more effective primary health care systems, ultimately contributing to a healthier and more secure world for all.
