Primary Health Care (PHC) is a foundational approach to health, recognized globally as essential for achieving universal health coverage and improving population health outcomes. Misunderstandings around the definition and implementation of PHC have persisted since its initial articulation in 1978. However, a clear and actionable definition, championed by the World Health Organization (WHO) and UNICEF, now guides global and national efforts.
According to WHO and UNICEF, “PHC 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 underscores the comprehensive nature of primary health care programs, extending beyond mere treatment to encompass a holistic view of health and well-being.
What are the Key Components of Primary Health Care?
Primary health care programs are built upon three interconnected and synergistic components, forming a robust framework for health systems designed around people’s needs.
Comprehensive Integrated Health Services
At the heart of PHC lies the provision of comprehensive and integrated health services. This extends beyond basic primary care to include essential public health functions. It means ensuring that individuals have access to a continuum of care, from health promotion and disease prevention initiatives to treatment, rehabilitation, and palliative care services. The emphasis is on integration, ensuring that these services work together seamlessly to address the diverse health needs of individuals and communities.
Multi-sectoral Policies and Actions
Recognizing that health is influenced by a wide range of factors beyond the health sector itself, PHC emphasizes multi-sectoral policies and actions. This component calls for addressing the upstream and wider determinants of health, such as social, economic, environmental, and behavioral factors. Effective primary health care programs require collaboration across various sectors, including education, social welfare, agriculture, and environment, to create healthier environments and address the root causes of ill-health.
Engaging and Empowering Communities
Primary health care is fundamentally about people. Therefore, engaging and empowering individuals, families, and communities is a crucial component. This involves fostering increased social participation in health-related decision-making and enhancing self-care and self-reliance in health. Community engagement ensures that health services are responsive to local needs and preferences, promoting ownership and sustainability of health initiatives.
Why is Primary Health Care So Important?
The importance of primary health care programs is multifaceted, extending from individual well-being to global health security. Member States globally have committed to PHC renewal and implementation, recognizing it as the cornerstone of sustainable health systems vital for achieving Universal Health Coverage (UHC), health-related Sustainable Development Goals (SDGs), and global health security.
Cornerstone for UHC, SDGs, and Health Security
PHC acts as the ‘programmatic engine’ driving progress towards UHC, the health-related SDGs, and health security. This commitment is solidified in landmark declarations like the Declaration of Astana and reinforced by resolutions and global monitoring reports. While UHC and SDG goals are ambitious, PHC provides the practical and effective means to accelerate progress and make these goals achievable.
Inclusive, Equitable, Cost-Effective
Primary health care is the most inclusive, equitable, cost-effective, and efficient approach to improving people’s physical and mental health, as well as social well-being. Its focus on prevention and early intervention reduces the need for costly specialist care, making health systems more sustainable. Moreover, by prioritizing equity, PHC aims to reduce health disparities and ensure that everyone, regardless of their background or location, has access to essential health services.
Improves Equity, Access, and Health Outcomes
Investments in PHC demonstrably improve equity and access to healthcare, enhance health care performance, strengthen the accountability of health systems, and ultimately improve health outcomes. Evidence from around the world consistently shows that strong PHC systems lead to better population health. Furthermore, PHC acknowledges the significant impact of factors beyond healthcare services on health and well-being, including social protection, food systems, education, and environmental factors, necessitating a broader approach to health improvement.
Enhances Health System Resilience
PHC is crucial for building health systems that are resilient to crises. It makes health systems more proactive in detecting early signs of epidemics and better prepared to respond effectively to surges in demand during health emergencies. Recognized as the “front door” of the health system, PHC provides the essential foundation for strengthening core public health functions needed to confront public health crises, as highlighted during the COVID-19 pandemic.
WHO’s Role in Strengthening Primary Health Care
The WHO plays a leading role in assisting countries to reorient their health systems towards PHC. This is seen as a critical strategy for achieving UHC, SDG3 (Good Health and Well-being), and global health security. WHO advocates for health systems that are fit for people, fit for context, and fit for purpose. This involves strengthening various aspects of health systems, including governance, financing, workforce, equity, information systems, quality, and emergency preparedness, among others.
To strengthen PHC globally, WHO has identified three strategic areas of work:
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Providing a ‘one-stop’ mechanism for PHC implementation support: WHO offers tailored support to Member States, considering their specific country context and priorities. This includes putting the Operational Framework for PHC into action and leveraging investment opportunities arising from the COVID-19 response to build back better PHC-based health systems during recovery.
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Producing PHC-oriented evidence and innovation: WHO focuses on generating evidence and fostering innovation related to PHC, particularly with a focus on reaching underserved populations. This involves building on existing evidence, best practices, and expertise from successful countries. Key initiatives include developing monitoring and measurement guidance to assess PHC progress and producing a Global report on PHC progress, as well as innovative capacity building through the WHO Academy.
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Promoting PHC renewal through policy leadership, advocacy, and strategic partnerships: WHO engages in policy leadership and advocacy to promote PHC renewal, forging strategic partnerships with governments, NGOs, civil society organizations, development partners, UN agencies, and donors. This includes establishing a Strategic Advisory Group on PHC to advise WHO, creating a PHC award to recognize excellence, and fostering new partnerships with diverse stakeholders, including young health leaders and parliamentarians.
In conclusion, primary health care programs represent a fundamental shift towards people-centered health systems. By embracing a whole-of-society approach and focusing on comprehensive, integrated, and equitable care, PHC offers the most effective pathway to achieving health and well-being for all, contributing significantly to global health security and sustainable development.
