Primary Health Care (PHC) is a concept that has been discussed and redefined numerous times since 1978. This has led to some confusion about what PHC truly means and how it should be implemented. To address this, a clear and simple definition has been developed to guide global, national, and local efforts in PHC. This definition aims to facilitate better coordination and implementation of PHC programs worldwide.
According to the World Health Organization (WHO) and UNICEF, Primary Health Care is defined as:
“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 emphasizes that PHC is not just about treating illnesses. It’s a comprehensive approach that involves the entire society and focuses on promoting health and well-being from the earliest stages of life. It covers the full spectrum of health services, from preventing diseases to providing treatment, rehabilitation, and palliative care. Crucially, PHC programs are designed to be accessible and integrated into people’s daily lives.
PHC programs are built upon three interconnected and mutually reinforcing components:
- Integrated Health Services: This includes comprehensive health services, with primary care as the central element, alongside essential public health functions. It means that PHC programs provide a range of services that work together to address various health needs.
- Multi-sectoral Policies and Actions: PHC recognizes that health is influenced by many factors outside of the healthcare system itself. This component emphasizes the need for policies and actions across different sectors – like education, food, and social welfare – to address the broader determinants of health.
- Engaging and Empowering Individuals and Communities: PHC programs are not delivered to people, but with people. This means actively involving individuals, families, and communities in their own health care, promoting self-care, and increasing social participation in health matters.
At its core, PHC is grounded in principles of social justice, equity, solidarity, and participation. It is based on the fundamental human right that everyone, without any discrimination, deserves the highest attainable standard of health.
To achieve truly universal health coverage (UHC), healthcare systems need to shift their focus. Instead of being structured around diseases and institutions, they need to be designed with people at the center. PHC programs are essential for this shift. They require governments at all levels to recognize that improving health goes beyond just the health sector. A “whole-of-government” approach is necessary, integrating health considerations into all policies and prioritizing equity throughout the entire life course.
PHC programs address the many factors that influence health, focusing on the interconnected aspects of physical, mental, and social well-being. They provide holistic care for all health needs throughout a person’s life, not just for specific diseases. Primary health care ensures that people receive comprehensive, quality care – from health promotion and prevention to treatment, rehabilitation, and palliative care – in locations that are convenient and accessible in their everyday environments.
Why is a Primary Health Care Program Important?
Member States globally have committed to renewing and implementing primary health care as the bedrock of sustainable health systems. This commitment is crucial for achieving Universal Health Coverage (UHC), the health-related Sustainable Development Goals (SDGs), and global health security. PHC serves as the essential “engine” that drives progress towards these ambitious goals. This commitment has been formally recognized in the Declaration of Astana, World Health Assembly Resolution 72/2, Global Monitoring Reports on UHC, and high-level declarations from the United Nations General Assembly on UHC. While achieving UHC, the SDGs, and health security is ambitious, it is achievable, and strengthening PHC programs is the key to accelerating progress.
PHC is the most inclusive, equitable, cost-effective, and efficient approach to improve people’s physical and mental health, as well as their overall social well-being. Growing evidence from around the world, especially during crises like the COVID-19 pandemic, demonstrates the wide-ranging positive impact of investing in PHC programs.
Globally, investments in PHC lead to improvements in equity and access to healthcare, enhance the performance and accountability of health systems, and ultimately improve health outcomes. While some of these benefits are directly linked to the health system and access to health services, it’s clear that a wide range of factors beyond traditional healthcare play a critical role in shaping health and well-being. These include social safety nets, food systems, education, and environmental conditions.
Primary Health Care programs are also vital for building more resilient health systems that can withstand crises. PHC strengthens the ability to proactively detect early signs of epidemics and respond effectively to surges in demand for services. While research is ongoing, there is broad agreement that PHC acts as the “front door” of the health system. It provides the foundational strength needed to enhance essential public health functions and effectively address public health emergencies like the COVID-19 pandemic.
WHO’s Role in Strengthening Primary Health Care Programs
The WHO is actively supporting countries in reorienting their health systems towards PHC. This reorientation is seen as a critical pathway to achieving UHC, SDG3 (Good Health and Well-being), and health security. The goal is to create health systems that are fit for people, fit for their specific context, and fit for their intended purpose. Strengthening health systems through PHC involves improvements across many areas, including: health governance and financing, the health workforce, integrating gender considerations, promoting equity and rights, strengthening information systems, improving quality and patient safety, and addressing health needs across the lifespan – from maternal and child health to healthy aging, sexual and reproductive health, access to essential medicines and medical supplies, emergency preparedness, and work on both communicable and non-communicable diseases.
To strengthen PHC programs worldwide, WHO has identified three key strategic areas of work:
- Providing a ‘one-stop’ mechanism for PHC implementation support: This involves offering tailored support to Member States based on 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 stronger, PHC-based health systems during recovery. This core function is informed by and builds upon existing work and experiences from countries and regions around the world.
- Producing PHC-oriented evidence and innovation: This focuses on generating evidence and fostering innovation in PHC, with a particular emphasis on reaching populations that are currently left behind. This work draws upon existing implementation evidence, best practice guidelines, successful country experiences, and published research to drive innovative solutions. Key outputs include monitoring and evaluation guidance to assess PHC progress in countries, a Global report on PHC progress, and an innovative capacity-building initiative as part of the WHO Academy.
- Promoting PHC renewal through policy leadership, advocacy, and strategic partnerships: This involves actively promoting PHC renewal through policy leadership and advocacy, and building strategic partnerships with governments, non-governmental organizations, civil society organizations, development partners, UN agencies, donors, and other stakeholders at global, regional, and country levels. This workstream includes establishing an external Strategic Advisory Group on PHC to advise WHO on PHC renewal globally, creating a PHC award to recognize excellence in PHC worldwide, and fostering new PHC partnerships and collaborative networks that include new stakeholders like young health leaders, parliamentarians, and civil society more broadly.
By focusing on these strategic areas, WHO aims to empower countries to build strong primary health care programs that are essential for achieving health for all and a healthier, more equitable world.
