Primary Health Care (PHC) is a foundational concept in global health, yet its meaning and implementation have often been debated since its inception in 1978. To clarify and streamline global, national, and local efforts, a clear and concise definition has been established to guide the future of PHC programs:
“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,” as defined by the World Health Organization (WHO) and UNICEF in their vision for primary health care in the 21st century.
This definition highlights that a primary health care program is more than just medical treatment. It encompasses a broad, integrated approach to health, focusing on three interconnected components:
- Comprehensive and Integrated Health Services: This includes primary care services along with essential public health functions. It emphasizes a holistic approach to health that addresses a wide range of needs.
- Multi-sectoral Policies and Actions: Recognizing that health is influenced by various factors outside the healthcare sector, PHC programs advocate for collaborative policies across different sectors to address the broader determinants of health.
- Engaging and Empowering Individuals and Communities: PHC emphasizes the active participation of individuals, families, and communities in health promotion and self-care, fostering greater social involvement and health autonomy.
At its heart, a primary health care program is driven by a commitment to social justice, equity, solidarity, and participation. It is built upon the fundamental principle that health is a basic human right, accessible to everyone without discrimination. This principle is crucial for achieving Universal Health Coverage (UHC), requiring a shift from disease-centered health systems to people-centered systems. Governments at all levels are urged to recognize the importance of cross-sector collaboration, adopting a whole-of-government approach that prioritizes equity and encompasses health interventions throughout the entire life course.
Why Primary Health Care Programs are Essential for Global Health
Primary health care programs are not just beneficial; they are fundamental for building sustainable and effective health systems globally. Member States have committed to PHC renewal as the cornerstone for achieving UHC, the health-related Sustainable Development Goals (SDGs), and global health security. PHC acts as the ‘programmatic engine’ driving progress towards these ambitious yet attainable goals. This commitment is solidified in key international declarations such as the Declaration of Astana, World Health Assembly Resolution 72/2, and UN General Assembly high-level declarations on UHC. Accelerated progress is urgently needed, and PHC provides the necessary framework to achieve it.
The significance of primary health care programs lies in their ability to be the most inclusive, equitable, cost-effective, and efficient approach to improving physical health, mental well-being, and overall social welfare. Growing global evidence consistently demonstrates the wide-ranging positive impact of investing in PHC, especially during crises like the COVID-19 pandemic.
Investing in PHC programs yields significant improvements across various aspects of health systems worldwide:
- Enhanced Equity and Access: PHC programs are designed to reduce health disparities and ensure healthcare access for all populations, regardless of socioeconomic status or location.
- Improved Healthcare Performance: By focusing on prevention and early intervention, PHC improves the overall efficiency and effectiveness of healthcare delivery.
- Increased Accountability of Health Systems: PHC strengthens health system accountability by bringing services closer to communities and empowering individuals to participate in their own care.
- Better Health Outcomes: Evidence clearly indicates that robust PHC systems lead to improved health outcomes across populations, encompassing both physical and mental health.
It’s crucial to recognize that health is shaped by a multitude of factors beyond healthcare services alone. Social protection, food security, education, and environmental conditions play equally vital roles. Primary health care programs acknowledge these broader determinants of health, advocating for a comprehensive approach that integrates various sectors to promote holistic well-being.
Moreover, primary health care is critical for building resilient health systems capable of withstanding crises. PHC serves as the “front door” to healthcare, enabling early detection of epidemics, proactive responses to health emergencies, and effective management of surges in demand for services. The COVID-19 pandemic underscored the vital role of PHC in providing a foundation for essential public health functions and strengthening overall health system resilience.
WHO’s Strategic Response to Strengthen Primary Health Care Programs Globally
The World Health Organization (WHO) plays a leading role in assisting countries to reorient their health systems towards PHC as a core strategy for achieving UHC, SDG3 (Good Health and Well-being), and health security. WHO advocates for health systems that are people-centered, context-appropriate, and purpose-built to meet the evolving health challenges of the 21st century. Strengthening health systems through PHC involves a multifaceted approach, encompassing:
- Health Governance and Financing: Establishing effective leadership and sustainable financing mechanisms for PHC programs.
- Health Workforce Development: Ensuring an adequate, well-trained, and equitably distributed health workforce to deliver PHC services.
- Addressing Gender, Equity, and Rights: Integrating gender perspectives, promoting equity, and upholding human rights within PHC programs.
- Strengthening Health Information Systems: Developing robust data systems to monitor progress, inform decision-making, and improve PHC program effectiveness.
- Enhancing Quality and Patient Safety: Prioritizing quality of care and patient safety within all PHC services.
- Focusing on Key Population Health Needs: Addressing the specific health needs across the life course, from maternal and child health to adolescent health and healthy aging, as well as sexual and reproductive health.
- Ensuring Access to Essential Medicines and Medical Supplies: Guaranteeing the availability of essential medicines and supplies at the primary care level.
- Strengthening Emergency Preparedness, Response, and Recovery: Integrating PHC into national emergency plans to enhance health system resilience.
- Addressing Communicable and Non-communicable Diseases: Utilizing PHC platforms for the prevention, detection, and management of both infectious and chronic diseases.
To effectively strengthen primary health care programs worldwide, WHO has identified three key strategic areas of focus:
- Providing a ‘One-Stop’ Implementation Support Mechanism: WHO offers tailored support to Member States, adapting to specific country contexts and priorities to facilitate PHC implementation. This includes operationalizing the Framework for PHC and leveraging investment opportunities arising from the COVID-19 response to build back stronger PHC-based systems. This effort is grounded in existing successful practices and experiences from countries and regions globally.
- Generating PHC-Oriented Evidence and Innovation: WHO is committed to producing evidence-based guidance and fostering innovation in PHC, with a particular focus on reaching underserved populations. This involves leveraging implementation evidence, best practice guidelines, successful country experiences, and research literature to drive innovative solutions. Key initiatives include developing monitoring and evaluation frameworks to assess PHC progress in countries, leading to a Global report on PHC progress, and establishing an innovative capacity-building program through the WHO Academy.
- Promoting PHC Renewal through Policy Leadership, Advocacy, and Strategic Partnerships: WHO actively promotes PHC renewal through policy advocacy, strategic partnerships with governments, NGOs, civil society organizations, development partners, UN agencies, donors, and other stakeholders at all levels. This includes establishing a Strategic Advisory Group on PHC to advise WHO on global PHC renewal, creating a PHC award to recognize excellence in the field, and fostering new PHC partnerships and networks involving diverse stakeholders such as young health leaders, parliamentarians, and civil society.
In conclusion, primary health care programs are not merely a component of health systems; they are the very foundation upon which equitable, accessible, and resilient healthcare is built. By understanding the core principles and embracing a whole-of-society approach, we can collectively work towards achieving health and well-being for all.
