Topic Area

Primary Health Care

Primary Health Care (PHC) is essential health care that’s accessible to individuals and families in the community, in ways that are acceptable to them, through their full participation, and at a cost that the community and the country can afford.1

Quick facts on phc

PHC is the foundation of a comprehensive health care system and aims to improve health equity and the overall well-being of people and communities across all stages of life

90% 

PHC can meet up to 90 percent of a person’s health care needs over their lifetime.2, 3, 4  

50%

About 50 percent of the world’s population still lacks access to PHC services.5

60 million

Estimates suggest that scaling up access to PHC interventions across low- and middle-income countries could avert as many as 60 million deaths by 2030.5

PHC is a comprehensive, multisectoral approach to care that is grounded in the belief that good health for all is not simply a matter of treating individual patients when they are sick. It is the most inclusive, equitable, cost-effective, and efficient approach to enhancing physical, mental, and social health and well-being worldwide.

According to the 2018 Declaration of Astana, PHC “is the most inclusive, effective and efficient approach to enhance people’s physical and mental health, as well as social well-being… It is a cornerstone of a sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals”. The PHC system serves as the foundation of the health system by promoting health, preventing disease, and managing care. It focuses on making services accessible by delivering them as close to people’s homes and communities as possible.

PHC is a comprehensive, multisectoral approach to care that is grounded in the belief that good health for all is not simply a matter of treating individual patients when they are sick. Though there is variation across countries in the exact set of services delivered through PHC systems, they generally span preventive, curative, promotive, rehabilitative, and palliative care services.

High-quality PHC is people-centered, accessible, coordinated, continuous, and comprehensive.6 With effective delivery of PHC services and prompt triage and referral to higher-level facilities, a strong PHC system can improve outcomes and health system efficiency.7

This Exemplars study looks at effectiveness and efficiency of PHC systems – specifically, how some countries can achieve stronger levels of PHC performance relative to their level of total spending on health.

It’s estimated that more than half of excess deaths in low- and middle-income countries (LMICs) – about 8 million every year- could be prevented with access to high-quality health care. 

A strong, effective PHC system is a critical foundation for assessing and meeting people’s health needs across the spectrum of services, age ranges, and populations.8, 9 Regular and preventive health care delivered through the PHC system can catch illnesses early, which saves money in the long run. Countries with high-quality PHC services see reduced hospital admissions and lower rates of emergency-department use. In countries with strong primary health care (PHC) systems, fewer children die before their fifth birthday and more people live longer, healthier lives.10, 11, 12

A PHC can also serve the role of master conductor of the health system: tracking, identifying and managing care of patients; developing and monitoring personalized care plans; and managing patient communications no matter where a given patient is located.

Because high-quality, accessible PHC gives health systems the capacity to serve a large and diverse set of health needs all at once, it can serve as the service delivery platform for approaches that are often disease-specific (“vertical”) such as tuberculosis or HIV treatment programs. The PHC system can also ensure that the system is reaching those populations most vulnerable or hard to reach.

Many countries, particularly LMICs, struggle to scale up effective PHC systems. Consequently, millions of people around the world still lack access to high-quality PHC services. 

PHC plays a key role in ensuring access to essential health services for all – but around the world, people still lack access to high-quality PHC services. The COVID-19 pandemic has further exposed weaknesses in PHC systems and has highlighted the significant inequities that persist.

Why? The challenges facing decision makers in PHC today are complex and, in many cases, specific to the current context. However, there are a few broad themes:

  • Primary health care is not adequately funded, and existing funds are not always spent wisely.
  • Health system governance is fragmented and complex, leading to fragmented care for patients.
  • PHC systems sometimes underachieve on clinical and experiential quality.
  • When patients anticipate receiving low-quality care, they often avoid the system altogether.
  • Challenges remain in ensuring equity of high-quality services.
  • PHC systems must be resilient and flexible to meet evolving population needs.

OUR PARTNERS

The consortium of research partners is co-led by the London School of Hygiene & Tropical Medicine and the KEMRI-Wellcome Trust Research Programme. It includes researchers from iccdr,b in Bangladesh, the University of Ghana, Universidad de Peruana Cayetano Heredia in Peru, the University of Rwanda, and the University of Zambia.

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  1. 1
    World Health Organization. WHO called to return to the Declaration of Alma-Ata: International conference on primary health care. World Health Organization website. Accessed November 27, 2021. https://www.who.int/teams/social-determinants-of-health/declaration-of-alma-ata
  2. 2
    World Health Organization (WHO). Assessing, measuring, improving PHC. WHO website. Accessed November 27, 2021. https://www.who.int/activities/assessing-measuring-improving-phc
  3. 3
    Primary Health Care Performance Initiative (PHCPI). Strong Primary Health Care Saves Lives In Times of Crisis and Calm. PHCPI website. Accessed November 27, 2021. https://improvingphc.org/
  4. 4
    Tracking Universal Health Care Coverage: 2017 Global Monitoring Report. World Health Organization, International Bank for Reconstruction, The World Bank Group; 2017. License: CC BY-NC-SA 3.0 IGO. Accessed November 27, 2021. http://documents.worldbank.org/curated/en/640121513095868125/pdf/122029-WP-REVISED-PUBLIC.pdf
  5. 5
    World Health Organization (WHO). Primary health care fact sheet. WHO website. Published April 1, 2021. Accessed November 27, 2021. https://www.who.int/news-room/fact-sheets/detail/primary-health-care
  6. 6
    Starfield B. Primary Care: Concept, Evaluation, and Policy. London: Oxford University Press; 1992. https://catalogue.nla.gov.au/Record/331833
  7. 7
    World Health Organization (WHO). Building the Economic Case for Primary Health Care: A Scoping Review. WHO; 2018. Technical Series on Primary Health Care. License: Creative Commons Attribution CC BY-NC-SA 3.0. IGO. https://www.who.int/publications/i/item/WHO-HIS-SDS-2018.48
  8. 8
    World Health Organization (WHO). Primary Health Care on the Road to Universal Health Coverage: 2019 Monitoring Report. Conference ed. Geneva: WHO; 2015. Accessed November 27, 2021.  https://www.who.int/healthinfo/universal_health_coverage/report/uhc_report_2019.pdf
  9. 9
    Rao M, Pilot E. The missing link – the role of primary care in global health. Glob Health Action. 2014;7:23693. Published February 13, 2014. Accessed November 27, 2021. https://doi.org/10.3402/gha.v7.23693
  10. 10
    Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Serv Res. 2003;38(3):831-865. Accessed November 27, 2021. https://doi.org/10.1111/1475-6773.00149
  11. 11
    Perry HB, Rassekh BM, Gupta S, Freeman PA. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long-term mortality impact. J Glob Health. 2017;7(1):010907. Accessed November 27, 2021. https://doi.org/10.7189/jogh.07.010907
  12. 12
    World Health Organization (WHO). Building the Economic Case for Primary Health Care: A Scoping Review. WHO; 2018. On Primary Health Care technical series. License: Creative Commons Attribution CC BY-NC-SA 3.0. IGO. https://www.who.int/docs/default-source/primary-health-care-conference/phc---economic-case.pdf?sfvrsn=8d0105b8_2