What is PHC?

What is PHC?

According to the World Health Organization (WHO), PHC includes three components:¹

• Primary care and public health, which meet people’s lifetime health needs through comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care, strategically prioritizing key health care services aimed at individuals and families (primary care) and the population (public health).
• Multisectoral policy and action, which systematically address the broader determinants of health (including social, economic, and environmental factors, as well as individual characteristics and behavior) through evidence-based policies and actions across all sectors.
• Empowering individuals, families, and communities to optimize their health – as advocates for policies that promote and protect health and well-being; as codevelopers of health and social services; and as caregivers for others and themselves.

Specific PHC core services vary across health systems but span preventive, curative, promotive, and rehabilitative services.³

• Preventive services aim to maintain and improve health by keeping people from falling ill in the first place, diagnosing illnesses earlier, and preventing further morbidity.
• Curative services restore and maintain health by treating people when they do fall ill.
• Promotive services aim to create living conditions that are conducive to good health. These include educational, organizational, economic, and environmental support systems.
• Rehabilitative services are those that optimize functioning and reduce disability in individuals with health conditions, including impairments, limitations, and restrictions.
• Palliative services bring comfort and relief to patients from serious, progressive illnesses to maintain quality of life and reduce suffering and deterioration.

Health for all: A short history of PHC

The global PHC movement was launched at an international conference in Almaty (formerly Alma-Ata), Kazakhstan, in 1978, as noted in the timeline below. Representatives from 134 health ministries signed a pathbreaking document called the Alma-Ata Declaration, which proposed a comprehensive, transformational vision for the future of health care around the world and introduced the concept of primary health care. The Alma-Ata vision of PHC was grounded in a radical pair of arguments: that poor health has economic, sociopolitical, and environmental causes; and that universal accessibility, need-based coverage, and community participation are the linchpins of any equitable and effective health care system. It was an explicit rejection of more mainstream approaches that focused on eradicating or controlling individual diseases rather than on the provision of comprehensive, holistic, community-based health care services for all.²

In alignment with the Alma-Ata Declaration’s vision, PHC addresses individual and population health needs. Community engagement is critical to both these aims. Care is provided for the community by the community via community health workers, community clinics, and community oversight.

The components of PHC

PHC systems comprise the elements necessary for PHC services to be delivered, including structures and inputs like financing and infrastructure as well as processes and outputs that influence how individuals interact with the PHC systems. These elements in turn determine the outcomes and impact of the health system, including effective coverage.

Notably, decision making and operations to support service delivery occur at all levels of the PHC system. Governance structures vary significantly from country to country, but in general, the country-wide policy setting and strategy planning happen at the national or central level of the health system. Below the national level, districts support the implementation of the national policies and manage the operations. At the facility level, health workers drive service delivery and management of the target population, including engagement with the community.

Additionally, all health care systems leverage some combination of public and private provision of services. However, the balance between the two varies widely from country to country and region to region. In some instances, private providers offer an alternative if the quality of care offered by public facilities is low and private services can extend the reach of the public health system.

PHC systems comprise all the elements necessary for these PHC services to be delivered, and the strength of a PHC system is determined by how well the underlying system components work together.

Project Overview

We’ll look 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. In each PHC Exemplar country, we will outline the story of how efficiency improvements were achieved. These stories will include an understanding of country context and strategy, define the operations of the core components of the system that drove the change, and detail remaining challenges and the areas of focus for the country moving forward. These lessons can then inform progress in countries that are underperforming relative to their current level of spending on health.

As displayed in the chart below, the five countries selected for study as PHC Exemplars achieve higher levels of effective coverage – one proximate measure of PHC performance – relative to peers who spend the same amount on health, indicating that their systems might be more efficient. These countries also represent a variety of pathways with respect to efficiency improvement and overall system maturity, offering rich learnings that may be relevant to a range of countries. In addition to being efficient, the PHC Exemplar countries demonstrated strong health outcomes and equitable delivery of high-quality health services.

Given the focus on the operational drivers of efficiency, the Exemplar work will focus primarily on the primary care and public health component of PHC to understand the actionable steps a ministry of health can take to improve the performance of their PHC system within their current levels of spend.