Primary health care (PHC) is an approach to organizing health systems around the needs of people and communities. It combines accessible, integrated health services with action on the conditions that influence health and participation by individuals, families, and communities. Its scope extends from health promotion and disease prevention to treatment, rehabilitation, and palliative care. The World Health Organization (WHO) describes PHC as a whole-of-society approach intended to improve health and its equitable distribution, bringing care as close as feasible to people’s everyday environments. (who.int)
Meaning and scope
Primary health care is broader than primary care, although the terms are sometimes used interchangeably. Primary care is the service-delivery process that provides accessible first-contact care, continuity over time, comprehensive attention to health needs, and coordination with other services. PHC incorporates that clinical function but also includes essential public health functions, policies outside the health sector, and community involvement. It therefore describes an approach to the entire health system, not simply a category of clinics or a limited package of basic treatments. (who.int)
WHO identifies three interdependent components:
- Integrated health services: primary care and essential public health functions form the core of services addressing people’s needs throughout life.
- Multisectoral policy and action: institutions address the wider conditions that shape health, including circumstances outside clinical care.
- Empowered people and communities: individuals and communities participate in decisions affecting their health and the organization of services. (who.int)
The approach concerns physical, mental, and social well-being rather than isolated diseases. Its stated principles include equity, solidarity, participation, and recognition of health within the framework of human rights. (who.int)
Historical development
The Declaration of Alma-Ata established PHC as a central international health-policy concept in 1978. It emerged from the International Conference on Primary Health Care, jointly convened by WHO and the United Nations Children’s Fund (UNICEF) in Alma-Ata, then in the Soviet Union, on 6–12 September 1978. The declaration identified PHC as the means of pursuing the goal of Health for All. It emphasized scientifically sound, socially acceptable care, universal accessibility, community participation, and costs that communities and countries could sustain. (who.int)
Alma-Ata’s minimum service areas included health education, food supply and nutrition, safe water and basic sanitation, maternal and child health care including family planning, immunization, control of locally endemic diseases, treatment of common illnesses and injuries, and essential medicines. These elements situated clinical services within a wider programme of social and economic development. (iris.who.int)
On 25 October 2018, countries endorsed the Declaration of Astana at a conference in Kazakhstan co-hosted by WHO, UNICEF, and the national government. It reaffirmed the Alma-Ata principles and connected renewed PHC commitments to universal health coverage and the health-related Sustainable Development Goals. Its commitments covered decisions across sectors, sustainable services, community empowerment, and alignment of stakeholder support with national plans. (unicef.org)
Services and organization
Primary care within PHC is characterized by five core functions: first-contact accessibility, continuity, coordination, comprehensiveness, and people-centredness. Accessibility concerns timely and equitable entry into care; continuity concerns sustained relationships; coordination links services; comprehensiveness addresses a broad range of needs; and people-centredness recognizes people’s participation in their care. These functions distinguish primary care from a series of disconnected clinical encounters. (who.int)
A PHC-oriented system connects individual care with population-level activities. Its service continuum includes prevention, diagnosis, treatment, and ongoing support, including attention to mental health. The specific organization of services depends on national circumstances, but the approach seeks integration rather than separation between clinical care and essential public health functions. (who.int)
WHO and UNICEF’s 2020 operational framework identifies 14 interacting levers for implementation. Four are strategic: political commitment and leadership, governance and policy frameworks, funding and resource allocation, and engagement of communities and other stakeholders. Operational levers concern models of care, the workforce, physical infrastructure, medicines and other health products, private-sector engagement, purchasing and payment, digital technologies, quality improvement, research, and monitoring. The framework treats these as mutually reinforcing features of system development rather than independent projects. (who.int)
Health determinants and participation
Action on social determinants of health is a defining feature of PHC. Conditions associated with education, housing, employment, income, and the environment influence health but cannot be addressed through medical consultations alone. Multisectoral action brings health objectives into decisions made across public institutions and other organizations. (who.int)
Community participation includes involvement in planning and implementation, not merely attendance at services. Alma-Ata explicitly recognized participation in health-care planning, while subsequent frameworks incorporate community engagement into governance and accountability. Participation also encompasses people’s role in managing their health and expressing needs and preferences. (who.int)
Coverage and measurement
Universal health coverage concerns access to needed, sufficiently high-quality services without financial hardship. PHC is a principal approach to pursuing that objective, but the concepts are not identical: universal coverage describes a coverage and financial-protection goal, whereas PHC describes how services and broader health action are organized. (who.int)
In 2022, WHO and UNICEF published a PHC measurement framework linking system structures and inputs to service-delivery processes, outputs, outcomes, and impacts. Its indicators cover capacities and performance across all three PHC components. Countries select and adapt indicators according to their context, priorities, and health-system maturity. This framework assesses more than consultation numbers: it connects service delivery with broader progress in health, coverage, and financial protection. (who.int)