A health system based on Primary Health Care orients its structures and functions toward the values of equity and social solidarity and the right of every human being to enjoy the highest attainable standard of health without distinction of race, religion, political belief, or economic or social condition. The principles required to sustain such a system are its capacity to respond equitably and efficiently to the health needs of citizens, including the ability to monitor progress for continuous improvement and renewal; the responsibility and accountability of governments; sustainability; participation; an orientation toward the highest standards of quality and safety; and intersectoral action.
- Primary health care can cover the majority of a person’s health needs throughout their life including prevention, treatment, rehabilitation, and palliative care.
- At least half of the world’s people still lack full coverage of essential health services.
- A fit-for-purpose workforce is essential to deliver primary health care, yet the world has an estimated shortfall of 18 million health workers.
- Of the 30 countries for which data are available, only 8 spend at least US$ 40 per person on primary health care per year.
Primary health care is a whole-of-society approach to health and well-being centered on the needs and preferences of individuals, families and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.
It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases. Primary health care ensures people receive comprehensive care - ranging from promotion and prevention to treatment, rehabilitation and palliative care - as close as feasible to people’s everyday environment.
Primary health care is rooted in a commitment to social justice and equity and in the recognition of the fundamental right to the highest attainable standard of health, as echoed in Article 25 of the Universal Declaration on Human Rights: “Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care and necessary social services […]”.
The concept of primary health care has been repeatedly reinterpreted and redefined. In some contexts, it has referred to the provision of ambulatory or first-level of personal health care services. In other contexts, primary health care has been understood as a set of priority health interventions for low-income populations (also called selective primary health care). Others have understood primary health care as an essential component of human development, focusing on the economic, social and political aspects.
WHO has developed a cohesive definition based on three components:
- meeting people’s health needs through comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care throughout the life course, strategically prioritizing key health care services aimed at individuals and families through primary care and the population through public health functions as the central elements of integrated health services;
- systematically addressing the broader determinants of health (including social, economic, environmental, as well as people’s characteristics and behaviours) through evidence-informed public policies and actions across all sectors; and
- empowering individuals, families, and communities to optimize their health, as advocates for policies that promote and protect health and well-being, as co-developers of health and social services, and as self-carers and care-givers to others.
Renewing primary health care and placing it at the centre of efforts to improve health and wellbeing are critical for three reasons:
- Primary health care is well-positioned to respond to rapid economic, technological, and demographic changes, all of which impact health and well-being. A recent analysis found that approximately half of the gains in reducing child mortality from 1990 to 2010 were due to factors outside the health sector (such as, water and sanitation, education, economic growth). A primary health care approach draws in a wide range of stakeholders to examine and change policies to address the social, economic, environmental and commercial determinants of health and well-being. Treating people and communities as key actors in the production of their own health and well-being is critical for understanding and responding to the complexities of our changing world.
- Primary health care has been proven to be a highly effective and efficient way to address the main causes and risks of poor health and well-being today, as well as handling the emerging challenges that threaten health and well-being tomorrow. It has also been shown to be a good value investment, as there is evidence that quality primary health care reduces total healthcare costs and improves efficiency by reducing hospital admissions. Addressing increasingly complex health needs calls for a multisectoral approach that integrates health-promoting and preventive policies, solutions that are responsive to communities, and health services that are people-centred. Primary health care also includes the key elements needed to improve health security and prevent health threats such as epidemics and antimicrobial resistance, through such measures as community engagement and education, rational prescribing, and a core set of essential public health functions, including surveillance. Strengthening systems at the community and peripheral health facility level contributes to building resilience, which is critical for withstanding shocks to the health system.
- Stronger primary health care is essential to achieving the health-related Sustainable Development Goals (SDGs) and universal health coverage. It will contribute to the attainment of other goals beyond the health goal (SDG3), including those on poverty, hunger, education, gender equality, clean water and sanitation, work and economic growth, reducing inequality and climate action.
WHO recognizes the central role of primary health care for achieving health and well-being for all, at all ages. WHO works with countries to:
- Identify priority areas for improving health and context-specific approaches which draw on the technical expertise across the WHO.
- Support countries to develop inclusive policies, in country leadership and health systems based on primary health care which promote health equity and works towards achieving the Sustainable Development Goals and universal health coverage.
- Address the wider inequity and social determinants of health through multi-sectoral action.