Chapter 7: Health Systems: principled integrated care
The core principles of primary health care
Primary health care became a core policy for WHO in 1978, with the adoption of the Declaration of Alma-Ata and the strategy of "Health for all by the year 2000". Twenty-five years later, international support for the values of primary health care remains strong. Preliminary results of a major review suggest that many in the global health community consider a primary health care orientation to be crucial for equitable progress in health (2).
No uniform, universally applicable definition of primary health care exists. Ambiguities were present in the Alma-Ata document, in which the concept was discussed as both a level of care and an overall approach to health policy and service provision. In high-income and middle-income countries, primary health care is mainly understood to be the first level of care. In low-income countries where significant challenges in access to health care persist, it is seen more as a system-wide strategy.
It is useful to understand primary health care as involving both core principles and a variable set of basic activities. For the purposes of this discussion, it is the principles that are most significant (3), including:
- universal access to care and coverage on the basis of need;
- commitment to health equity as part of development oriented to social justice;
- community participation in defining and implementing health agendas;
- intersectoral approaches to health.