Historical overview and unrealized potential of PHC; country illustrations from Brazil, India, and South Africa (Chapter 2)

"Chapter 2 of the report “Implementing the primary health care (PHC) approach: a primer” captures country illustrations from Brazil, India, and South Africa, detailing a historical account of PHC over time.

The case study from Brazil describes the prioritization of PHC to attain universal health coverage (UHC). From the 1950s to 1970s, Brazil expanded health coverage by investing in large public hospitals, strengthening private sector engagement, and through the “Health Reform Movement”. The Unified Health System created in 1990 aimed to build community participation and decentralize the management and funding behind primary care. The 1994 Family Health Strategy established multidisciplinary primary care teams, community health agents, and improved financial support for municipalities. Despite improved health outcomes and access, Brazil’s changing political and economic landscape challenges the prioritization of primary and universal healthcare.

India’s case study highlights its journey toward an integrated PHC model. Initially, India used a mix of vertical programs targeting specific health issues and horizontal investment in primary health centers. However, integration was weak, and urban-favored policies widened the urban-rural health divide. Since 2017, national policies have aimed at strengthening PHC and achieving universal healthcare, but chronic underfunding remains a barrier.

South Africa’s case study focuses on the community-oriented primary care (COPC) model. Emerging in 1940, COPC faced constraints, leading to the closure of COPC centers. Post-Apartheid, the District Health System provided comprehensive care. Interventions in 2010 and 2015 faced challenges but influenced global health policies and contributed to the Declaration of Alma-Ata in 1978.