Primary health care

Primary health care is a whole-of-society approach to health that aims at ensuring the highest possible levels of health and well-being and their equitable distribution by focusing on people’s needs, as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment. Primary health care entails three interrelated and synergistic components: multisectoral policies and actions to address the upstream and wider determinants of health; increased social participation through engaging and empowering individuals, families and communities; and enhanced self-care and self-reliance in health. It requires comprehensive integrated health services that embrace primary care as well as public health goods and functions as central components.

For health care to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people and with people. This includes all populations including refugees and migrants. In the Declaration of Astana, governments and international partners committed to orient health systems towards primary health care for accelerated progress on UHC and the health-related SDGs.

Universal Health Coverage

Universal Health Coverage (UHC) means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care. WHO’s work is aligned with SDG 3.8, which focuses on achieving UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all, which includes refugees and migrants. Approximately half the world’s population lacks access to such essential health services. Therefore, to achieve UHC for all by 2030, at least one billion more people will need to have access to essential health services in each five-year period between 2015 and 2030. Refugees and migrants must be included. Investments in quality primary health care will be the cornerstone for achieving UHC around the world.

The Political Declaration of the High-level Meeting on Universal Health Coverage (Universal Health Coverage: Moving Together to Build a Healthier World) in paragraph 71 states "Address the particular needs and vulnerabilities of migrants, refugees, internally displaced persons and indigenous peoples, which may include assistance, health care and psychological and other counselling services, in accordance with relevant international commitments, as applicable, and in line with national contexts and priorities". 

Health care financing

Health care financing is a core function of health systems that can enable progress towards UHC by improving effective service coverage and financial protection. Today, millions of people do not access services due to cost. Many others receive poor quality of services even when they pay out of pocket. Carefully designed and implemented health financing policies can help to address these issues.

Safeguarding the financing of critical health system functions in fragile and conflict-affected settings is a priority given the increased risks to population health security. These include population-based interventions such as disease surveillance; ensuring safe medication, water and sanitation system; and provision of other common goods. This message is as valid for external funders as it is for national governments given the increased reliance on external humanitarian and development funding in such settings.

Health workforce

Health systems can only function with health workers: improving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health are dependent on their availability, accessibility, acceptability and quality. The health workforce has a vital role in providing health services to all people, including refugees and migrants; building the resilience of communities and health systems to respond to disasters caused by natural or artificial hazards; and in responses to environmental, technological and biological hazards and risks.

Strengthening health workers for culturally sensitive health services

Refugees and migrants may face a number of challenges to accessing health care, including language and cultural differences, institutional discrimination and restricted use of health services, which shape their interactions with the host country’s health system and health workforce. The health workforce has a vital role in providing people-centred health services and building the resilience of health systems to respond to the health needs of refugees and migrants. This requires health workers with specific competencies.

The WHO Health and Migration Programme, in close collaboration with the WHO Health Workforce Department, have developed the Refugee and Migrant Health: Global Competency Standards for Health Workers (the Standards) and the accompanying Knowledge Guide and Curriculum Guide to promote the provision of people-centred health care to all refugees and migrants. 

Migration of health workers

The World Health Assembly unanimously adopted the WHO Global Code of Practice on the International Recruitment of Health Personnel  on 21 May 2010. The Code, which is voluntary in nature, serves as an ethical framework to guide Member States in the recruitment of health workers. Destination countries are encouraged to collaborate with source countries to sustain health human resource development and training as appropriate. The Code calls on States to discourage active recruitment of health personnel from developing countries facing critical shortages of health workers. It encourages the implementation of the Code in collaboration with all stakeholders, including health workers, recruiters, employers and civil society.

Primary Health Care