What is ‘primary care’ (PC) and ‘primary health care’ (PHC)?

Primary Health Care (PHC) and Primary Care  (PC) are two separate terms that has defined meaning accepted worldwide. However, these two terms have been used interchangeably for a long period of time by administrators and clinicians. This page clarifies meaning and traces the history of the two phrases giving links to references.

Increasing quality of care especially at a first contact care has focused on getting ‘Public Health’ and ‘Primary Care’ woking together for the betterment of the people of the world. This page will also point to such global initiatives promoted especially by the WHO.  

1919 – Dawson report 

In 1919 Sir Bertrand Dawson was commissioned by the new Ministry of Health to chair a council to advise on the systematised provision of health services. The report in 1920 proposed the linkage of hospitals into a single system.

The report suggested that the organisation of medicine had become insufficient and was failing to bring the advance of medical knowledge adequately within the reach of the people: ‘The insufficiency of organisation has become more apparent with the growth of knowledge, and with the increasing conviction that the best means of maintaining health and curing disease should be made available to all citizens.’   [Ref-1]  [Ref-Original Report]


The report outlined the following service model:’

  • Doctors surgery
  • Primary health centers
  • Secondary health centers
  • Teaching hospitals

1978 – WHO Alma Ata declaration

International Conference at Alma-Ata (USSR) in September 1978

The International Conference on Primary Health Care (PHC) in Alma-Ata, Kazakhstan, in 1978, brought together 134 countries and 67 international organizations. The conference defined and granted international recognition to the concept of Primary Health Care as a strategy to reach the goal of Health for All in 2000.

DECLARATION OF ALMA-ATA

International Conference on Primary Health Care,
Alma-Ata, USSR, 6-12 September 1978

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration:

I
The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

II
The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

III
Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.

IV
The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

V
Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.

VI
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

VII
Primary health care:

  1. reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;
  2. addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;
  3. includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;
  4. involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors;
  5. requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;
  6. should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need;
  7. relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

VIII
All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country’s resources and to use available external resources rationally.

IX
All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.

X
An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world’s resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.

The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, non-governmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration.


Read the new Astana declaration (2018 October)

On 25-26 October 2018, the world came together in Astana, Kazakhstan, at the Global Conference on Primary Health Care to renew a commitment to primary health care to achieve universal health coverage and the Sustainable Development Goals. The Conference was held at the Palace of Independence and was cohosted by the Government of Kazakhstan, WHO and UNICEF.


2008 – The World Health Report – Primary Health Care (Now More Than Ever)

 

Why a renewal of primary health care (PHC), and why now, more than ever? Globalization is putting the social cohesion of many countries under stress, and health systems are clearly not performing as well as they could and should. People are increasingly impatient with the inability of health services to deliver. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.”  This report was an attempt to reignite PHC, however, the PHC this report talks about and the PHC that was initially introduced in the 1978 Alma Ata report is not the same. With the passage of time may be the definitions also should change?


The ultimate goal of primary health care (PHC) is better heath for all. WHO has identified five key elements to achieving that goal:

  • reducing exclusion and social disparities in health (universal coverage reforms)
  • organizing health services around people’s needs and expectations (service delivery reforms)
  • integrating health into all sectors (public policy reforms)
  • pursuing collaborative models of policy dialogue (leadership reforms);
  • increasing stakeholder participation

 


2018 WHO. Primary health care: closing the gap between public health and primary care through integration

Primary health care has three main elements: 1) primary care and essential public health functions as the core of integrated services, 2) multisectoral policy and action, 3) empowered people and communities. This paper focuses on the first element and describes ways in which primary care and public health can be effectively integrated to achieve population health benefits.

Worldwide primary care has been shown to be associated with enhanced access to health services, better health outcomes, and a decrease in hospitalization and emergency department visits (18). Primary care can also help counteract the negative effect of poor economic conditions on health (19). Traditional primary care focuses on personal health care services and continuity of care. The curative, “disease model” of the 1970s, which is still common today in many countries, is changing rapidly. Ageing, population growth, a rising burden of chronic, noncommunicable diseases and multimorbidity, and technological advances are driving the transformation of primary care.

FULL Paper

WHO-HIS-SDS-2018.49-eng

 
 

Primary Health Care is essential health care universally accessible to individuals and families in the community by means acceptable to them, at a cost that the community and country can afford, integral part both of the country’s health care system, of which it is the nucleus, and of the overall social and economic development of the community. It is the first contact of individuals, family and the community with the national health care system, bringing health care as close as possible to where people live and work and constitutes the first element of a continuing health care process. PHC addresses the main health problems of the community, providing promotive, preventive, curative, supportive and rehabilitative services accordingly.


 

 


 

 

2018 WHO – Primary health care: closing the gap between public health and primary care through integration

Primary health care has three main elements: 1) primary care and essential public health functions as the core of integrated services, 2) multisectoral policy and action, 3) empowered people and communities. This paper focuses on the first element and describes ways in which primary care and public health can be effectively integrated to achieve population health benefits.

Worldwide primary care has been shown to be associated with enhanced access to health services, better health outcomes, and a decrease in hospitalization and emergency department visits (18). Primary care can also help counteract the negative effect of poor economic conditions on health (19). Traditional primary care focuses on personal health care services and continuity of care. The curative, “disease model” of the 1970s, which is still common today in many countries, is changing rapidly. Ageing, population growth, a rising burden of chronic, noncommunicable diseases and multimorbidity, and technological advances are driving the transformation of primary care.

FULL Paper

WHO-HIS-SDS-2018.49-eng

Reference papers and website that give different view points of  the 


The terms primary health care, primary care, general practice and family medicine are often used interchangeably. Here are short descriptions of how each is defined by WHO.

Primary health care (PHC) refers to the concept elaborated in the 1978 Declaration of Alma-Ata, which is based on the principles of equity, participation, intersectoral action, appropriate technology and a central role played by the health system.

Primary care (PC) is more than just the level of care or gate keeping; it is a key process in the health system. It is first-contact, accessible, continued, comprehensive and coordinated care. First-contact care is accessible at the time of need; ongoing care focuses on the long-term health of a person rather than the short duration of the disease; comprehensive care is a range of services appropriate to the common problems in the respective population and coordination is the role by which primary care acts to coordinate other specialists that the patient may need. PC is a subset of PHC.

General practice is a term now often used loosely to cover the general practitioner and other personnel, and is therefore synonymous with primary care and family medicine. Originally, it was meant to describe the concept and model around the most significant single player in primary care: the general practitioner or primary care physician, while family medicine originally encompassed the notion of a team approach. Whenever the concept of solo practitioner (general practice) versus team-based approach (family medicine) is relevant, the distinction is still made (and important). The specificity of the general practitioner is that he/she is: “the only clinician who operates at the nine levels of care: prevention, pre-symptomatic detection of disease, early diagnosis, diagnosis of established disease, management of disease, management of disease complications, rehabilitation, palliative care and counselling”. [Atun R. What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services? WHO/Europe, 2004]

Family medicine (FM) or primary care teams can vary between countries and in size: the core team usually is the general practitioner and a nurse, but can comprise a multidisciplinary team of up to 30 professionals including community nurses, midwives, feldspars, dentists, physiotherapists, social workers, psychiatrists, speech therapists, dietitian, pharmacists, administrative staff and managers. In 2003, WHO defined a primary care team as a group of “fellow professionals with complementary contributions to make in patient care. This would be part of a broader social trend away from deference and hierarchy and towards mutual respect and shared responsibility and cooperation”. By definition primary care/family medicine teams are patient centred, so their composition and organisational model can change over time.

 


Primary Care

America’s Health in a New Era

Institute of Medicine (US) Committee on the Future of Primary Care; Editors: Molla S. Donaldson, Karl D. Yordy, Kathleen N. Lohr, and Neal A. Vanselow.

Washington (DC): National Academies Press (US); 1996.

ISBN-10: 0-309-05399-4

PubMed Link – complete book

DEFINITION OF PRIMARY CARE
Primary care in the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.

Integrated is intended in this report to encompass the provision of comprehensive, coordinated, and continuous services that provide a seamless process of care. Integration combines events and information about events occurring in disparate settings, levels of care and over time, preferable throughout the life span. Comprehensive. Comprehensive care addresses any health problem at any given stage of a patient’s life cycle. Coordinated. Coordinated ensures the provision of a combination of health services and information that meets a patient’s needs. It also refers to the connection between, or the rational ordering of, those services, including the resources of the community. Continuous. Continuity is a characteristic that refers to care over time by a single individual or team of health care professionals (“clinician continuity”) and to effective and timely communication of health information (events, risks, advice, and patient preferences) (“record continuity”).
Accessible refers to the ease with which a patient can initiate an interaction for any health problem with a clinician (e.g., by phone or at a treatment location) and includes efforts to eliminate barriers such as those posed by geography, administrative hurdles, financing, culture, and language.
Health care services refers to an array of services that are performed by health care professionals or under their direction, for the purpose of promoting, maintaining, or restoring health (Last, 1988). The term refers to all settings of care (such as hospitals, nursing homes, clinicians’ offices, intermediate care facilities, schools, and homes).
Clinician means an individual who uses a recognized scientific knowledge base and has the authority to direct the delivery of personal health services to patients.
Accountable applies to primary care clinicians and the systems in which they operate. These clinicians and systems are responsible to their patients and communities for addressing a large majority of personal health needs through a sustained partnership with a patient in the context of a family and community and for (1) quality of care, (2) patient satisfaction, (3) efficient use of resources, and (4) ethical behavior.
Majority of personal health care needs refers to the essential characteristic of primary care clinicians: that they receive all problems that patients bring— unrestricted by problem or organ system—and have the appropriate training to diagnose and manage a large majority of those problems and to involve other health care practitioners for further evaluation or treatment when appropriate. Personal health care needs include physical, mental, emotional, and social concerns that involve the functioning of an individual.
Sustained partnership refers to the relationship established between the patient and clinician with the mutual expectation of continuation over time. It is predicated on the development of mutual trust, respect, and responsibility.Patient means an individual who interacts with a clinician either because of illness or for health promotion and disease prevention.
Context of family and community refers to an understanding of the patient’s living conditions, family dynamics, and cultural background. Communities refers to the population served, whether they are patients or not. Community can refer to a geopolitical boundary (a city, county, or state), or to neighbours who share values, experiences, language, religion, culture, or ethnic heritage.

 

 

Primary care (PC) and primary health care (PHC). W

Awofeso – What is the difference between ‘primary care’ and ‘

 

 

 

 

Defining Primary Care

Since its introduction in 1961, the term primary care has been defined in various ways, often using one or more of the following categories to describe what primary care is or who provides it (Lee, 1992; Spitz, 1994). These categories include:

  • The care provided by certain clinicians—Some proposed legislation, for example, lists the medical specialties of primary care as family medicine, general internal medicine, general pediatrics, and obstetrics and gynecology. Some experts and groups have included nurse practitioners and physician assistants (OTA, 1986; Pew Health Professions Commission, 1994);
  • set of activities whose functions define the boundaries of primary care—such as curing or alleviating common illnesses and disabilities;
  • level of care or setting—an entry point to a system that includes secondary care (by community hospitals) and tertiary care (by medical centers and teaching hospitals) (Fry, 1980); ambulatory versus inpatient care;
  • set of attributes, as in the 1978 IOM definition—care that is accessible, comprehensive, coordinated, continuous, and accountable—or as defined by Starfield (1992)—care that is characterized by first contact, accessibility, longitudinality, and comprehensiveness;
  • strategy for organizing the health care system as a whole—such as community-oriented primary care, which gives priority to and allocates resources to community-based health care and places less emphasis on hospital-based, technology-intensive, acute-care medicine (IOM, 1984).

PubMed article link

 


Barbara Starfield was an American pediatrician. She was an advocate for primary health care worldwide. Her academic and professional life was almost fully dedicated to the Johns Hopkins University.

The paper “Contribution of Primary Care to Health Systems and Health” by BARBARA STARFIELD, LEIYU SHI, and JAMES MACINKO can be read at this link

This book published by Starfield, Primary Care: Balancing Health Needs, Services, and Technology (2nd Ed) is one of the classic books about ‘primary care’.

The Distinction between Public Health and Community/Social/Preventive Medicine

GREAT deal of confusion exists with regard to the meaning of the terms “public health,” “community medicine,””social medicine,”and “preventive medicine”

The terms are often used interchangeably, practice which adds to the confusion. Attempts to clarify the meaning of these terms are not simply exercises in semantics for there are important issues at stake. Both explicitly and implicitly, these terms carry major implications for public health policy. In every country of the world, the direction of policy has been molded, for better or for worse, by the the theoretical orientation inherent in their use. 

Read the full-test….

1985_Article_TheDistinctionBetweenPublicHea

 

 

Primary Care: America’s Health in a New Era   Page 33 [LINK]


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Primary Care (PC) and Primary Health Care (PHC)

 


Family Medicine – LINK


The WHO -WONCA MOU 2019 March

WONCA President, Donald Li, and Dr Tedros Adhanom Ghebreyesus, Director General of WHO sign a Memorandum of Understanding on behalf of both organisations, reflecting the crucial role played by family medicine in achieving the goal of Universal Health Coverage. The MOU offers all our members and Member Organisations an official entry point to build even closer collaboration with WHO colleagues globally. [Ref]

 


WHO world (International) website does not have a definition for ”primary care”.(2021-03-02).

However, the WHO Europe clearly defines the PHC, PC and also General Practice and Family Medicine [Reference link].

The WHO European site also has a book titled “Primary Care in Drivers Seat?” and an interesting article named “What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services?” [Reference link].