Why Primary Health Care Still Anchors Strong Health Systems

Primary health care (PHC) is repeatedly rediscovered in political declarations — and repeatedly underfunded in budgets. Yet WHO and UNICEF continue to describe PHC as the most inclusive, effective and efficient approach to people’s physical and mental health and social well-being, and as a cornerstone of universal health coverage (UHC). The claim is familiar; the unfinished test is whether money, workforce, and access rules follow the rhetoric.

From Alma-Ata to Astana

In October 2018, governments meeting in Astana renewed the global commitment to primary health care. The Declaration of Astana, co-hosted with WHO and UNICEF, reaffirms health as a fundamental right and argues that strengthening PHC is the most inclusive, effective and efficient approach to enhance physical and mental health as well as social well-being.

The Declaration’s four pledges remain a useful checklist: bold political choices for health across sectors; sustainable primary health care; empowered individuals and communities; and aligned stakeholder support behind national strategies. The news from Astana was explicit that single-disease programmes without strong systems leave countries vulnerable — a lesson reinforced by later health emergencies.

Why PHC anchors universal coverage

WHO’s health-topic framing of primary health care emphasises comprehensive care across the life course — promotion, prevention, treatment, rehabilitation and palliative care — close to where people live and work, with community participation and action on determinants. UHC without that foundation becomes a promise of hospital bills rather than continuous care.

In a 2023 report to the World Health Assembly, WHO states that a primary health care approach across all levels of the health system can deliver around 90% of essential interventions for universal health coverage. The same document links PHC to large shares of projected SDG health gains — including tens of millions of lives saved by 2030 under modelled scenarios. Those are planning magnitudes, not guarantees; they still explain why ministries keep returning to PHC when UHC targets stall.

About 90 percent of essential interventions for universal health coverage can be delivered through a primary health care approach.

~90%

of essential UHC interventions can be delivered through a primary health care approach.

Source: WHO — Reorienting health systems to primary health care (WHA76/6).

Budgets still tell another story

Commitment language is necessary but not sufficient. OECD Health at a Glance analyses of prevention and primary health care spending show that PHC still represents a limited share of current health expenditure on average across OECD countries — often around the mid-teens as a percentage of total health spending, with wide country variation. If PHC is the cornerstone of UHC, budgets that keep concentrating growth in hospitals contradict the architecture Astana described.

Public health training materials such as CDC’s Introduction to Public Health also place access to care and determinants alongside clinical services — a reminder that “primary care visits” alone are not the whole PHC package. Community engagement, multisector action and essential public health functions sit beside family medicine and first-contact clinics.

Closing

Strong health systems are not built by stacking specialty hospitals first and hoping primary care catches the leftovers. They are built by making first-contact, continuous, coordinated care the default — and by linking that care to prevention and the social conditions that drive demand.

Astana did not invent primary health care; it restated an unfinished assignment. When I read “PHC is the cornerstone of UHC,” I look next at whether workforce plans, package design and public budgets treat first-contact care as infrastructure — or as a residual after hospital politics. Declarations matter only when money, staff, and access rules follow them. If primary care remains the rhetorical priority and, in practice, the fiscal leftover, universal coverage will keep sounding stronger on paper than it feels at the first point of contact.

Sources & further reading

1. WHO/UNICEF — Declaration of Astana (PDF)
2. WHO — Primary health care (health topic)
3. WHO/UNICEF — New global commitment to primary health care for all at Astana conference
4. WHO — Reorienting health systems to primary health care (WHA76/6)
5. CDC — Introduction to Public Health (Public Health 101 Series)
6. OECD — Health expenditure on prevention and primary healthcare (Health at a Glance)