For more than a quarter of a century Primary Health Care (PHC) has been recognized as one of the key components of an effective health system.
Experiences in more–developed and less–developed countries alike have demonstrated that PHC can be adapted and interpreted to suit a wide variety of political, social, and cultural contexts. A comprehensive review of PHC –both in theory and practice–and a critical look at how this concept can be “renewed” to better reflect the current health and development needs of people around the world, is now in order. This document –written to fulfill a mandate established in 2003 by a resolution of the Pan American Health Organization (PAHO)–states the position of PAHO on the proposed renewal of PHC. The goal of this paper is to generate ideas and recommendations to enable such a renewal, and to help strengthen and reinvigorate PHC into a concept that can lead the development of health systems for the coming quarter century and beyond. There are several reasons for adopting a renewed approach to PHC, including: the rise of new epidemiologic challenges that PHC must evolve to address; the need to correct weaknesses and inconsistencies present in some of the widely divergent approaches to PHC; the development of new tools and knowledge of best practices that PHC can capitalize on to be more effective; and a growing recognition that PHC is an approach to strengthen society’s ability to reduce inequities in health. In addition, a renewed approach to PHC is viewed as an essential condition for meeting the commitments of internationally agreed–upon development goals, including those contained in the United Nations Millennium Declaration addressing the social determinants of health and achieving the highest attainable level of health by everyone. By examining concepts and components of PHC and the evidence of its impact, this document builds upon the legacy of Alma Ata and the primary health care movement, distills lessons learned from PHC and health reform experiences, and proposes a set of key values, principles, and elements essential for building health systems based on PHC. It postulates that such systems will be necessary
to tackle the “unfinished health agenda” in the Americas, as well as to consolidate and maintain past progress, and rise to the new health and development challenges and commitments of the twenty–first century.
The ultimate goal of the renewal of PHC is to obtain sustainable health gains for all. The proposal presented here is meant to be visionary; the realization of this document’s recommendations, and the realization of PHC‘s potential, will be limited only by our commitment and imagination...