The History of Primary Health Care

Introduction to the history of primary healthcare.

The history of primary healthcare.
From the small efforts of various groups to promote accessible and affordable health to all, the first significant step in the history of primary healthcare was the World Health Organization (WHO)’s “Health for all by the year 2000” initiative of 1977 which promoted UHC.
Although it was deemed impossible, atleast it led to the Alma Ata declaration in 1978 where various leaders established primary healthcare as the most practical and effective was of achieving the goal “Health for all by year 2000”.
30 years down the line, in 2008, the World Health Organisation launched the “Primary healthcare: now more than ever” report which highlighted several reforms necessary to make primary healthcare effective.
Then in 2018 was the Astana Declaration which traced the progress of primary healthcare since the Alma Ata declaration and established ways of strengthening primary healthcare to achieve universal health coverage.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Policy Framework for primary healthcare in Africa” which outline the goals to be met by Africa to achieve effective PHC for UHC in Africa.

Health for all by the year 2000

“Health for all by the year 2000” was a global health initiative launched by the World Health Organization (WHO) in 1977.
The initiative had three main objectives:
1. To achieve a level of health that would permit all individuals to lead a socially and economically productive life.
2. To reduce the gap in health status between developed and developing countries.
3. To provide essential health care to all individuals and families in the community.

Unfortunately, the goal of “Health for all by the year 2000” was not achieved but it did help in raising awareness of the need for accessible and affordable health for all, and this led to the establishment of primary healthcare in the 1978’s Alma Ata declaration.

The Alma Ata Declaration of 1978

The Alma-Ata Declaration is a health policy document that was adopted at the International Conference on Primary Health Care held in Alma-Ata, Kazakhstan in 1978.
The Declaration has had a profound impact on global health policy and practice. It has been a driving force behind the development of primary healthcare as a central component of health systems around the world.
It defined primary healthcare as “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.”
And it also emphasized the importance of community participation, health promotion, and disease prevention in addition to curative services. It recognized the need for a comprehensive approach to healthcare that addressed not just physical health, but also mental, social, and spiritual well-being.

WHO’S “Primary Health Care: Now More Than Ever” Report of 2008

The report “Primary Health Care: Now More Than Ever” was published in 2008 by the World Health Organization (WHO). The report emphasized the importance of primary health care as the foundation of any effective health system and called for a renewed global commitment to primary health care as a means of achieving better health for all.
It highlighted four key reforms necessary to strengthen primary healthcare:
1. Strengthening health systems: The report called for a comprehensive approach to strengthening health systems, including investments in health infrastructure, health workforce education and training, and health information systems.
2. Improving access to primary health care: The report emphasized the need to improve access to primary health care services, particularly for underserved populations, through strategies such as expanding health coverage and reducing financial barriers to care.
3. Enhancing the quality of primary health care: The report called for efforts to improve the quality of primary health care services through initiatives such as strengthening health workforce capacity, promoting evidence-based practice, and implementing quality assurance systems.
4. Fostering community participation and empowerment: The report highlighted the importance of engaging communities in primary health care planning and decision-making to promote health equity and social justice.
Overall, the report called for a coordinated and sustained effort to strengthen primary health care systems worldwide, with a focus on addressing the health needs of the most vulnerable populations.

The Astana Declaration of 2018

The Astana Declaration is a global commitment to achieving universal health coverage (UHC) through primary health care (PHC). The declaration was adopted at the Global Conference on Primary Health Care in Astana, Kazakhstan in 2018, which marked the 40th anniversary of the historic Alma-Ata Declaration of 1978.
The Astana Declaration reaffirms the principles of the Alma-Ata Declaration, which recognized primary health care as the key to achieving health for all. The Astana Declaration goes further by emphasizing the need for a renewed commitment to primary health care as the foundation of health systems, and as a means of achieving universal health coverage.
The Astana Declaration calls for a series of actions to strengthen primary health care systems, including:
1. Investing in primary health care as the cornerstone of health systems
2. Strengthening health systems through increased funding and resources
3. Ensuring access to essential health services for all, including through community-based approaches
4. Empowering individuals and communities to participate in their own health and health care
5. Strengthening health workforce education and training to ensure a skilled and motivated health workforce
6. Strengthening health information systems to improve decision-making and accountability
7. Strengthening partnerships and cooperation between different sectors and actors to achieve shared health goals.

AfroPHC’s Policy Framework for PHC and UHC in Africa

This week we have been looking at the history of primary healthcare.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Building PHC Teams for UHC in Africa” which underscores the crucial role of the PHC workforce within a team based approach. It also outlines the key actions that need to be met by Africa to achieve effective PHC for UHC in Africa.
This policy framework was funded by Primary Health Care Performance Initiative (PHCPI) and echoes the voices of frontline primary healthcare workers and leaders across, Africa, collated through a series of virtual policy workshops and group discussions. The final workshop was held in October 2022 in Johannesburg, South Africa where a cohort of about 30 multicountry multiprofessional delegates met in person to finalise the policy framework.
In summary, the policy calls to Africa to pay heed to the call of its health professionals, to seize opportunities to overcome African challenges, to embrace the World Health Organisation’s Report of 2008 and Astana Declaration of 2018 by prioritizing integrated, resilient, person-centred and high quality PHC within UHC, re-organising UHC around PHC service delivery, integrating public health with primary care, and bringing private PHC providers into a regulated PHC system for UHC in Africa.

WHO policy brief on COVID-19 infodemic management

The WHO policy brief on COVID-19 infodemic management outlines key actions for countries to consider when developing infodemic management policies, focusing on opportunities for strengthening and supporting such a network of actors.

The policy brief on infodemic management can be used by health authorities to support the development of a comprehensive infodemic management strategy, adapted to their country that leverages these activities efficiently. The brief highlights the importance of equipping health workers with skills to address health misinformation and the need for designated infodemic management teams to generate rapid actionable insights for health systems.

The policy brief is available in all official WHO languages.

The key points in the policy brief: 1. Train health workers, who are often the most trusted source of health information, to better identify and address health misinformation. 2. Tailor health, information and digital literacy initiatives to specific populations, and seek to debunk misinformation before it is widely disseminated through digital media and other channels. 3. Strive to develop high-quality, accessible health information in different digital formats designed for reuse, remixing and sharing and for rapid digital spread through social networks. 4. Establish an infodemic workforce for rapid infodemic insights generation and response, if necessary, by training staff to fulfil these functions; and ensure this function is clearly linked to and aligned with risk communications and community engagement efforts…more

WHO: More than half of child deaths are due to conditions that could be easily prevented or treated given access to health care and improvements to their quality of life

Background Evidence has been accumulating that community health workers (CHWs) providing evidence–based interventions as part of community–based primary health care (CBPHC) can lead to reductions in maternal, neonatal and child mortality. However, investments to strengthen and scale–up CHW programs still remain modest.

Methods We used the Lives Saved Tool (LiST) to estimate the number of maternal, neonatal and child deaths and stillbirths that could be prevented if 73 countries effectively scaled up the population coverage of 30 evidence–based interventions that CHWs can deliver in these high–burden countries. We set population coverage targets at 50%, 70%, and 90% and summed the country–level results by region and by all high–burden countries combined. We also estimated which specific interventions would save the most lives.

Findings LiST estimates that a total of 3.0 (sensitivity bounds 1.8–4.0), 4.9 (3.1–6.3) and 6.9 (3.7–8.7) million deaths would be prevented between 2016 and 2020 if CBPHC is gradually scaled up during this period and if coverage of key interventions reaches 50%, 70%, and 90% respectively. There would be 14%, 23%, and 32% fewer deaths in the final year compared to a scenario assuming no intervention coverage scale up. The Africa Region would receive the most benefit by far: 58% of the lives saved at 90% coverage would be in this region. The interventions contributing the greatest impact are nutritional interventions during pregnancy, treatment of malaria with artemisinin compounds, oral rehydration solution for childhood diarrhea, hand washing with soap, and oral antibiotics for pneumonia.

Conclusions Scaling up CHW programming to increase population–level coverage of life–saving interventions represents a very promising strategy to achieve universal health coverage and end preventable maternal and child deaths by 2030. Numerous practical challenges must be overcome, but there is no better alternative at present. Expanding the coverage of key interventions for maternal nutrition and treatment of childhood illnesses, in particular, may produce the greatest gains. Recognizing the millions of lives of mothers and their young offspring that could

be achieved by expanding coverage of evidence–based interventions provided by CHWs and strengthening the CBPHC systems that support them underscores the pressing need for commitment from governments and donors over the next 15 years to prioritize funding, so that robust CHW platforms can be refined, strengthened, and expanded... more

African Health Ministers announce ‘pivotal’ new strategy to combat communicable diseases

With the burden of cardiovascular disease, mental and neurological disorders and diabetes rising in the region, African health ministers on Tuesday, endorsed a new strategy to boost access to the diagnosis, treatment and care of severe noncommunicable diseases.

The health ministers, gathering for the seventy-second session of the UN World Health Organization (WHO) Regional Committee for Africa in Lomé, Togo, adopted the strategy, known as PEN-PLUS. That plan will be implemented as a regional strategy to address severe noncommunicable diseases at first-level referral health facilities. The strategy supports building the capacity of district hospitals and other first-level referral facilities to diagnose and manage severe noncommunicable diseases…more

WHO makes new recommendations for Ebola treatments, calls for improved access

The World Health Organization (WHO) has published its first guideline for Ebola virus disease therapeutics, with new strong recommendations for the use of two monoclonal antibodies. WHO calls on the global community to increase access to these lifesaving medicines.

Ebola is a severe and too often fatal illness caused by the Ebola virus. Previous Ebola outbreaks and responses have shown that early diagnosis and treatment with optimized supportive care —with fluid and electrolyte repletion and treatment of symptoms—significantly improve survival. Now, following a systematic review and meta-analysis of randomized clinical trials of therapeutics for the disease, WHO has made strong recommendations for two monoclonal antibody treatments: mAb114 (Ansuvimab; Ebanga) and REGN-EB3 (Inmazeb)…

The new guidance complements clinical care guidance that outlines the optimized supportive care Ebola patients should receive, from the relevant tests to administer, to managing pain, nutrition and co-infections, and other approaches that put the patient on the best path to recovery.

Dr Richard Kojan, co-chair of the Guideline Development Group… “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.”…

There is also a recommendation on therapeutics that should not be used to treat patients: these include ZMapp and remdesivir...more

WHO/Europe training course on NCD 2022

Message to our members on behalf of WHO


WHO/Europe training course on noncommunicable diseases 2022

30 August is the last day to register for the WHO/Europe training course on noncommunicable diseases 2022

If you are a researcher, policy maker or postgraduate scholar with an interest in noncommunicable diseases (NCDs), you have an opportunity to take part in a unique WHO training course developed for early or mid-career health professionals.
The course will enable participants to:

understand novel challenges in the area of NCDs, and work on solution-oriented approaches to tackle the burden of NCDs;
acquire skills in developing NCD prevention approaches;
gather, analyze and publish NCD-related data;
build capacity and learn how to transfer research into policy-related contexts; and
network with colleagues.


Learn more and register here.

The course is jointly developed by the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), WHO collaborating centres and partner organizations.
Please feel free to share the information on the WHO NCD training course 2022 among your professional networks.

WHO publishes new guidelines on HIV, hepatitis and STIs

The guidelines outline a public health response to HIV, viral hepatitis and sexually transmitted infections (STIs) for 5 key populations (men who have sex with men, trans and gender diverse people, sex workers, people who inject drugs and people in prisons and other closed settings)…

“The new data from UNAIDS show that around 70% of new HIV infections occur among key populations and their partners…” said Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes…

These guidelines also acknowledge that behavioural interventions aimed at changing behaviours – which tend to be prioritized in many settings – have no impact on incidence of HIV, viral hepatitis and STIs or on behaviour change…more

Consultation invitation – WHO Foundation

Dear colleagues,

With apologies for cross-posting, sharing this invitation for a consultation on the WHO Foundation’s strategy document for those of you who might be interested. The attached invitation notes that the draft strategy will be shared with registered participants ahead of the virtual consultation.

If you are interested, please register by August 19 for one of the two sessions:

● Option #1// Tuesday, August 30: 17:00 Central European Time i.e. 08.00 Pacific Daylight Time (PDT) / 11.00 Eastern Time (ET) / 16.00 West Africa Time (WAT)/ 18.00 East Africa Time (EAT) / 20:30 India Standard Time (IST) / 23.00 Singapore Standard Time (SST)
Registration Link: https://us06web.zoom.us/meeting/register/tZMscO6oqjorHddt-gT4UCoV7_s_4pKdjyT7
● Option #2// Thursday, September 1: 09:00 Central European Time (CET) i.e. 00.00 Pacific Daylight Time (PDT) / 03.00 Eastern Time (ET) / 08.00 West Africa Time (WAT)/ 10.00 East Africa Time (EAT) / 12:30 India Standard Time (IST) / 15:00 Singapore Standard Time (SST)
Registration Link: https://us06web.zoom.us/meeting/register/tZ0rcu-qpj0uEtaN-zYQ80IlUAdL-Iq9Mb7d

New global alliance launched to end AIDS in children by 2030

Globally, only half of children living with HIV are on life-saving treatment. UNAIDS, UNICEF, and WHO have brought together a new alliance to fix one of the most glaring disparities in the AIDS response…more

WHO launches appeal to respond to urgent health needs in the greater Horn of Africa

The health and lives of people in the greater Horn of Africa are threatened as the region faces an unprecedented food crisis. In order to carry out urgent, life-saving work, WHO is launching a funding appeal for US$ 123.7 million…more

Fifth Global Forum on Human Resources for Health: 3-5 April 2023

The Fifth Global Forum on Human Resources for Health will be held from 3 to 5 April 2023. The format of the Forum will be hybrid, to enable virtual and in-person sessions and will be hosted from the Auditorium of the WHO headquarters in Geneva.
The Forum will be held under the theme of Protecting, safeguarding, and investing in the health and care workforce. Marking more than five years since the adoption of the Global Strategy on Human Resources for Health: Workforce 2030, the Forum will provide updates on progress in its implementation and share evidence and experiences on workforce development, as well as opportunities for a post COVID-19 era that will inform the implementation of the Working for Health 2022-2030 Action Plan (2022-2030). It will examine the required policy solutions, investments, and multi-sectoral partnerships to address health and care workforce challenges and advance health systems towards universal health coverage and health security. The outcomes of the Forum will inform the United Nations General Assembly’s High-Level Meeting on UHC in September 2023.

The Forum is intersectoral and will engage participation from a range of actors, including high-impact decision-makers, across education, finance, gender, health, labour/employment, and migration sectors. In person participation will be for speakers participating in the high-level roundtable dialogue. Technical sessions and other learning and networking activities will be available upon registration through an IT platform dedicated for the Forum.

The language of the Forum will be English with simultaneous interpretation available in Arabic, Chinese, French, Russian and Spanish, for the high-level roundtables.

Please contact the Forum Secretariat at 5GF@who.int for any queries. Find out more at https://www.who.int/teams/health-workforce/about/5thglobalforum-hrh/.


In solidarity,
WHO Health Workforce team

WHO and UNICEF: COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades

The largest sustained decline in childhood vaccinations in approximately 30 years has been recorded in official data published today by WHO and UNICEF.

The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3) – a marker for immunization coverage within and across countries – fell 5 percentage points between 2019 and 2021 to 81 per cent.

As a result, 25 million children missed out on one or more doses of DTP through routine immunization services in 2021 alone. This is 2 million more than those who missed out in 2020 and 6 million more than in 2019, highlighting the growing number of children at risk from devastating but preventable diseases. The decline was due to many factors including an increased number of children living in conflict and fragile settings where immunization access is often challenging, increased misinformation and COVID-19 related issues such as service and supply chain disruptions, resource diversion to response efforts, and containment measures that limited immunization service access and availability…more

WHO publication “Implication of the COVID-19 Pandemic for Patient Safety: A Rapid Review”, Tuesday, 09 August 2022

Dear Colleagues,

Greetings from the WHO Patient Safety Flagship in Geneva.

The COVID-19 pandemic has profoundly impacted nearly all countries’ health systems and diminished their capability to provide safe health care, specifically due to errors, harm and delays in diagnosis, treatment and care management. In preparation for the forthcoming fifth Global Ministerial Summits on Patient Safety, scheduled to be held on 23-24 February 2023 in Montreux, Switzerland as the host country, has been working with WHO to better understand the implications of the COVID-19 pandemic for patient safety.

As part of this ongoing initiative, WHO Patient Safety Flagship is planning to launch the publication “Implication of the COVID-19 Pandemic for Patient Safety: A Rapid Review”, in a virtual event on Tuesday, 09 August 2022, 14:00-15:30 (CEST).

The objectives of this event are to:

– provide an overview of implications of the COVID-19 pandemic for patients, health workers, and the general public

– highlight the importance of managing risks and addressing avoidable harm in a pandemic situation

– discuss implications of the pandemic for patient safety within the broader context of preparedness, response and recovery

– lay the foundation for follow-up work around generating more robust evidence and supporting countries in their efforts to build resilient and safer health care systems.

We hope that you join us for this event on Tuesday, 09 August 2022 at 14:00-15:30 CEST.

Please register at the link. https://echo.zoom.us/webinar/register/WN_yVOgkzyvSaCzPXW1r6CY5A, also included in the attached flyer [HIFA does not carry attachments].

Simultaneous interpretation will be available in English, French and Spanish.


Thanks and best regards,

Dr Neelam DHINGRA
Unit Head
WHO Patient Safety Flagship/

Monkeypox declared global health emergency by WHO as cases surge

The global monkeypox outbreak has been declared a public health emergency of international concern by the World Health Organization (WHO) – the strongest call to action the agency can make.

It is the seventh time such a declaration has been made since 2009, the most recent being for Covid-19, which was given the same label by the WHO in 2020, and follows a meeting of a committee of experts on Thursday…more