CONCEPTS OF PRIMARY HEALTH CARE

Introduction
Primary Health Care is a comprehensive, accessible, community-based care system that aims to
meet the essential health needs of the population through scientific, socially acceptable, and
affordable methods.

It focuses on preventive, promotive, curative, and rehabilitative services and forms the first level of
contact between individuals, families, and the health system.

Alma-Ata Declaration (1978)

The Alma-Ata Declaration was adopted at the International Conference on Primary Health Care
held in Alma-Ata (now Almaty, Kazakhstan) in September 1978, jointly organized by the World
Health Organization (WHO) and UNICEF.

It declared that:

• Health is a fundamental human right.

• The existing inequality in health status is politically, socially, and economically

unacceptable.

• Governments have a responsibility to provide adequate health and social measures for all.

• Primary Health Care is the key to achieving the goal of “Health for All by the Year 2000”.

The Alma-Ata Declaration emphasized that PHC should be available, accessible, affordable, and
culturally acceptable to all individuals and that it must involve inter-sectoral collaboration and
active community participation.

Definition (WHO, 1978)

Primary Health Care is defined as:

“Essential health care made universally accessible to individuals and families in the community by
means acceptable to them, through their full participation, and at a cost that the community and
country can afford.”
 Elements of Primary Health Care (8 Essential Components)
As outlined in the Alma-Ata Declaration, PHC includes the following eight essential elements:

Health Education

Education concerning prevailing health problems and the methods of preventing and controlling
them, promoting awareness, behavior change, and self-care.

Nutrition

Promotion of food supply and proper nutrition to combat malnutrition, anemia, and
undernourishment through dietary education and community food programs.

Safe Water and Sanitation

An adequate supply of safe water and basic sanitation to reduce waterborne diseases and improve
hygiene practices.

Maternal and Child Health (MCH)

Maternal and child health care including family planning services to reduce maternal and infant
mortality, promote safe childbirth, and provide reproductive health education.

Immunization

Immunization against major infectious diseases like measles, polio, diphtheria, pertussis, tetanus,
and tuberculosis to achieve population-level protection.

Control of Endemic Diseases

Prevention and control of locally endemic diseases such as malaria, kala-azar (Visceral
leishmaniasis), dengue, and typhoid through surveillance, early treatment, and public cooperation.

Treatment of Common Illnesses

Appropriate treatment of common diseases and injuries using locally acceptable and cost-effective
medical and nursing care.
Essential Drugs

Provision of essential drugs required for basic health care to ensure timely and affordable treatment,
avoiding irrational or unnecessary prescriptions.

Concepts/ Principles of Primary Health care

Equitable Distribution

• Everyone should have equal access to basic health services, regardless of where they live or how
much money they have.

• Primary Health Care is based on the belief that health is a human right, not a privilege. In most
countries, healthcare is often better in cities and private hospitals, leaving rural and poor
populations neglected.

• This principle ensures that health services are available in remote villages, slums, tribal areas, and
underserved communities.

• PHC brings health services closer to people’s homes by establishing sub-centres, PHCs, outreach
clinics, and health camps.

• It reduces health inequalities between rich and poor, urban and rural, men and women, literate and
illiterate.

Example: ASHA workers and mobile medical vans are deployed in tribal and backward areas to
ensure fair access.

Unless everyone can reach and afford health care, national health cannot improve. Equitable
distribution promotes social justice and strengthens public trust in the system.

Community Participation

• People must be actively involved in their own health — in planning, delivering, and evaluating
services.

• Health cannot be achieved only by doctors or nurses. People must become owners and partners in
the health system.

• PHC encourages communities to identify their own health problems and suggest solutions.

• They participate through Village Health Sanitation and Nutrition Committees (VHSNCs), Self-
Help Groups (SHGs), and local health volunteers.
• Women’s groups, Panchayati Raj Institutions (PRIs), school teachers, and NGOs play an
important role in local health decisions.

• They help in spreading awareness, monitoring services, providing feedback, and holding staff
accountable.

• When people are involved, they are more responsible, more aware, and more satisfied with
services. It also makes health programs culturally relevant, locally adapted, and sustainable.

Focus on Prevention and Health Promotion

• Preventing illness and promoting healthy living is more effective and cheaper than only treating
diseases.

• PHC shifts the focus from hospitals and medicines to education, behavior change, and early
protection.

• It emphasizes immunization, hygiene, nutrition, safe water, sanitation, safe motherhood, and
family planning.

• It includes activities like health education campaigns, school health programs, and community
awareness drives.

• Nurses, ANMs, and ASHAs regularly conduct home visits, counseling sessions, and group
meetings to teach people about prevention.

• Most diseases like diarrhea, malaria, TB, and malnutrition can be prevented at low cost.

• Health promotion builds a culture of self-care and responsible health behavior, reducing hospital
load and improving population health.

Use of Appropriate Technology

• Use simple, low-cost, locally acceptable tools and methods that meet community needs
effectively.

• Technology does not mean only modern machines. In PHC, it refers to any tool or method that is
safe, effective, affordable, and easy to use.

• It must suit the local language, culture, education level, and economic condition.

• Examples include oral rehydration salts (ORS) for diarrhea, zinc tablets, handpumps for clean
water, mosquito nets, birth kits, and mobile health apps.

• Even visual charts, flipbooks, and folk songs are appropriate educational tools in low-literacy
communities.

• Advanced hospitals and expensive treatments are out of reach for most people.
• Appropriate technology makes health care affordable, reachable, and practical in every setting,
especially rural and low-resource areas.

Multi-Sectoral Approach

• Health cannot be improved by the health sector alone; it requires combined effort of many
sectors.

• Health is linked to nutrition, water, sanitation, education, agriculture, housing, roads, and
employment.

• For example, malnutrition is not only a medical issue; it also involves food supply, income, and
education.

• PHC involves coordination between various departments:

- Health + Education = School health programs, adolescent health

- Health + Agriculture = Nutrition improvement, kitchen gardens
- Health + Sanitation = Safe water, toilets, waste disposal
- Health + Women & Child Welfare = MCH programs, immunization, nutrition
- Health + Transport & Communication = Emergency services, vaccine delivery
Nurses and health workers often refer, coordinate, and advocate across sectors to get support for
the community.

• Without cross-sector collaboration, health programs fail to address the root causes of disease. A
multi-sectoral approach ensures comprehensive health development, not just medical treatment.

Conclusion
These five principles are the backbone of Primary Health Care. They ensure that health care is not
only available but also accessible, affordable, participatory, preventive, and people-centered. When
applied properly, they help build healthy individuals, empowered communities, and resilient
nations.