Primary Health Care

Primary health care may refer to the first contact between a patient and the health system, but within the history of medicine it is commonly associated with a specific strategy that aimed to achieve “Health for All by the Year 2000” through promotion of basic health services. In this more precise understanding, Primary Health Care was an approach that distanced itself from both sophisticated hospital-based health care for the privileged few and technocentric, single-disease programs. Primary health care saw health in a broader intersectional and community-based perspective, favored simple technologies and affordable interventions, and welcomed the use of semi-skilled personnel as well as practitioners of Indigenous traditions of medicine. The vision of primary health care had historical precedents, but, as a specific approach, it was mainly developed in the 1970s. It was endorsed as a strategy in 1978 when the World Health Organization (WHO), UNICEF, 134 governments, and 67 international organizations at a major international conference adopted the “Alma-Ata Declaration on Primary Health Care.” In the 1980s attempts to implement the new doctrine were carried out throughout the world. This took place in an ideological environment increasingly influenced by neoliberalism, which was ideologically against increasing state involvement in health and in favor of market-driven approaches that emphasized cost-efficiency. It was, therefore, hostile to many of the assumptions underpinning primary health care. A rival approach known as Selective Primary Health Care emerged soon after Alma-Ata, and, in 1982, UNICEF adopted four specific health interventions—known under the acronym GOBI—as the core of its health-related activities. The World Health Organization found itself increasingly isolated as conservative governments in the Global North and major donors, such as the World Bank, distanced themselves from primary health care. By the early 1990s, most scholars agree that primary health care was no longer an important part of the global health agenda, even if it is important to keep sight of diverging regional developments. This article understands primary health care as a vision that was influential from the late 1960s to the early 1990s, and it considers the WHO under Director-General Halfdan Mahler as its main stakeholder. As many of the contemporary texts that went into the making and unmaking of primary health care are easily available as part of primary health care’s historiography, this article contains sections with references to the most important contemporary accounts. The history of primary health care is presented here as consisting of two phases: the 1970s, when the vision was developed and codified, and the 1980s, when attempts were made to implement the vision. Separate sections consider contemporary accounts. The article ends with sections considering developments during both the 1970s and the 1980s in each of the WHO regions, including some examples of contemporary accounts. The article is restricted to material in English.