WHO defines PHC 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.

Primary Health Care is not a "one-size-fits-all" model; it is different in each community depending upon:

• Needs of the residents.
• Availability of health care providers.
• The community's geographic location.
• Proximity to other health care services in the area.

• Essential Health Care: This is the care that meets the local needs of the majority that enables an individual to live a socially and economically productive life.
• Practically, Scientifically Sound Methods and Technology: The health care system should be able to effectively solve the health problems in that community using proven methods.
• Accessibility of Health Care: The services to promote health in the community should be easily reachable by the individual / community.
• Full Community Participation and Involvement: The community should acquire responsibility for their own health and welfare in the community. Community members should not be left out in any activities. When people are involved in organizing, planning, prioritizing, implementing, monitoring, and evaluating, these services then become socially acceptable and sustainable.
• Affordability of Health Care: The cost of health care and its maintenance should be cheap and easily met by the community and country.
• Self-Reliance: The community should be independent, confident, and trusting in itself, transitioning from passive recipients to active partners with government, NGOs, and donors. Thus, the community and government should be able to maintain (sustain) PHC activities without external interference.
• Self-Determination: The community should be able to decide on its own and take action on matters concerning their own health and development.
• Integration: All sectors work together towards the social-economic development of the community with health as a nucleus in order to promote the health status of the people and refer where necessary.

The health care system is stratified into three main tiers to ensure comprehensive coverage, appropriate referrals, and specialized care management.

There are 6 basic principles identified in the primary health care approach that ensure services are fair, sustainable, and effective.

1. Equitable Distribution: This means that health services must be shared equally by all people irrespective of their social, economic, cultural, and religious differences. All people—the rich or poor, the urban or rural—must have access to health services. This principle addresses the current imbalance in health care by distributing the health care budget to rural areas rather than concentrating it only in cities.
2. Manpower Development: Primary health care aims at mobilizing the human potential of the entire country by making use of available resources. This ensures there is an availability of an adequate number of appropriate health personnel required to devise and implement plans and actions. Strategies include the re-orientation of existing health workers, development of new categories of workers in health, and motivation and training of all manpower to serve the community.
3. Community Participation: This is a process by which individuals, families, and communities assume responsibility in promoting their own health and welfare. To promote the development of the community and the community’s self-reliance, residents themselves need to participate in decisions about their health. Community members and health workers/providers need to work together in partnership to seek solutions to the complex problems facing communities today.
4. Appropriate Technology: This is technology that is scientifically sound, flexible, adaptable to the community’s local needs, and acceptable to those who use it and to whom it is applied. It can be maintained by the community people themselves in keeping with the principle of self-reliance, using the resources the community has and can afford. It includes issues of costs and affordability within the context of existing resources (e.g., number and type of health professionals' equipment, and their distribution). Appropriate technology requires low capital investment, conserves natural resources, is managed by its users, and is in harmony with the environment.
5. Multisectoral Approach: Health and family welfare programs cannot stand on their own in an isolated manner. It is recognized that the health of a community cannot be improved within just the health sector; other sectors are equally important in promoting the community’s health and self-reliance. These sectors include agriculture, animal husbandry, education, housing, public works, communication, water, environment, rural development, cooperatives, and industries. They must work together in a multi-sectoral partnership to coordinate goals, plans, and activities to avoid conflicting efforts or duplication.
6. Self-Reliance: This principle applies at three client levels: individual, family, and community. PHC practitioners play a major role in helping people achieve self-reliance in relation to their health care through community participation and involvement. This means individuals, families, or communities are encouraged to change their attitude from being passive recipients to active partners with or without government or donor support.

• Community Participation: Very important for PHC programs to be socially acceptable and sustainable. It is a process whereby individuals and families assume responsibility for their own health and that of their community. The community can participate by providing resources (e.g., finances and raw materials like bricks, sand, stones, etc.).
• Intersectoral / Multi-sectoral Partnership: There is no sector which works in isolation; the activity of one sector has an influence on the other (e.g., agriculture, water and sanitation, finance).
• Equity: All people irrespective of color, tribe, race, or nationality in every country should have access to essential health care.
• Appropriate Technology: Technology which is scientifically sound, adaptable to local needs, culturally acceptable, and financially feasible.
• Political and Social Support: Political leaders must be committed to policy formation, resource mobilization and allocation, and mobilization of the community to support PHC programs.

• Effective policy making.
• Consistent monitoring and evaluation of PHC activities.
• Ensuring adequate budgetary allocation.
• Top-to-bottom mobilization of resources and community.
• Ensuring priority plans at different levels reflect PHC characteristics, elements, and pillars.
• Active involvement and participation of leadership.
• Setting aside a specific day for observing PHC (e.g., PHC Day).

• Embezzlement of funds.
• Civil wars and political instability.
• Self-centeredness of leaders.
• Delay of service delivery due to rigid top-bottom approaches.
• Conflict of ideas and partisan divides.
• The prioritization of high salaries for political leaders over health budgets.

These eight elements were the first and original components declared under the Alma-Ata conference:

1. Health Education: Education concerning prevailing health problems including the methods of preventing or controlling them. This was a broad component, and each country was supposed to make strategies for its implementation. (For example, in Uganda: STI/HIV/AIDS, Malaria, Tuberculosis, and epidemics have priority in the health education department – MOB).
2. Promotion of Safe Food Supply and Proper Nutrition: Involves improving food production, processing, storage, marketing, preparation, and consumption with the ultimate goal of improving nutritional status and the community's economy. Education is necessary, especially regarding cultural beliefs and practices affecting proper nutrition.
3. Provision of Adequate Safe Water Supply and Proper Sanitation:
   • Focuses on the quality of water sources and their availability in communities.
   • Sanitation involves controlling factors in the human environment that bear on health (e.g., housing). More emphasis is placed on latrine coverage, refuse disposal, and sewage management.
4. Provision of Maternal Child Health and Family Planning: Health services rendered to mothers and children through ante-natal, maternity, post-natal, and family planning clinics, with the aim of improving the lives of mothers and children. Most donor funding in the form of conditional grants is targeted to this component so services are subsidized.
5. Immunization Against Major Infectious Diseases: This receives a lion’s share of donor funding. WHO/UNICEF & CDC have been spearheading immunization worldwide. In Uganda, 8 diseases are targeted: poliomyelitis, tuberculosis, measles, diphtheria, whooping cough (pertussis), tetanus, hemophilic influenza type B, and hepatitis B under the EPI. Other vaccines like pneumococcal and Rotavirus are proposed to be included, and the Human Papilloma Virus (HPV) vaccine against Cervical Cancer is also being introduced.
6. Prevention and Control of Locally Endemic Diseases: Special programs have been established to eradicate endemic diseases (e.g., Malaria control program, TB/Leprosy control program, Onchocerciasis, Schistosomiasis, Guinea worm).
7. Appropriate Treatment of Common Diseases and Minor Injuries: Involves establishing primary health centers (HC II, III, and IV) with qualified health professionals. It also includes home-based care through Community Health Workers (CHWs) who are trained to treat and refer to the next level.
8. Provision of Essential Drugs: The aim is to supply the community with the most needed drugs that meet the community’s needs, depending on the level of the health facility.

In the case of Uganda, more components have been added to the original 8 elements to address comprehensive local needs:

9. Dental Health and Oral Care: Includes oral hygiene education, prevention of oral and dental diseases, and treatment of dental diseases.
10. Mental Health (Community Mental Health): Directed to care for and rehabilitate the mentally sick in their community, and prevention of mental illness.
11. Rehabilitative Health Services: Targeting the physically and mentally handicapped. Provided by community-based rehabilitation programs to help PLW/PLWDs live independent lives, earn an income, and feel important and acceptable to the community.
12. STI/HIV/AIDS Prevention and Care: Efforts geared toward the prevention and control of STI/HIV infection, alongside the treatment and care of the sick.
13. Eye Care (Primary Comprehensive Eye Care): Aims to prevent eye-related problems in the community through health education, and includes treatment and referral of patients with eye-related problems.

To implement the elements and uphold the principles of PHC, the following specific strategies are utilized:

• Use of local resources.
• Use of Appropriate Technology.
• Community Participation.
• Information dissemination.
• Mobilization of Political Will.
• Inter-Sectoral Collaboration.
• Provision of accessible health services.
• Reorientation of other health providers is needed.
• Emphasize disease prevention and health promotion.