1. For universal health coverage (UHC) to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people.
2. PHC is rooted in a commitment to social justice, equity, solidarity and participation.
3. PHC requires governments at all levels to underscore the importance of action beyond the health sector in order to pursue a whole-of government approach to health, including health-in-all-policies, a strong focus on equity and that encompass the entire life-course.
4. PHC addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.
5. It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases.
6. Primary health care ensures people receive quality comprehensive care - ranging from promotion and prevention to treatment, rehabilitation and palliative care as close as feasible to people's everyday environment
7. In May 1998, the World Health Organization adopted a resolution in support of the new global Health for All policy.
8. The new policy, Health for All in the 21st Century, succeeds the Health for All by the Year 2000 strategy launched in 1977
9. In the new policy, the worldwide call for social justice is elaborated in key values, goals, objectives and targets.

Basic needs refer to those things that are necessary to sustain life. They represent the minimum requirements of a community for a decent standard of life. Food, water, and environment are personal and immediate matters.

Food, Air, Water:

• Oxygen: Our most important nutrient, essential for life, and needed constantly by every cell to release energy from food. We can only survive a few minutes without it.
• Water: Comprises about 60% of solid tissue by weight. Besides oxygen, it is the most important nutrient ("jack of all trades"). It regulates temperature, carries nutrients/oxygen, removes waste, and cushions joints. Ideal medium due to solubility, liquid state at survivor temps, and neutral pH. Requirement: At least 3 liters a day.
• Nutritious food: Maintains health, promotes growth in children, and prevents blindness.

Clothing: Satisfies physical, psychological, and social needs through protection, adornment, identification, modesty, and status.

Shelter/Housing: Universally viewed as a basic human need. The UN identifies it as a fundamental human right: "the right to live somewhere in security, peace and dignity." For low-income families, it is a valuable asset providing comfort and an opportunity to change their lives for the better.

Education: A basic human right necessary for sustainable social and economic development. Education of girls is a major determinant of development. It is an empowering tool crucial for poverty reduction.

Health Security: WHO defines this as activities required to minimize the danger and impact of acute public health events (pandemics, epidemics, spread of infectious diseases) that endanger collective health across geographical regions. It is essential to achieving human security.

Note: Physical and mental well-being starts with access to fresh air, water, nutritious food, a stable home, healthy relationships, and a life free from violence, injury, and toxic stress.

Level	Description and Focus	Facilities / Institutions
1. Primary Level Health Care	The first level of contact between the recipient of care and the health care delivery system. Essential health care is provided. The majority of problems at this level are solved by the people with some assistance and guidance of health workers.	Rural: Sub-centers, Primary Health Centres (PHC), Community Health Centres (CHC), Health Posts (HP). Urban: Maternal child health & family welfare centres, dispensaries.
2. Secondary Level Health Care	At this level, more complex problems are taken care of, requiring secondary level of preventive and curative services. Cases that cannot be handled at the primary level are referred here.	District Health Centres, District Hospitals, Zonal Hospitals, Sub-Divisional Hospitals (SDH).
3. Tertiary Level Health Care	A highly specialized level of health care. These institutions serve as referral units for both primary and secondary levels. They also serve as teaching institutions for the education and training of various categories of health care professionals.	Medical Colleges, Specialized Hospitals, State/Regional/Central level institutions.

PHC covers the entire spectrum of care focusing on individuals, families, and communities. The spectrum includes:

• Promotive
• Preventive
• Curative
• Rehabilitative
• Supportive (Palliative)

The Declaration of Alma-Ata outlined the 8 essential elements of Primary Health Care. These elements are also known as "essential health care" and PHC addresses the main health problems in the community by providing promotive, preventive, curative, and rehabilitative services accordingly.

1. Education: Education concerning prevailing health problems and the methods of preventing & controlling them.
2. Food & Nutrition: Promotion of food supply and proper nutrition.
3. Water & Sanitation: An adequate supply of safe water & basic sanitation (environmental sanitation and good waste disposal).
4. Maternal & Child Health Care (MCH): Including family planning.
5. Immunization: Immunization against major infectious diseases.
6. Endemic Diseases: Prevention & control of locally endemic diseases.
7. Treatment: Appropriate treatment of common diseases & minor injuries (provision of medical care and emergency treatment).
8. Essential Drugs: Provision of essential drugs.

More in the next lesson under Concepts.

To implement the elements effectively, PHC operates on foundational principles, often referred to as the " Cornerstones" in Primary Health Care.

• 1. Equitable Distribution: Health services must be shared by all people irrespective of their ability to pay. All (rich or poor, urban or rural) must have access to health services with special attention to the needy and vulnerable groups. This has been termed as "Social Justice". (Coverage and accessibility aim to reach populations in any geographical area).
• 2. Community Participation (Involvement): Active involvement of individuals, families, and communities in the promotion of their own health. It is the process by which individuals assume responsibilities for their own health and welfare, developing the capacity to contribute to their own and their country's development in planning, implementation, and maintenance of health services.
• 3. Multisectoral Approach (Intra and Inter-sectoral linkages): Coordinated action between the health sector and other related sectors (agriculture, education, social welfare, animal husbandry, housing). No sector can achieve its goals in isolation. An important element is planning with other sectors to avoid unnecessary duplication of activities.
• 4. Appropriate Health Technology: Implies the use of methods, techniques, and equipment which are scientifically sound, adaptable to local needs, socially acceptable, and maintainable by the people themselves in keeping with the principle of self-reliance with the resources the community can afford (e.g., Oral Rehydration Therapy).
• 5. Focus on Prevention: The emphasis is on prevention. It runs through all the elements of primary health care.

• Human Resource: Full use of all available resources including human potential.
• Services by Community Health Worker: Forming a link between community people and the health system, given short/simple training to handle basic needs.
• Referral System: Integrated, functional, and mutually supportive systems leading to comprehensive health care, moving severe cases to higher/specialized centers.
• Logistics of Supply: Planning, budgeting, procurement, storage, and distribution control of supplies.
• Physical Facilities and Control and Evaluation.

HFA is defined as "the attainment by all peoples of the world by a particular date (kept at that time as the year 2000), of a level of health that will permit them to lead a socially and economically productive life."

The Global Strategy for Health for All by the Year 2000 (HFA2000) set the following guiding targets to be achieved by year 2000:

• Life expectancy at birth above 60 years
• Infant mortality rate below 50 per 1000 live births
• Under-5 mortality rate below 70 per 1000 live births.
• About 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of there household budget.
• Scaling up primary health care (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
• Achieving the targets for PHC requires an additional investment of around US $ 200 to US$ 370 billion a year for a more comprehensive package of health services.
• At the UN high level UHC meeting in 2019, countries committed to strengthening primary health care.
• WHO recommends that every country allocate or reallocate an additional 1% of GDP to PHC from government and external funding sources.

In May 1998, the WHO adopted a resolution in support of the new global Health for All policy. This policy succeeds the 1977 strategy, elaborating a worldwide call for social justice into 10 key global health targets to be pursued, divided into three subgroups:

Subgroup	Target Details
I. Health Outcome Targets	1. Health Equity: By 2005, health equity indices used to promote/monitor equity (initially assessed via child growth/stunting). 2. Survival: By 2020, meet targets for Maternal mortality (<100/100,000 live births), Child mortality (<45/1000 live births), and Life expectancy (>70 years). 3. Reverse 5 Major Pandemics: By 2020, reduce disease burden by reversing trends of TB, HIV/AIDS, Malaria, Tobacco-related diseases, and violence/trauma. 4. Eradicate/Eliminate Specific Diseases: Measles (eradicate by 2020), Lymphatic filariasis (eliminate 2020), Chagas (interrupt transmission 2010), Leprosy (eliminate 2010), Trachoma (eliminate 2020), Vitamin A & Iodine deficiencies (eliminate before 2020).
II. Determinants of Health	5. Improve Access to Basics: By 2020, major progress in safe drinking water, adequate sanitation, food, shelter, and managing environmental risks. 6. Measures to Promote Health: By 2020, actively managing strategies that strengthen health-enhancing lifestyles and weaken damaging ones (educational, regulatory, economic).
III. Health Policies & Sustainable Systems	7. National HFA Policies: By 2005, operational mechanisms for developing/monitoring policies consistent with HFA. 8. Comprehensive Care Access: By 2010, universal access throughout life to comprehensive, essential, quality health care. 9. Information & Surveillance: By 2010, establish appropriate global and national health information, surveillance, and alert systems. 10. Support Research: By 2010, research policies and institutional mechanisms operational at global, regional, and country levels.

Member States have committed to primary health care renewal and implementation as the cornerstone of a sustainable health system for Universal Health Coverage (UHC), health-related Sustainable Development Goals (SDGs), and health security.

UHC means that all individuals & communities receive the health services they need without suffering financial hardships. For UHC to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people.

1. Comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces.
2. Multi-sectoral policies and actions to address the upstream and wider determinants of health.
3. Engaging and empowering individuals, families, and communities for increased social participation and enhanced self-care and self-reliance in health.

• About 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget.
• Scaling up PHC interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
• Achieving targets for PHC requires an additional investment of around US $200 to US $370 billion a year for a more comprehensive package of health services.
• WHO recommends that every country allocate or reallocate an additional 1% of GDP to PHC from government and external funding sources.
• PHC is the most inclusive, equitable, cost-effective, and efficient approach to enhance physical and mental health. It makes health systems more resilient to situations of crisis (like the COVID-19 pandemic) and proactive in early detection.

Current criticisms of existing health systems note that they are predominantly urban-oriented, mostly curative, and accessible mainly to a small part of the population. Specific implementation challenges include:

• Poor staffing and shortage of health personnel.
• Inadequate technology and equipment.
• Poor condition of infrastructure / infrastructure gap, especially in rural areas.
• Concentrated focus on curative health services rather than preventive and promotive health care services.
• Challenging geographic distribution.
• Poor quality of health care services.
• Lack of financial support in health care programs.
• Lack of community participation.
• Poor distribution of health workers (health workers concentrated in urban areas).
• Lack of intersectoral collaboration.

Primary health care emphasizes the development of universally acceptable, affordable, and accessible essential health services that are community-based and emphasizes health promotion and maintenance, self-reliance, and community participation in decision making about health. To implement the PHC concept, nurses must focus on the prevention of disease and the promotion of health, as well as on care of the actually ill and those in need of rehabilitation.

No.	Role & Responsibility
1	Assessing Health Status: Assessing the health status of individuals and communities to identify specific needs and vulnerabilities.
2	Health Education: Educating the community concerning prevailing health problems and the methods of preventing and controlling them.
3	Promoting Essentials: Promoting food supply and proper nutrition, as well as ensuring water supply and basic sanitation.
4	MCH & Family Planning: Providing comprehensive maternal and child health care, including active family planning services.
5	Immunization: Administering vaccines against major infectious diseases.
6	Treatments & Integrated Care: Treating minor ailments/injuries, providing integrated health care including emergency response, and making necessary referrals.
7	Mobilizing Community: Encouraging and mobilizing active community involvement and participation in health initiatives.
8	Epidemiological Surveillance: Maintaining surveillance to proactively monitor and manage outbreaks or endemic disease patterns.
9	Training & Supervision: Training and supervising community health workers to ensure they provide adequate care at the grassroots level.
10	Collaboration & Monitoring: Collaborating with other development sectors and continuously monitoring the progress of primary health care initiatives.