The 13 Components of Primary Health Care Explained

Understanding the components of primary health care as proposed by the World Health Organization (WHO) is a recurrent objective if you are into any form of public health. These components were enacted and discussed in the Alma-Ata Declaration of 1978.

The Declaration of Alma-Ata involves the proceedings of a joint conference by the WHO and the United Nations Children’s Fund (UNICEF) on the 12th of September 1978 in Alma-Ata, Russia. This declaration outlined a set of objectives and plans for achieving health care for all people worldwide.

The primary goal of the Alma-Ata International Conference (now Almaty, Kazakhstan) was to achieve “Health for All by the Year 2000″. The conference brought together 134 countries and 67 international organizations. In the end, the proceeding was captioned under the name “Primary Health Care”, which sums the various components and structure of health care that aid the achievement of “Health for All at All Ages”.^[1]Declaration of Alma-Ata – WHO

Primary Health Care Definition

Primary Health Care (PHC) is defined 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”.^[2]Primary Health Care: 25 Years of the Alma-Ata Declaration –Paho.org.

The components of this definition of PHC encompass a strategy to establish a sustainable healthcare system in all communities around the world, tackling the problem of inequitable availability of healthcare.

i. Essential healthcare: This talks about fundamental health services that cater to the most common health needs and problems of a given country or group of people. It includes preventive, promotive, curative, rehabilitative, and palliative services.

ii. Based on practical, scientifically sound, and socially acceptable methods and technology: Practical interventions and solutions must be realistic and effective within the local context, scientifically sound refers to evidenced-based methods, while socially acceptable describes methods that respect local culture, beliefs, and preferences to ensure community trust and participation.

iii. Made universally accessible to individuals and families: Services must be available to everyone regardless of socioeconomic status, geographic location, and other barriers. Delivering primary health care to individuals and families reflects the need to provide such services close to where people live and work, and promote community-based solutions.

iv. Their full participation: This encourages active participation of the community in planning, implementing, and maintaining health care programs. It is based on the belief that there is higher motivation and a feeling of ownership when the community is allowed to participate fully in the services.

v. At a cost that the individual and community: This ensures that health services are sustainable and do not impose an undue financial burden on individuals or the nation.

vi. They can afford to maintain their health at every stage of their development: This recognizes the dynamic nature of health needs and resources as a community develops socially and economically. Sustainable primary health care must be based on flexible

vii. In the spirit of self-reliance and self-determination: This encourages communities to develop their essential healthcare systems using their local resources and expertise without overt reliance on external aid or interventions.

Primary health care is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. It enables health systems to support a person’s health needs through health promotion, disease prevention, treatment, rehabilitation, palliative care, etc., in a way that is centered on people’s needs and respects their preferences.^[3]Primary health care – WHO.

The 13 Components of Primary Health Care

According to the World Health Organization, three statements summarize the components of PHC:

• Integrated health services that meet people’s health needs throughout their lives
• Solutions that address the broader determinants of health through multisectoral policy and action
• Interventions that empower individuals, families, and communities to take charge of their own health.

The first component above could be further subdivided into 13 health components that cater to all the essential health needs of any country. The other two components above form what is described as the principles of PHC. At the outset, 8 essential components of PHC were outlined but newer components were recently added to the list.^[4]IAPSM Gujarat Chapter. 2013. Primary Health Care

In this section, you will see the current 13 components of PHC according to the World Health Organization, and what they each stand for.

1. Health Education

Health education involves teaching people about the identification, prevention, and control of common diseases to achieve better health in the population. It involves methods of dissemination of information including mass media, health talks, group discussions, demonstrations, role-play, drama, and other traditional modes of public health education.

Health education is a core tenet of PHC because it ensures people have enough of the right information to lead more healthful lifestyles and make informed decisions about their health. It inculcates information for the prevention, treatment, and control of the spread of diseases in the community.

2. Immunization against the major communicable diseases

Immunization is another component of PHC that focuses on the prevention of common communicable diseases that are vaccine-preventable. Globally, deaths from vaccine-preventable diseases are still at alarming rates despite the availability of vaccines. This component of primary healthcare prioritizes immunization for children and eligible groups against major vaccine-preventable diseases.

Some examples of vaccine-preventable diseases include tuberculosis, polio, yellow fever, diphtheria, tetanus, etc. Since the Alma-Ata conference, many countries have adopted routine immunization programs for children and other susceptible groups to improve health for all and reduce preventable mortalities.

3. Prevention and control of locally endemic diseases

By focusing on locally endemic diseases, the community and individuals will be more interested as they can see that the problems affect them. This improves community participation, which is the core principle of primary health care, and ensures the sustainability of the program.

A disease is said to be endemic if it affects more than 10% of the population. Locally endemic diseases are oftentimes restricted to a subset of a population exposed to the same predisposing factors. For example, goiter is known to be commoner/endemic in highland areas with low soil and water levels of iodine. Malaria is endemic in sub-Saharan Africa and parts of India.

With effective prophylaxis, vector control, and effective medications for the treatment of sick individuals, locally endemic diseases can be prevented and controlled in the community. Thus, ensuring better health for the population.

4. Maternal and child health care, including family planning

Maternal and child health care is aimed at reducing maternal and child mortalities. These are important indices of any country’s health system. The lower the number of maternal and child deaths a country has, the better is its health system.

Including maternal and child health in the primary health care model addresses the common issues related to childbearing and motherhood in all human communities. This involves antenatal care services, delivery, postnatal care, pre-conception care, and fertility services.

Family planning is a subset of maternal and child health which entails the prevention of unwanted pregnancies, determination of family size, and birth spacing. It also inculcates health education on contraception, safe motherhood, and child spacing for healthy motherhood and family.

5. Adequate supply of safe water, and basic sani­tation

Lack of access to adequate quality water is often associated with the incidence of water-related diseases like cholera, typhoid, diarrhea diseases, scabies, trachoma, guinea worm, schistosomiasis, etc. Hence, an adequate supply of safe water was included in core tenets of primary health care.

Basic environmental sanitation is also important in the reduction of food and hygiene-related diseases. Many disease vectors breed when in a filthy environment, water, land, and air.

Thus, by providing an adequate supply of safe water and prioritizing basic sanitation, many common diseases can be prevented, ensuring better health for the family, individuals, and their community.

6. Promotion of food supply and proper nutrition

Proper food and nutrition is one of the major pillars of health. Adequate nutrition helps in healthy growth, body development, and the development of the immune system to fight against infections and diseases.

Nutritional diseases or malnutrition is one of the topmost killer diseases in children, and these include marasmus and kwashiorkor. Adequate nutrition also helps in the development of a child’s body, and brain, and for full functionality of the body’s organs and tissues.

Thus, this was included in the essential components of PHC to ensure health education and implementation of policies and interventions aimed at food supplementation, fortification, and availability to susceptible groups within the community.

7. Provision of essential drugs

In line with the objective of PHC to provide essential healthcare that caters to the common needs of the community, essential drugs are medications needed for prophylaxis or treatment of common illnesses and diseases. They are well-selected specifically for every country or community.

This advanced the essential medicine list concept to support equitable and effective healthcare delivery. Each country can focus on procuring essential medicines, thus ensuring more efficient use of limited financial resources while still providing adequate healthcare tailored to its needs.

While the World Health Organization publishes a model list of essential medicine list for global reference, individual countries adapt this list to meet their specific health needs, priorities, and contexts. This further emphasizes the “essential” nature of primary healthcare.

8. Appropriate treatment of common diseases and injuries

A functional healthcare system should be able to provide appropriate treatment for common injuries and diseases, which is why this was discussed in PHC. Treatment of common diseases and injuries involves the provision of essential medicine (as discussed in the essential drugs component above), adequate and well-functioning facilities, and well-trained health workers.

In light of these, primary healthcare devised a model of categorizing healthcare centers into strata, developing a two-way referral system between the primary health facilities and higher centers. It also prioritizes the training of health workers at different levels to help implement all the other components of primary healthcare, including health education.

9. Prevention and control of non-communicable diseases

This is one of the newly added components of PHC. It aims to prevent and treat non-communicable diseases like diabetes, hypertension, cancer, arthritis, etc., through health education, and treatment.

10. Primary mental health

Mental health and well-being were recently included in the components of PHC as a reflection of the holistic definition of health as a complete state of physical, mental, and social well-being of an individual and not necessarily the absence of disease or infirmity.^[5]Constitution of the World Health Organization – WHO

Mental health plays a very crucial aspect of general well-being. It can impact all aspects of a person’s life, which is why it was important to include it as a core component of primary healthcare.

11. Primary dental health

This involves the provision of dental health services to individuals and the community at a cost they can afford to maintain. It helps manage dental-related disease conditions to provide holistic health for all.

12. Primary eye care

Primary eye care acts as the first line of treatment for eye conditions before referral to a specialized health facility. The primary healthcare model consists of all basic interventions or treatments for eye conditions, as well as other components discussed here. Thus, earning the name “Healthcare under one roof”.

13. Primary geriatric care

For primary healthcare to be comprehensive enough, one component still needs to be included, which is geriatric care. This is the care of aged people and the treatment of health challenges associated with aging.

To attain universal healthcare, primary geriatric care was designed to enhance access to healthcare for old people with special health conditions regardless of their financial status or where they live within any given country.

Principles of Primary Healthcare

For the components of primary healthcare to be efficiently delivered, certain principles needed to be established and promoted. These are the principles of primary healthcare as follows.

1. Political will: The goals and components of PHC will not be accomplished if the government of the day is not motivated to make them work.
2. Equitable distribution of resources: Equitable distribution of resources ensures that every community or state has adequate resources that meet their population needs. Equitability is different from equality, but every population needs to have as many healthcare resources as it needs.
3. Community participation: Primary healthcare aims at achieving healthcare for all irrespective of age, sex, and financial status. By involving community participation, this goal can be realized.
4. Intersectoral participation: Intersectoral participation or collaboration entails developing a mutual relationship between different sectors of the economy in the provision of primary healthcare. For example, involving the local agricultural sector can help meet the goal of providing food and proper nutrition.
5. Appropriate technology: The role of technology cannot be overemphasized in the attainment of the various components of primary healthcare. Medical diagnosis and treatment now rely largely on technology. Hence, appropriate technology was included as one of the principal tenets of primary healthcare.

Frequently Asked Questions

Are the components of PHC the same as the principles?

No, the components of PHC are not the same as its principles, though they are closely related. The components are the objectives or goals, while the principles are the strategies to achieve the goals/components of primary health care.

What is the significance of the components of PHC?

The components of primary health care collectively provide comprehensive and accessible healthcare to all. They reduce health inequities by focusing on prevention and essential treatment and also strengthen health systems to address both local and global health challenges.

Final words

Primary Healthcare is essential healthcare based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families at a cost that the community and country can afford to maintain at every stage of their development. This definition is all-encompassing.

The components of primary health care aim at providing healthcare to all at all ages, focusing on local diseases and health problems. These align with the ‘essential healthcare’ keyword in the definition of PHC. The other aspects of PHC describe the principles of primary health care, which are political will, equitable distribution of resources, community participation, intersectoral participation, and appropriate technology.