Primary Health Care (PHC), based on the Alma Ata declaration, calls for the movement of responsibility, resources, and control away from medical systems and curative measures toward health promotion. However, PHC implementation in practice appears to be heavily influenced by medical systems with its own attendant effects on the attainment of PHC goals. This study therefore examines the extent and effects of medical systems influence on PHC implementation in Ghana. The study uses the thematic framework approach to qualitative data analysis to analyze data collected from PHC managers through interviews. Ethical clearance for the study was obtained from the Noguchi Memorial Institute for Medical Research. Findings suggest that PHC in practice is tied to the apron-strings of medical systems. While this has catalyzed successes in disease control programs and other medicine-based interventions, it has swayed PHC from its intended shift toward health promotion. Community ownership, participation, and empowerment in PHC is therefore lost in the maze of medical systems which reserves power over PHC decision making and implementation to medical professionals while focusing attention on treatment and curative services. Ultimately, PHC has gradually metamorphosed into mini-clinics instead of the revolutionary community-driven promotive services espoused by Alma Ata with concomitant effects on the attainment of Universal Health Coverage. Further, findings show how gradually, the primary in PHC is being used as a descriptor of the first or basic level of hospital-based care instead of a first point of addressing existing health problems using preventive, promotive, and other community driven approaches. Without a reorientation of health systems, significant efforts and resources are channeled toward empowering health workers instead of local communities with significant effects on the long term sustainability of health efforts and the attainment of UHC. The study recommends further studies toward practical means of reducing the influence of medical systems.

PurposeResources as well as the capacity to employ them judiciously may well be the key to the attainment of the SDGs and other related health goals through primary health care (PHC). Within this PHC framework, however, the source of resources for PHC as well as the systems for managing these associated resources remain unclear, complex and lack substantive integration systems of implementing ministries, departments and agencies (both local and international) in Ghana. These issues are addressed by this study.Design/methodology/approachThe framework approach to thematic analysis was used to analyse qualitative data collected from key PHC managers in Ghana selected purposively from the national, regional and district levels. Data were collected through in-depth interviews specially designed in line with the study objectives. The study was also governed by the Noguchi Memorial Institute for Medical Research which provided ethical clearance for the study.FindingsAs per Alma Ata's recommendation, PHC in its purest form is a resource dense activity with far-reaching implications on individuals and communities. Without adequate resources, PHC implementation remained merely on paper. Findings show that the key capacities required for PHC implementation were finance, human resource, technology and logistics. While significant cases of shortages and inadequacies were evident, management and maintenance of these capacities appeared to be another significant determinant of PHC implementation. Additionally, the poor allocation, distribution and sustainability of these capacities had a negative effect on PHC outcomes with more resources being concentrated in capital towns than in rural areas.Research limitations/implicationsThis study has significant implications on the way PHC is seen, implemented and assessed not in Ghana but in other developing countries. In addition to examining the nature and extent of capacities required for PHC implementation, it gives significant pathways on how limited resources, when properly managed, may catalyse the attainment of the PHC goals. Subsequently, PHC implementation will profit from stakeholder attention and further research into practical ways of ensuring efficiency in the allocation, distribution and management of resources especially considering the limited resources available and the budding constraints associated with the dependency on external stakeholders for PHC implementation.Originality/valueThis study is part of a series on PHC implementation in Ghana. Quite apart from putting core implementation issues into perspective, it presents first-hand information on Ghana's PHC implementation journey and is thus relevant for researchers, students, practitioners and the wider public.