Primary care: The central function and main focus of the health system

Abstract

Forty-three years ago, the World Health Organisation's Alma-Ata Declaration 1 formally adopted the position that 'It [primary health care] forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community.' 1 This has never been an easy notion for governments to understand. The 20 th century saw a rise in health technology and growth of hospital care as the embodiment of health systems. Primary care is, by comparison, difficult to define (it is not a place, like a hospital), difficult to arrange (there are many different primary care approaches), and difficult to control (because lines of accountability are blurred). Largely left to develop organically, primary health care is different in different places. Despite this, signatory countries to the Alma-Ata Declaration persevered for many years with attempting to develop health systems aligned to inclusiveness, equity and other primary health care principles. Today, in the context of a global pandemic, we see retreat from that position. There is increasing talk of health system 'failure' without more critical care beds in hospitals, and COVID-19 vaccinations are seen as a way to protect hospitals from being over-run, rather than primarily as a way of protecting people from harm.