April 14, 2024


Attendees of the international primary health care conference in Kazakhstan gain exclusive access to global evidence compiled by the Observatory and WHO 


It is time to harness the power of primary health care (PHC) to transform health systems in Europe. This was the call to action issued by the WHO Regional Office for Europe, the Ministry of Health of Kazakhstan and UNICEF, organizers of the International Conference on PHC in Astana.

Attendees of the conference, which commemorated both the 45th anniversary of the Alma-Ata Declaration and the 5th anniversary of the Astana Declaration, gained exclusive access to a global study compiling evidence from countries on their PHC-oriented health systems. 

“Implementing the Primary Health Care approach: a Primer”, which will be published jointly by the European Observatory on Health Systems and Policies and WHO in early 2024, was at the centre of one of the conference’s plenary sessions.

“We know enough to move our health systems towards primary health care,” said Dheepa Rajan, keynote speaker and health systems adviser at the European Observatory on Health Systems and Policies.

“Yes, there are gaps in the evidence, which we lay out in our book, but we also have a growing body of literature demonstrating that PHC is where you need to invest if you want your health system to be more equitable, efficient, resilient, and more accessible. So there is no excuse for a lack of policy action”.

Photo: Primary Health Care facility in Kazakhstan. Credit: WHO/Jerome Flayosc

Political economy of primary health care helps to understand lack of implementation

The history of primary health care since Alma Ata has demonstrated that a number of tensions linked to its political economy can offer lessons as to why the strong evidence base has not been fully translated into decisive investment into PHC.

Firstly, tensions have historically existed between vertical and horizontal approaches. Donors and international philanthropies, as well as national governments have favoured vertical approaches, which include programming, funding, and service delivery focused on a disease or population group. 

“PHC is, however, by definition, comprehensive and horizontal, therefore more complex,” reminded Dheepa Rajan. “Policy interventions oriented towards PHC need to happen at the systems level.”

Secondly, despite its good intentions, the pro-poor focus that many countries have historically taken to strengthen primary health care has unfortunately fed a false perception that PHC is only for impoverished communities and an inferior care solution for low-income settings.

Thirdly, the rapid scientific and technological progress in the decades after World War II led to an over-focus on hospitals, specialization, and care which was perceived to be ‘modern’. Generalism, in turn, suffered from lower prestige and investment, with many decision-makers failing to acknowledge that it requires a specific skill set and training with needs to be fostered and incentivized. 

A vicious cycle then ensues, with the public losing trust in frontline services without adequately trained generalists, reinforcing the perception that quality care is high-tech, specialized care. 

Participants of the session were reminded that generalists employ a range of non-medical skills – which also requires specific training – as they work with patients’ families and communities, traditional healers, social workers, and many others. 

Sign up to be notified when the global study becomes available: “Implementing the Primary Health Care approach: a Primer” 


Below, Dheepa Rajan, senior adviser at the European Observatory on Health Systems and Policies, on the main TV broadcaster in Kazakhstan ahead of the PHC conference in Astana.



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