Landmarks in the development of Primary Health Care

The 1978 Alma-Ata Declaration placed Primary Health Care (PHC) at the centre of health services and at the forefront of overall social policy, and 40 years later, the Astana Declaration confirmed the principles of PHC and renewed its content. PHC has been influenced by events and writings that date from the early 20th century. The 1920 "Dawson Report" in the UK, which was not implemented, was the first to propose the organization of Primary and Secondary Health Centres, to be supported by teaching hospitals and other services. In the 1940s, Community Oriented Primary Care (COPC) in poor districts of South Africa combined the methodologies of public health and PHC with active community participation to achieve substantial improvements in the health of the population. In 1961, the "ecology of health" or the pyramid of health care utilization, showed how frequently the adult population makes use of health services, and provided the basis for the development of the three levels of health care. A new paper, 40 years later, showed that, in terms of "order of magnitude", the original findings remain valid. With the Declaration of Alma-Ata, the member states of the World Health Organization (WHO) and UNICEF affirmed their commitment to reduce health inequalities through the development of horizontal, integrated and comprehensive PHC with community participation. The disparity between words and deeds, however, and "selective PHC" limited its success. In the developed countries, PHC was identified with the services provided by general practice/family medicine. The revival of interest in PHC in the 2000s is demonstrated by the World Health Report of 2008 "PHC: now more than ever". In 2018, the Astana Declaration revitalized the vision of PHC, but uncertainties are still expressed about its prospects. The uncertainties are augmented by the current Covid-19 pandemic and its unforeseen effects on society, the economy and politics and, by extension, on the health care services.