Expert Insight

Primary Health Care – Time for action!

Nurses in Tonga World Bank/Tom Perry
Strong primary health care is essential to achieving Universal Health Coverage. Yet, currently the reality is a far cry from this important goal. Over the years, many documents, declarations, resolutions and investments related to primary health care have been made, but progress has been less than satisfactory.

In the 1980s and 90s, the global health community debated the terms “primary care” (medical, curative, focusing on diagnosis and treatment of illness) and “primary health care” (broader, more comprehensive, and involves delivery of essential, affordable, accessible and acceptable care), exploring what a “primary health care” approach might yield. Yet, over the years, inadequate progress has been made on each. For many decades, health care financing was also viewed (and still sometimes is) as an expense – not as an investment with the return of saving lives and supporting people to contribute to their country’s economy and beyond.


And then came the 2014 Ebola outbreak.

Ebola devastated the health systems and economies of the affected countries. This was one more wake-up call that without strong health systems and strong primary health care no community and no country will prosper.

Nurses have been calling for strong primary health care for decades. We were one of the leading groups embracing the Alma Ata Declaration at the International Conference on Primary Health Care 40 years ago. In our recent action on the Global Strategy on Human Resources for Health, the International Council of Nurses (ICN), the global voice of nursing, states 'No Healthcare without a Healthcare Workforce, and No Healthcare Workforce without Nurses and Midwives.'” 

This sounds like common sense, but there remains a dire need to restructure, refinance and re-conceptualize primary health care systems, or better stated the lack of primary health care systems – with particular attention to the centrality of the healthcare workforce. This will not happen without a strong global movement and clear expectations for accountability on primary health care.


Today, with momentum growing around universal health coverage, it is more important than ever to strengthen primary health care. To ensure every person has access to essential and affordable health services, we need strong and responsive health care systems to deliver them, especially at the primary care level. And we need data! Better measurement and knowledge-sharing can help countries build the systems that meet the needs of people and communities.

In addition to better data, some of the necessary steps to strengthen primary health care are quite achievable and affordable:

  • Policy development: We need to make sure that policies are developed by those who know the reality on the ground: nurses, community leaders and other key players. ICN has been calling for nursing voices around the policy table for many years. But the reality remains that the financial, system and policy decisions far too often happen thousands of kilometers away from the places they touch and far too often lack gender balance. Decisions that might make sense in the cabinet office are often irrelevant and unrealistic in the field. We talk about people-centered care but we decide in the boardroom what it should look like. Does that make sense?
  • Policy implementation: We need to make sure that policies are also implemented by those who know the realities on the ground. We must set up goals, provide resources and then get out of the way. We will be amazed how the right people will make the right decisions. Yes, there will be mistakes. But, if we balance enabling people with ensuring accountability, I believe we will progress much faster than we have.
  • Teamwork: Finally, we need to get teams working together in the field. Our current approach of vertical funding of multiple initiatives is not giving us the best return possible.

Now is the time for action.

ICN supports the Primary Health Care Performance Initiative to catalyze improvements in PHC through better measurement and knowledge-sharing, while engaging critical voices on the ground, like nurses. By focusing on service delivery, PHCPI intends to give countries insight into the "how" of their PHC systems, not just the "what" that is conveyed through commonly used input, output and outcome measures. PHCPI offers its indicators not to burden countries with additional reporting requirements, but to offer a set of high-utility metrics that will help practitioners and policymakers who wish to better understand and improve their PHC systems.

More information on nurses and PHC can be found here:

Dr. Judith Shamian RN, PhD, D.Sc, (Hon), LLD (Hon), FAAN, is the President of the International Council of Nurses (ICN).