2023 World Population Data Sheet Special Focus on Climate and Vulnerability

Primary health care (PHC) serves as the foundation of a comprehensive health system for individuals, families, and communities. It can meet up to 90% of a person’s health needs throughout their lives, whether to promote healthy practices; prevent, manage, or cure an illness; or provide symptom relief, comfort and support to individuals living with serious illnesses.

With access to quality PHC, people can live longer, healthier lives. However, about 50% of the world’s population still lacks access to PHC.

Scaling up access to quality PHC across low- and middle-income countries—where the majority of the global population lives—could avert as many as 60 million deaths by 2030 and increase life expectancy by 3.7 years.

Achieving this goal requires an estimated additional annual investment across the world of US$200 billion to US$328 billion to strengthen and sustain PHC systems to provide quality, people-centered care delivered close to home that is responsive both to people’s needs and to changes in context.

What Is Primary Health Care?

PHC is an approach to health that is integrated, tailored to individuals’ and families’ needs, and delivered as close as possible to people’s daily environment. The global PHC movement calls for a whole-of-society approach to increasing equitable access to basic health care services within and across countries.

Comprehensive, integrated health services.

Policies and actions involving multiple sectors that address broader factors influencing health, including people’s social, economic, and physical environments.

Individuals, families, and communities’ participation in the design and oversight of health services and their own care.

Strong, resilient PHC systems can ensure quality, continuous, comprehensive, and coordinated people-centered care throughout people’s lives. They can improve health outcomes for populations, meeting their changing needs to prevent and treat health issues as they emerge over time.

Primary Health Care Can Help Countries Achieve Their Sustainable Development Goals

Despite significant progress made since the early 1990s, in much of the world we are off track to meet the Sustainable Development Goal (SDG) targets 3.1 and 3.2 for reducing deaths among mothers, newborns, and children under age 5. (See figure.) At the World Health Assembly in May 2024, Member States agreed to invest in accelerating their progress toward meeting these targets. Actions for progress would largely build upon services offered through PHC, including services in communities and facilities, with referrals to emergency care and more specialized care as needed.

Many Countries Are Off Track to Meet Sustainable Development Goal Targets for Neonatal Mortality, Under-5 Mortality, and Maternal Mortality

Off track to meet:
Neonatal mortality rate
Maternal mortality ratio
Maternal mortality ratio & neonatal mortality rate
Neonatal mortality & under-5 mortality rates
All three rates
None (on track/have met targets for all three rates)
Missing data on 1 or more indicators

Notes: Countries are classified as off-track to meet the SDG target for maternal mortality if the maternal mortality ratio is higher than 140 deaths per 100,000 live births. The criteria for being off-track for neonatal mortality and under-5 mortality vary across countries depending on the current rate and the rate of reduction. The SDG target for the neonatal mortality rate is 12 per 100,000 live births; the target for the under-5 mortality rate is 25 per 100,000 live births. See sources for more details.

Sources: UNICEF, “Never Forgotten: The Situation of Stillbirth Around the Globe,” Jan. 9, 2023; United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), Levels & Trends in Child Mortality: Report 2023 (United Nations Children’s Fund: New York, 2024); and PRB analysis of the maternal mortality ratio in Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division (Geneva: World Health Organization, 2023).

In addition to providing vital care that can decrease mortality rates for mothers and young children, PHC supports people with chronic conditions. For instance, PHC plays an important role in managing high blood pressure, also known as hypertension. Management of hypertension is one of the most important interventions to meet the SDG target 3.4, a one-third reduction in premature mortality from the leading noncommunicable diseases.

Globally, an estimated 1.3 billion adults were affected by hypertension in 2019, yet only one-fifth of them had their hypertension controlled. (See figure.) Left uncontrolled, hypertension can lead to stroke, heart attack, heart failure, kidney damage, and many other health problems—including cardiovascular disease, the world’s leading cause of death. Hypertension causes more deaths than other leading noncommunicable disease risk factors, including tobacco use and high blood sugar. Integrating hypertension and diabetes prevention, detection, and management into PHC, including by training community health workers to provide screening, counselling, and follow-up, has been shown to improve hypertension care management in many countries, from Pakistan to the United States.

Globally, Only 21% of Adults Ages 30-79 With Hypertension Are Considered to Have the Condition Controlled

Percent of adults ages 30-70 with hypertension whose condition is under control
Data not available

Note: Controlled hypertension is defined as a systolic blood pressure of ≤140 mmHg, a diastolic blood pressure of ≤90 mmHg, or taking medication for hypertension.

Sources: World Health Organization (WHO), The Global Health Observatory; and WHO, Global Report on Hypertension: The Race Against a Silent Killer (Geneva: WHO, 2023).

The Delivery of Primary Health Care Varies Across and Within Countries

While global guidance identifies an essential package of health services needed for all (universal health coverage), countries tailor what they offer as PHC based on their resources and population needs. As a consequence, countries need to track changes in their health service delivery systems, population’s age structures, illness distributions, and the needs of different age groups. With this information, they can adjust the scope of services; training of health workers; and equipment, supplies, and medications required to deliver quality PHC.

For example, in South Africa, which has high burdens of HIV, tuberculosis, and noncommunicable diseases, PHC incorporates HIV and sexually transmitted disease detection, care, and treatment; and tuberculosis testing and treatment. It also includes child health, reproductive health (antenatal, family planning, and maternity care), chronic disease (hypertension, diabetes, asthma), trauma and injuries, and management of disabilities.

Care in South Africa is provided through a network, with priority streams consisting of PHC outreach teams comprised of community health workers; district maternal, child, neonatal, and women’s health clinical specialist teams; an integrated school health program; and private general practitioners contracted to work in public facilities to address staffing gaps in the public sector.

In contrast, PHC services in the United Kingdom are the first point of contact and the “front door” of the National Health System. Services include general care (including advice, well-child visits, and antenatal care), dental care, optometry, and community pharmacies. Care is provided through primary care networks consisting of general practitioners, nurses, mental health professionals, pharmacists, physiotherapists, paramedics, physician associates, and social workers.

The National Health System includes a framework for patient and public participation in assessing needs, planning and prioritizing, and monitoring PHC services to achieve the best outcomes.

In Thailand, delivery of primary health care varies within the country depending on whether a person lives in a rural or urban setting. PHC in rural areas is provided by the public District Health Systems Network, composed of subdistrict health centers and district hospitals. The District Health Systems Network provides a comprehensive range of services throughout a person’s life course, including health promotion, disease prevention, and primary care services. It also supports public health functions such as disease surveillance and response.

PHC is less well-developed in Thailand’s urban settings. Most urban populations obtain their care from both public and private hospital-based outpatient departments, which provide primary care services similar to the District Health Systems Network.

As urbanization continues, it will be important for countries to pay increasing attention to strengthening their systems and networks of care in urban and peri-urban spaces.

The Shortage of Professional Health Care Workers Reduces Quality of Care

The effective delivery of PHC needs a robust and diverse workforce deployed in communities and facilities. Investments in increasing the availability and retention of skilled health personnel providing PHC services can improve population health outcomes. Yet, countries across the world are facing shortages in professional health staffing, which contribute to overworked health care workers and reduced quality of care. Migration of health professionals to places with better pay and working conditions contributes to low numbers of skilled staff in under-resourced settings within countries and globally.

In Ghana, where about 80% of health care needs are met by nurses, chronic shortages in the availability of nurses led to a national Human Resources for Health strategy implemented by the Ministry of Health between 2007 and 2011. The strategy included investments in increasing pre- and post-service training to ensure nurses were available and had the skills to deliver PHC services. As a result, the nursing workforce in Ghana grew 640% from 16,800 in 2008 to 125,000 in 2018.

While Ghana’s efforts focused on building up its nursing workforce, some countries are addressing their staffing challenges through more strategic use of community health workers (CHWs). In addition to nurses, CHWs are an integral part of the PHC workforce. Trained to provide preventive, promotive, and basic curative care and to refer more complex issues to facilities, CHWs can be uniquely positioned to bridge the gap in access to care among those most affected by health disparities and inequities.

CHW roles and responsibilities vary greatly from country to country, and there is great variation in their accreditation and whether they serve as volunteers or are paid. (See figure.) CHWs should not be considered as a means to reduce costs of care—they are key members of interdisciplinary teams that help achieve equitable access and delivery of quality primary health care.

Increasingly, Community Health Workers Are Accredited or Receive a Wage

Is at least one CHW group salaried & accredited?
Salaried and accredited
Only accredited
Neither
Data not available
Out of scope

Note: Out of scope means countries were not considered in the PROCHW Policy Dashboard.

Sources: Community Health Impact Coalition, “40/92 Countries Currently Have One or More CHW Group Who Are Accredited and Salaried,” PROCHW Policy Dashboard.

How Can Primary Health Care Better Meet People’s Needs?

While workforce shortages and the different service packages countries offer under PHC influence how effectively it can help them meet key SDGs, budgets are also an important factor. Resource constraints can limit PHC’s potential to meet up to 90% of an individual’s lifetime health needs and improve population health to accelerate progress in meeting SDG targets. The amount governments invest in PHC varies significantly. (See figure.)

Total Health Spending and PHC-Specific Spending per Person Vary Substantially Across Countries

Total Health Spending

Notes: Data refer to the current expenditure on total health care and on PHC per person in U.S. dollars, including both government and nongovernment expenditure. Data are from the latest year for which they are available between 2021 and 2022 for total health spending and 2018 and 2022 for PHC-specific spending.

Source: World Health Organization, Global Health Expenditure Database.

Make Investments in Primary Health Care a Priority

Annual government spending on PHC is on average $3 per capita in low-income countries and $16 per capita in lower-middle-income countries, which falls far short of most benchmarks used for the minimum amount needed to provide a basic package of health services. Much of the variation in estimated government spending levels, as well as overall spending levels from both government and nongovernment sources, can be explained by national income levels, but substantial differences can also be found among countries at similar income levels.

Government investments in health are often supplemented by outside sources, such as funders, with families often paying out of pocket, leading to fragmented PHC financing.

Governments typically invest heavily in higher-level care and equipment, like hospitals in the capital city and x-ray machines, while external funding is often used for prevention and PHC, and nearly half of private spending (most of which is out of pocket) is on medicines. Out-of-pocket spending on PHC remains high, particularly in low-income countries, continuing to expose households to financial risk.

To achieve the SDGs in health, including the target of universal health coverage, efforts to prioritize PHC in national health agendas and increase domestic spending on PHC are going to have to engage with a broad range of actors who influence decisions and funding for the health sector.

Foster Trust in and Accountability of the Health System

The West African Ebola outbreak, global COVID-19 pandemic, and shocks and disruptions such as conflict and climate extremes stress systems’ capacity to continuously provide accessible, equitable PHC and can lead to an erosion in trust in formal health systems. Dialogues between governments and the people they serve, especially those considered to be socially vulnerable or marginalized, can lead to primary care systems that are more responsive to people’s needs.

There is growing evidence that social participation in health-system planning and governance has the potential to foster trust in health systems, advance equity, and align the delivery of health care with the reality of people’s lives. This participation can take the form of local meetings between primary care staff and community members who share their concerns to jointly prioritize and problem solve, public hearings held by local authorities, public expenditure tracking systems, and other activities.

At the World Health Assembly in May 2024, Member States agreed to “implement, strengthen, and sustain regular and meaningful social participation in health-related decisions across the system.” This decision paves the way for people, communities, and civil society to have a stronger voice in influencing the decisions that affect their health and well-being.

References

Alliance for Health Policy and Systems Research and World Health Organization (WHO), Primary Health Care Systems (PRIMASYS): Case Study From South Africa, Abridged Version (Geneva: WHO, 2017).

James Avoka Asamani, Ninon P. Amertil, Hamza Ismaila et al., “Nurses and Midwives Demographic Shift in Ghana—The Policy Implications of a Looming Crisis,” Human Resources for Health 17, no. 32 (2019).

Bougangue Bassoumah, Andani Mohammed Adam, and Martin Nyaaba Adokiya, “Challenges to the Utilization of Community-Based Health Planning and Services: The Views of Stakeholders in Yendi Municipality, Ghana,” BMC Health Services Research 21, no. 1223 (2021).

Darius Erlangga, Timothy Powell-Jackson, Dina Balabanova et al., “Determinants of Government Spending on Primary Healthcare: A Global Data Analysis,” BMJ Global Health 8, no. 11 (2023): e012562.

Kara Hanson, Nouria Brikci, Darius Erlangga et al., “The Lancet Global Health Commission on Financing Primary Health Care: Putting People at the Centre,” The Lancet Global Health Commissions 10, no. 5 (2022): E715-E772.

Andrew L. Hartzler, Leah Tuzzio, Clarissa Hsu et al., “Roles and Functions of Community Health Workers in Primary Care,” Annals of Family Medicine 16, no. 3 (2018): 240-45.

NHS England, “Primary Care Services.”

Udani Samarasekera, “Experts Welcome WHA Resolution on Maternal and Child Health,” The Lancet 403, no. 10443 (2024).

USAID, Strengthening Primary Health Care Through Community Health Workers: Closing the $2 Billion Gap (2022).

WHO, “Primary Health Care.”