Health (WHO Constitution): a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

Primary health care (PHC) is essential health care based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation, at a cost the community and country can afford. It is the first level of contact with the health system, bringing care as close as possible to where people live and work.

PHC is not the same as primary care.

• Primary care — first-contact clinical services for individuals (a level of care)
• Primary health care — a whole-of-society approach and strategy that includes primary care plus public health functions, action on social determinants, and community empowerment

Milestones

Global health addresses health issues and determinants that cross national borders and require cooperation among countries, with a priority on equity.

Principles (pillars) of PHC

• Equitable distribution and accessibility — services reach everyone, especially the underserved
• Community participation — people plan, implement, and evaluate their own health activities
• Intersectoral collaboration — health works with agriculture, education, housing, water, public works, social welfare
• Appropriate technology — methods that are scientifically sound, acceptable, affordable, and sustainable locally
• Emphasis on prevention and promotion, with referral support for curative care
• Self-reliance — communities build capacity to manage their own health

Philippine cornerstones (pillars) of PHC — commonly tested in Philippine CHN:

1. Active community participation
2. Intra- and intersectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available (government and partner support such as training, supplies, referral, and funding)

Essential elements of PHC (Alma-Ata)

1. Education about prevailing health problems and how to prevent and control them
2. Promotion of food supply and proper nutrition
3. Adequate safe water and basic sanitation
4. Maternal and child health care, including family planning
5. Immunization against the major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Provision of essential drugs

WHO's current PHC framework — three components

1. Integrated health services, with primary care and essential public health functions at the core
2. Multisectoral policy and action on the broader determinants of health
3. Empowered people and communities

Universal health coverage (UHC) means all people get the quality health services they need without financial hardship. Its three dimensions are who is covered (population), which services are covered, and how much of the cost is covered (financial protection). UHC does not require that every service be free; it requires fair financing so that payment does not cause hardship.

Selected SDG 3 targets (by 2030)

Global health governance

• World Health Organization (WHO) — the United Nations specialized agency that directs and coordinates international health work, sets norms and standards, and supports countries
• International Health Regulations (IHR, 2005) — the legally binding framework under which WHO can declare a Public Health Emergency of International Concern (PHEIC) and countries must detect, report, and respond to public health risks
• Other partners: UNICEF, the World Bank, global health funds, bilateral official development assistance (ODA) from donor governments, and non-governmental organizations

Measuring disease burden: disability-adjusted life years (DALYs) = years of life lost to premature death (YLL) + years lived with disability (YLD); one DALY is one lost year of healthy life.

Program approaches

• Vertical (selective) — disease-specific programs with their own staff and funding (e.g., a single-disease eradication campaign); fast results but can fragment services
• Horizontal (comprehensive) — strengthen the general health system and PHC to address many problems together
• Current strategy favors integrating disease programs within strong PHC ("diagonal" approach)

PHC in the Philippine community

• The UHC Act (RA 11223) builds its system on a primary care provider for every Filipino, defines primary care as first-contact, accessible, continuous, comprehensive, and coordinated care, and requires province-wide and city-wide systems to provide surveillance and health promotion — a PHC-based design.
• Community participation is visible in barangay health workers, trained volunteers accredited by the local health board (RA 7883), and in community organizing (COPAR, Topic 10).
• Levels of PHC workers: village or barangay health workers (first contact in the community, e.g., BHWs, trained traditional birth attendants), intermediate-level health workers (public health nurses, rural health midwives, sanitary inspectors, and the municipal health officer at the RHU), and first-line hospital staff who receive referrals.
• Intersectoral collaboration happens through local health boards, barangay councils, schools, and social welfare offices.
• Appropriate technology examples: oral rehydration solution for diarrhea, growth monitoring charts, home-based maternal records, basic water treatment methods.

Cost-effective interventions to reduce child deaths in low- and middle-income settings: immunization, oral rehydration, exclusive breastfeeding promotion, nutrition support, safe water and sanitation, and prompt treatment of pneumonia and diarrhea.

Cultural competence in global and community health: understanding local beliefs, language, and practices makes health education and programs acceptable and sustainable; programs imposed without cultural fit are often rejected.

• Deliver PHC elements at the community level: health education, maternal and child health, immunization, nutrition, sanitation advocacy, treatment of common conditions per protocol, and rational use of essential medicines
• Mobilize and train community volunteers; support community decision-making
• Coordinate with other sectors for water, sanitation, food security, and education
• Take part in surveillance and report events per national and IHR-linked requirements through the health system
• Advocate for equity: prioritize geographically isolated, poor, and marginalized groups
• Work in global health settings (humanitarian missions, overseas practice) with cultural humility and respect for host-country laws and systems

• The right to health and equity are the ethical foundation of PHC and UHC; the Alma-Ata and Astana declarations frame health as a shared responsibility of governments and communities.
• RA 11223 gives the Philippine legal basis for UHC, including automatic inclusion in the National Health Insurance Program and a primary care provider for every Filipino.
• RA 7883 recognizes and supports barangay health workers; they must be trained and accredited, and they work within their defined role.
• Under the IHR (2005), countries have obligations to detect, assess, report, and respond to public health events of international concern.
• Respect for autonomy and culture: community participation must be genuine, not token; programs should not exploit communities or override informed choices.
• Nurses remain bound by the Philippine Nursing Act of 2002 (RA 9173) when providing PHC services.

Case 1 — Diarrhea outbreak in a sitio. Cases increase after heavy rains.

• Correct approach: treat cases with oral rehydration, report and investigate, and work with the barangay council and sanitation staff on safe water and toilets.
• Why: combines treatment of common diseases, safe water and sanitation, and intersectoral collaboration.

Case 2 — Is UHC "free care"? A resident says UHC means all hospital services must cost nothing.

• Correct explanation: UHC aims for access to needed quality services without financial hardship; basic or ward accommodation has no co-payment, but other amenities may have costs.
• Why: UHC is about financial protection and fair contribution, not zero cost for everything.

Case 3 — Community-led planning. A PHN plans to introduce a new nutrition program designed at the regional office without consulting residents.

• Better action: hold a community assembly, share data, and plan the program with residents and local leaders.
• Why: community participation is a core PHC principle and improves acceptance and sustainability.

• Treating PHC and primary care as identical; PHC is the broader approach.
• Placing Alma-Ata in Astana, or dating Astana to 1978 — Alma-Ata was 1978; Astana was 2018.
• Assuming UHC means everything is free.
• Mixing up SDG 3.1 (maternal mortality ratio below 70 per 100,000 live births) with the neonatal target (12 per 1,000) or under-5 target (25 per 1,000).
• Believing WHO can act only through advice; the IHR is legally binding on member states.
• Thinking vertical programs are the preferred long-term model; integration within PHC is preferred.
• DALY is YLL plus YLD, not either one alone.

• WHO health definition: complete physical, mental, and social well-being, not merely absence of disease.
• Alma-Ata 1978 (WHO and UNICEF): PHC as the key to "Health for All by 2000."
• LOI 949 (19 October 1979) adopted PHC in the Philippines; Philippine cornerstones: community participation, intra- and intersectoral linkages, appropriate technology, support mechanisms.
• Astana 2018: renewed PHC as the foundation of UHC and the SDGs.
• PHC pillars: accessibility/equity, community participation, intersectoral collaboration, appropriate technology, prevention and promotion.
• Eight Alma-Ata elements: education, nutrition, water and sanitation, maternal and child health with family planning, immunization, endemic disease control, treatment of common conditions, essential drugs.
• WHO PHC components: integrated services, multisectoral action, empowered communities.
• UHC dimensions: population, services, financial protection.
• SDG 3 targets: maternal mortality ratio below 70/100,000; neonatal at most 12/1,000; under-5 at most 25/1,000; NCD premature deaths down one third.
• IHR (2005) allows WHO to declare a PHEIC.
• DALY = YLL + YLD.
• RA 11223 applies PHC through a primary care provider for every Filipino.