Primary health care, community health and the importance of community health workers
- Page updated onApril 12, 2026
Although since its inception there have been all kinds of attempts to reduce its meaning to that of «gateway» to the health system or to that of «non-specialized health services», the concept of primary health care is as ambitious as you can imagine. Primary health care is a strategy to achieve health for all, born at the end of the 20th century on a strong foundation: the consensus of health as a right and the need for a global socioeconomic transformation in favor of social justice and community power.
Today, primary health care seems to have taken a back seat, hidden behind the ubiquitous universal health coverage. However, its sound principles are more important than ever, in the face of the growing needs of the population and the shortcuts (with a neoliberal stamp) that are often camouflaged in the new global health financing proposals.
Table of contents:
Primary health care: Health, with a capital "H"
In 1978, all member countries of the World Health Organization recognized, in one of the most inspiring global health policies in our history, a strategy that made the leap from the biomedical to the right to health, its social determinants, from the community and for the community.
In fact, the Declaration of Alma Ata contained such revolutionary phrases as «the people have the right and the duty to participate individually and collectively in the planning and implementation of their health care», «governments have the obligation to take care of the health of their people, obligation which can only be fulfilled by the adoption of appropriate health and social measures» or «all countries should cooperate, in a spirit of solidarity and service, in order to ensure primary health care for the entire population».
Primary health care is much more than a front door
Primary health care, in its beginnings, was not only considered as the first level of contact (or gateway) of families and the community with the health system. Nor was it only a bridge to other sectors to address health problems. Primary health care was designed as the central function and main core around which any health system should be built. It is what allows this system to understand health as holistic and to act on the social determinants of health and disease.
The new model gave anyone access to integrated services (prevention, promotion, cure and rehabilitation), longitudinal (with a continuous relationship with people throughout their lives), integrated (considering the biomedical and the psychosocial), accessible (through a reception in health centers in each small population and community) and with a strong community orientation and participation.
Community participation is a pillar of primary care and health systems.
When we speak of community participation in primary care, we are referring to a genuine commitment to it. As established in 1978, «primary health care requires and encourages to a maximum degree the self-responsibility and participation of the community and the individual in the planning, organization, operation and control of primary health care». Successive reinterpretations of primary health care also put the focus on decision-making processes, to make them more democratic, transparent and accountable, thus allowing the community to have power and control in the health system.
From idealism to structural reform in primary health care
In 1982, only four years after the publication of the Alma Ata declaration, there was an enormous world economic crisis that led to the collection of the foreign debt of many middle- and low-income countries that were trying to implement the new strategy towards health for all. The International Monetary Fund and the World Bank provided loans conditioned to the application of structural adjustment policies, forcing these countries to cut back on social policies and sectors such as education and health.
Selective primary health care
As a result of the structural adjustment policies of the 1980s, the citizens of many countries saw how, in just a few years, the dream of primary health care was diluted. Health was no longer intended to be approached with a holistic vision and from a perspective of social justice and community participation. Instead, the door was opened to neoliberal approaches that only prioritized economic growth. The objective was not to promote health, but to facilitate the payment of foreign debt to creditors.
Under this new framework, governments and international health actors reinterpreted primary health care in its minimum expression. To do so, they stripped it of all its revolutionary, social and community bases. Thus, they limited it to the provision of a minimum package of basic and inexpensive services. These included growth monitoring for the prevention of malnutrition, oral rehydration as a treatment for simple diarrhea, promotion of breastfeeding, vaccinations, the spacing of pregnancies and the distribution of nutritional supplements.
At that time, international health initiatives with a vertical approach also appeared. These were focused on the prevention and treatment of a few diseases considered a priority, lacking a vision of strengthening health systems.
The results, evidently, were not equivalent to those expected with a complete vision of primary health care. This led authors to speak of the failure of primary health care, when in fact it had not been implemented.
A new goal: universal health coverage
At the beginning of the 21st century, the political discourse in favor of the primary health care of '78, which many people and civil society organizations had never ceased to demand, was taken up again.
New resolutions and reports (such as the 2005 World Health Assembly resolution 58.33, the 2008 World Health Report, or the 2018 Astana Declaration) seemed to accept that there has been a failure to develop the Alma Ata proposal over several decades. However, when it came to reintroducing interest in primary health care, they twisted the language. Primary health care was now presented as a means to achieve universal health coverage and was in the shadow of this new goal.
Many argue that with the change from primary health care to universal health coverage we've lost out. Under the noble objective of universal health coverage, fundamental aspects of the primary health care strategy have been ignored, such as the need for community participation and control, the importance of influencing the social determinants of health and disease or the obligation of governments to establish a public network of accessible and quality health services.
In place of these pillars stands a single pillar, that of financing mechanisms that allow services to be «bought» from public and private health care providers, and even through private insurers. This results in an opening of doors to the privatization of the heart of health systems, now less efficient, less equitable and more difficult to govern under a right-to-health approach.
Community health agents: seed of the new primary health care
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These people, most of them women, have often maintained their commitment despite institutional mistreatment or instrumentalization by political powers as well as by the health services themselves or cooperation actors. Deprived of adequate recognition and incentives, they have been used as cheap labor, without being granted mechanisms for participation and control of the system.
Today, despite continued bashing of primary health care or misunderstood community participation and the failure of numerous poorly conceived or inadequately supported community health agent programs, these people continue to demonstrate their enormous transformative potential in their communities. Therefore, from a vision of equity, social protection, public health and gender, the strengthening of a health system cannot be understood without thinking about the empowerment of these volunteers and the rest of their community.
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How to cite this page
Abarca, B. (April 12, 2026). Primary care, community health and the importance of community health workers. Salud Everywhere. https://saludeverywhere.com/en/health-in-humanitarian-crises/primary-health-care-and-community-health/
External links
- WHO, 2025. Global curriculum guide for community health workers.
- O’Donovan, 2025. Costs and cost-effectiveness of integrated horizontal community health worker programmes in low- and middle-income countries (2015–2024): a scoping literature review.
- WHO, 2024. Implementing the Primary Health Care Approach: a Primer. PHC Global Report, volume 1.
- Community health impact coalition.
- World Bank, 2022. Walking the Talk: Reimagining Primary Health Care after COVID-19.
- WHO, UNICEF, 2020. Operational framework for primary health care.
- Sanders, 2019. From primary health care to universal health coverage—one step forward and two steps back.
- WHO, 2018. Primary health care and health emergencies.
- Rifkin, 2018. Alma Ata after 40 years: Primary Health Care and Health for All – from consensus to complexity.
- People’s Health Movement, 2018. Alternative Civil Society Astana Declaration on Primary Health Care.
- WHO, 2018. Declaration of Astana.
- WHO, UNICEF, 2018. A vision for primary health care in the 21st century.
- People’s Health Movement, 2017. Universal health coverage: only about financial protection? Global Health Watch 5.
- People’s Health Movement, 2017. Revitalizing community control in primary health care. Global Health Watch 5.
- Zurro, 2011. Atención primaria de salud y atención familiar y comunitaria.
- WHO, 2008. The world health report 2008: primary health care now more than ever.
- People’s Health Movement, 2000. The People’s Charter for Health.
- Barbara Starfield, 1998. Primary care. Balancing health needs, services, and technology.
- OMS, 1978. Declaration of Alma-Ata.