Primary Care

History of Primary Care

The term “primary care” was first introduced by Lord Dawson, the chief of the British Army's medical services, during World War I. The term, describing “primary healthcare centres” within an English National Health Service, was coined in the Dawson Report in 1920. During the 1960s, the concept of primary care became popular in the United States. In 1966, three influential groups, the National Commission on Community Health Service, the Citizen's Commission on Graduate Medical Education, and the Ad Hoc Committee on Education for Family Practice, commissioned reports to examine the role of the generalist physician resulting in white papers by Folsom, Millis and Willard. The specialty of family medicine was also established during this period. In 1978, the specialty of primary care was also recognized in reports from the World Health Organization and from the Institute of Medicine.

Declaration of Alma-Ata

In 1978, the World Health Organization held an International Conference on Primary Care at Alma-Ata. The Declaration of Alma-Ata, resulting from the conference, states,

“Primary healthcare is essential healthcare 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 and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reli-ance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing healthcare as close as possible to where people live and work, and constitutes the first element of a continuing healthcare process.” The key elements of the primary healthcare are, as described by the declaration include global cooperation and peace, a system adapted to the particular circumstances of a country and the communities within it, social and economic development, health promotion and disease prevention strategies, equity in health status, and involvement of all sectors in the promotion of health. The conference participants recognized that primary healthcare must address all causes of poor health including access, cultural, economic, political and social determinants.

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