Primary Health Care

Our goal
To improve people’s health outcomes by strengthening the quality, accessibility, and efficiency of primary health care systems.
Mary Illya, volunteer health worker manages the pharmacy at the Primary Health Care Center in Akwanga, Nasarawa State, Nigeria on April 16, 2019.
Mary, a volunteer health worker, manages the pharmacy at the Primary Health Care Center in Akwanga, Nasarawa State, Nigeria. ©Gates Archive/Nelson Owoich

At a glance

  • A well-functioning primary health care (PHC) system can provide most of the health services that people need throughout their lives, including reproductive, maternal, newborn, and child health services, immunizations, nutrition services, and treatment for infectious and noncommunicable diseases.
  • Although PHC is the cornerstone of a strong health system, more than half of the world’s population lacks access to primary health care.
  • Women play an outsized role in the health of their children, families, and communities, so it is critical to design PHC systems to meet their needs.
  • Despite the benefits of PHC, insufficient and fragmented spending on PHC hinders the ability of countries to respond effectively to community needs and deliver high-quality care.
  • Evidence from strong PHC systems shows that with enough funding and the right policies, countries can improve PHC delivery.
Our strategy

Our strategy

The Primary Health Care team helps national governments reform their PHC systems and works to advance service delivery innovation in priority countries. When primary health systems are well-functioning, women and their families can live longer and healthier lives and countries can be better prepared to respond to health emergencies.

We support tailored approaches to enable more efficient funding for local delivery of essential health services and adequate supplies and resources at health facilities. We work to improve how PHC systems operate and how they are monitored and evaluated, including through the use of data for decision-making.

We also support countries in adopting new approaches to improve PHC delivery and lower its cost, including by exploring ways to use digital technology to increase the efficiency of health systems and help ensure that people have access to the care they need.

Our advocacy efforts highlight to countries and donors that PHC spending is a necessary long-term investment in population health and our shared future prosperity. We advocate for sustainable financing for PHC systems and proven PHC interventions. We work with partners to ensure that country-level and global partners are connected. And we support countries in accessing global funding mechanisms.

Oumar Seydi, Director, Africa offices, receives a post-visit brief at the Kibera Health Center in Nairobi, Kenya on April 22, 2022.
Oumar Seydi, Director, Africa offices, receives a post-visit brief at the Kibera Health Center in Nairobi, Kenya. ©Gates Archive/Khadija Farah
“Strong primary health care is the backbone of any health system and is crucial to progress on all health goals. The PHC system keeps families healthy in normal times and is the first line of defense in a health emergency like COVID-19.”
Tracey McNeill
Director, Primary Health Care
Bill & Melinda Gates Foundation
Areas of focus

Areas of focus

To advance progress on PHC and improve health outcomes, we work with partners to implement systems-strengthening approaches that are tailored to each community and country. We help countries spend more effectively on their health systems, measure progress, and scale up their impact, and we advocate for high-quality essential health services for all. 

We help governments implement reforms that improve the quality and quantity of essential PHC services while making the most of existing health budgets. Drawing on evidence from well-functioning PHC systems, we work with leaders and decision-makers to prioritize, implement, monitor, and adapt systems-level changes that are sequenced according to each country’s needs. Although every country requires a unique approach, our team focuses on cost-effective, proven reforms: adjusting financing models, decentralizing operations, building resilient and well-equipped workforces, and streamlining the use of data and accountability measures across health system management teams.

We help design and strengthen measures to track how well PHC systems are functioning, and we build the capacity of health management teams to ensure country autonomy in performance tracking. To help fill information gaps, we enable the collection of independent data from health facilities. Our team regularly engages with country leaders to help identify key areas for operational improvements and ensure that decision-making is supported by data.

We provide catalytic funding and support for government-led testing of innovative approaches to PHC service delivery through digital technologies. We focus on innovations that are patient-centered, integrated into public health systems, and designed to promote equitable access to essential services, especially for vulnerable populations. In all of our efforts, we work to ensure that digital tools do not contribute to further fragmentation of existing health systems.

Our team supports a cadre of regional and local technical assistance organizations, engages directly with other funders, and assists stakeholders in collecting compelling data and evidence to accelerate the adoption of proven mechanisms to strengthen PHC systems and PHC financing.

We advocate for countries and donors to invest in PHC systems and proven PHC interventions, thereby improving health outcomes for women and their families. Our goal is to ensure that health funding reaches the last mile—getting medicines on shelves and health workers to their posts. Our advocacy work is built on close collaboration with country stakeholders to ensure that PHC systems are built and led by those who understand them best. We also work to amplify the critical role of PHC in improving health outcomes and advancing progress on development goals such as universal health care. We support evidence-based dialogue on PHC and work to strengthen and expand the partner and champion ecosystem advocating for PHC.

Why focus on primary health care?

Why focus on primary health care?

Primary health care is a necessary component of a well-functioning health system. Countries with strong PHC systems see fewer children die before their fifth birthday and more people living longer, healthier lives.

PHC can provide all the basic health services that people need throughout their lives. Strong PHC systems can detect, prevent, and manage illnesses before they spiral out of control, helping to avoid needless suffering and excessive costs.

Without strong PHC, health systems can become overwhelmed, causing disruptions to essential services such as treatment of chronic diseases and routine immunizations. Communities with strong PHC are better able to detect and stop local disease outbreaks as well as implement public health measures during crises like the COVID-19 pandemic. Strong PHC systems are also essential to meeting women’s health needs—from access to family planning products and HIV prevention to maternal health services.

Despite the benefits of PHC, these systems are chronically underfunded, which leads to dire consequences: Every year, between 5.7 and 8.4 million people die from problems associated with low-quality health care. Insufficient and fragmented spending on PHC hinders countries’ abilities to respond to community needs and deliver high-quality care. Countries must also make overdue investments to ensure that their PHC systems are designed to meet women’s needs.

To advance progress on PHC and improve health outcomes, countries and donors must work together to spend smarter on health systems.

Health worker Salamatu Saidu holds up a guide for the mothers at Badarawa PHC during their group counseling in Kaduna, Nigeria on July 17 , 2019.
Salamatu, a health worker, holds up a guide for mothers at Badarawa PHC during their group counseling in Kaduna, Nigeria. ©Gates Archive/Yagazie Emezi
Strategy leadership

Strategy leadership

The following leaders are working to strengthen PHC by applying their expertise in health systems design, financing, and service delivery.