Why primary health care?

Primary Health Care (PHC) is often the first point of contact an individual has with the healthcare setting and can be delivered in different settings by a wide range of providers (World Health Organization, 2018a). Behera et al. (Reference Behera and Prasad2022) describe PHC as the practice of diagnosing and managing health conditions, while also providing ongoing care and support for long-term and chronic illnesses. PHC offers an integrated, people-centred approach to health that addresses the root causes of poor health, including social determinants like poverty, inequality, and inadequate access to resources (World Health Organization, 2020). Unlike secondary and tertiary care, which tend to focus on specialized, acute care, PHC emphasizes prevention, early detection, and ongoing care at the community level (World Health Organization, 2019). PHC is well-suited to address the challenges posed by permacrises because it integrates health services with social and environmental policies, enabling a holistic approach to health that emphasizes resilience and equity (World Health Organization, 2018b).

Its primary aim is not only to treat illness but to prevent it and promote overall well-being (World Health Organization, 2020). In an era where permacrisis is a defining feature of global health, PHC is more important than ever. It provides a solid foundation for health systems to respond to multiple emergency situations such as the ongoing outbreaks of emerging infectious diseases, the long-term challenges posed by climate change, the negative health outcomes resulting from armed conflicts, and NCDs (World Health Organization, 2018b, World Health Organization & United Nations Children’s Fund, 2020).

PHC’s value lies in its ability to address both immediate health needs and long-term resilience. It ensures that essential health services remain accessible during times of crisis, whether caused by climate-related disasters, emerging infectious diseases, or political instability (World Health Organization, 2018b, Ngo Bibaa, Reference Ngo Bibaa2020). For example, in conflict-affected settings of Ekondo-titi in Cameroon where communities were cut off from immunization services for over 5 years, a measles and Mpox outbreak were successfully contained with PHC interventions (Metuge et al., Reference Metuge, Omam, Jarman and Njomo2021, Jarman et al., Reference Jarman, Alain, Conroy and Omam2022). Similarly, during the COVID-19 pandemic in Nigeria, adequate PHC staffing, flexible financing, and strong local government leadership were pivotal in restoring health service delivery volumes (Neill et al., Reference Neill, Peters, Bello, Dairo, Azais, Samuel Jegede, Adebowale, Nzelu, Azodo, Adoghe, Wang, Bartlein, Liu, OgunlaYi, Yaradua, Shapira, Hansen, Fawole and Ahmed2023) The adaptability of PHC is further demonstrated by Aljohani et al. (Reference Aljohani, Almofawwez, Alorinan, Alshamrani, Alnasser, Alghamdi, Alharbi and Alabduljabbar2024), who highlight the role of general and family physicians as frontline providers offering immediate care, psychosocial support, and community leadership across multiple crises. In Europe, Kumpunen et al. (Reference Kumpunen, Webb, Permanand, Zheleznyakov, Edwards, Van Ginneken and Jakab2022) describe the re-orientation of PHC systems into three distinct models: the deployment of multidisciplinary primary care teams for emergency response, the prioritization of vulnerable patients, and the adoption of digital tools to enhance both COVID-19 and non-COVID-19 care. These examples highlight PHC’s suitability for responding to public health emergencies, including the current global concern around mpox outbreaks (Zuluaga-Gómez et al., Reference Zuluaga-Gómez, Quintero-Vanegas, Gómez-Roldán, Agudelo-Herrera, Giraldo, Gonzalez-Arroyave and Ardila2022). Moreover, the ongoing threat of future pandemics or other public health emergencies of international concern further emphasizes the need to invest in robust PHC systems capable of early detection, rapid response, and continuous care. While PHC is not a panacea for all crises, it offers a vital foundation for health systems, especially in low-resource and crisis-affected settings.

Addressing systemic health challenges

A key contribution of PHC in an era of permacrisis is its capacity to address the underlying social determinants of health, including those exacerbated by climate change and conflict. Issues such as food insecurity, poor access to clean water, education, and housing are intricately linked to health outcomes (Marmot et al., Reference Marmot, Friel, Bell, Houweling and Taylor2008) and are increasingly threatened by environmental changes, such as droughts, floods, and extreme weather events, infectious disease outbreaks, as well as by the displacement caused by conflict. These challenges disproportionately affect vulnerable populations, heightening the burden of disease and creating barriers to accessing essential health services (Quinn and Kumar, Reference Quinn and Kumar2014; Workman et al., Reference Workman, Stoler, Harris, Ercumen, Kearns and Mapunda2022). By integrating health services with efforts to improve these social determinants, PHC can help mitigate the negative impacts of conflicts, climate change, disease outbreaks and food insecurity, promoting long-term resilience and better health outcomes in affected communities.

In conflict-affected settings, PHC offers a vital opportunity to bring services closer to populations, reducing the risks and challenges associated with long-distance travel to access stand-alone services. By delivering an integrated package of care, healthcare providers including Community Health Workers (CHWs) can ensure that communities receive comprehensive support while minimizing the risks of kidnapping or exposure to crossfire during travel (Omam and Metuge, Reference Omam and Metuge2023).

In the context of climate crises, PHC is essential in responding to the health impacts of extreme weather events, environmental pollution, and resource scarcity (Lokotola et al., Reference Lokotola, Mash, Naidoo, Mubangizi, Mofolo and Schwerdtle2023; Haines et al., Reference Haines, Kimani-murage and Gopfert2024). The health effects of climate change, including the spread of vector-borne diseases, heat stress, and malnutrition, disproportionately affect vulnerable populations. PHC can play a critical role in building community resilience to these effects by providing health education, promoting climate-adaptive health practices, and ensuring access to healthcare in areas impacted by climate-related disasters.

During periods of disease outbreaks like the COVID-19 pandemic, health systems globally were stretched beyond their limits. The pandemic highlighted the critical need for enhanced primary health systems capable of managing routine care while responding to emergencies. PHC serves as the first line of defence, offering continuity of care for chronic conditions, mental health support, maternal and child health services, and vaccines, all essential elements in times of crisis (World Health Organization, 2020). These lessons are particularly pertinent as the world shifts its focus from COVID-19 to other emerging health threats, such as the resurgence of mpox, Marburg and the rising impact of new infectious outbreaks.

In the context of food insecurity, PHC can directly address malnutrition and its associated health impacts through integrated services such as community-based nutrition programmes, supplementary feeding initiatives, and micronutrient supplementation (Kraef et al., Reference Kraef, Wood, Von Philipsborn, Singh, Peterson and Kallestrup2020; Omam and Metuge, Reference Omam and Metuge2023). For example, PHC facilities can screen children for malnutrition, provide therapeutic foods, and monitor their recovery, as seen in emergency nutrition interventions in drought-affected regions. Additionally, PHC can promote household food security through health education programmes on climate-resilient agriculture, breastfeeding practices, and diversified diets. Collaboration with local and international partners can further enhance these efforts by integrating food distribution and healthcare services, ensuring that populations receive both immediate nutritional support and long-term health benefits.

A people-centred approach to permacrises

In the face of permacrises, a people-centred approach to health becomes indispensable. PHC stands out for its emphasis on community involvement and tailored care that addresses the multifaceted challenges these crises present. By engaging communities in decision-making and designing interventions that respond directly to their needs and specificities in the face of compounding challenges. For example, in conflict zones, PHC can deploy mobile clinics to reach displaced populations, while in areas affected by climate change-induced food insecurity, it can integrate nutritional screening and therapeutic feeding into routine services (Omam et al., Reference Omam, Jarman, Ekokobe, Evon and Omam2021; Omam and Metuge, Reference Omam and Metuge2023). Such adaptability is critical in addressing the compounded barriers people face in permacrises, including long distances to care, financial constraints, and poorly equipped health facilities.

Moreover, by incorporating local knowledge and practices into health systems, PHC not only improves service delivery but also fosters trust and resilience within communities. Its flexibility facilitates effective operation in diverse settings, whether remote villages devastated by floods, overcrowded refugee camps, or urban slums grappling with disease outbreaks (Gizaw et al., Reference Gizaw, Astale and Kassie2022). A people-centred approach ensures that health interventions are not only immediate and responsive but also capable of strengthening global health security by enhancing community resilience, facilitating early detection of emerging diseases, and maintaining routine care during emergencies.

Looking ahead: the role of PHC in shaping the future of global health

As the world faces an uncertain future marked by ongoing permacrisis, PHC remains a crucial pillar for advancing global health. The path to achieving universal health coverage and improving health outcomes in the face of global crises lies in strengthening primary health systems. PHC offers a holistic, inclusive, and sustainable approach to health that can mitigate the adverse effects of permacrisis while promoting long-term resilience (Chotchoungchatchai et al., Reference Chotchoungchatchai, Marshall, Witthayapipopsakul, Panichkriangkrai, Patcharanarumol and Tangcharoensathien2020; World Health Organization & United Nations Children’s Fund, 2020).

To ensure that PHC can respond effectively to the challenges posed by permacrisis, governments, international organizations, and other stakeholders must invest in strengthening PHC systems, particularly in vulnerable settings. This includes increasing funding for health infrastructure, supporting the integration of CHWs in formal health systems, and ensuring that PHC services are integrated with broader social policies. The future of global health depends on a commitment to PHC as a cornerstone of sustainable health systems capable of withstanding the shocks of an increasingly uncertain world.

In conclusion, PHC is not merely a response to individual health crises; it is the cornerstone of global health security and resilience in an era defined by permacrisis. By investing in PHC, we can address the immediate health needs of populations, build long-term resilience to systemic and natural shocks, and tackle the root causes of health inequalities. Strengthening PHC is essential to navigating the complexities of permacrises and advancing toward the goal of achieving health for all, even in the face of persistent and interconnected global challenges.