Primary Health Care and Community/Family Medicine
Core concepts
Primary health care is the first level of contact with the health system and a coordinating hub for comprehensive, continuous, accessible, community-oriented, and family-oriented care. Know the Alma-Ata and Astana declarations, the distinction between PHC and selective PHC, and the relationship between PHC and universal health coverage. Family medicine adds continuity, comprehensiveness, coordination, and a biopsychosocial approach. Understand community diagnosis, referral systems, gatekeeping, multidisciplinary teams, essential medicines, clinical audit, quality improvement, and patient-centred communication.
Traps
PHC is not merely first-contact care or a cheap package for the poor. Gatekeeping is not the same as rationing. Family medicine is not the same as a family doctor treating only families. Community diagnosis is not a clinic satisfaction survey. A referral without feedback breaks continuity. Audit is not punishment; it is a cycle of standards, measurement, change, and re-audit.
Worked example
A health centre audits hypertension care: 100 records, 70 had blood pressure recorded at the last visit, 50 of those were controlled, and 20 had no documented medication review. Standards: 90% blood pressure recorded and 70% controlled. The team introduces a checklist and nurse-led review, then re-audits. The gap between standard and practice drives improvement, not blame.
Rule of thumb
PHC is not a gate but a hub: accessible first contact, comprehensive continuous care, and coordinated referral.