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What is PHC, and what is its relationship with UHC?

Primary Health Care (PHC) is the foundation of a comprehensive, community-based approach to delivering preventive, promotive, curative, and rehabilitative services at the community level, guided by principles of equity, social justice, community participation, and intersectoral collaboration. Universal Health Coverage (UHC), on the other hand, is a broader systemic goal that ensures universal access to essential health services without incurring financial hardship. Conceptually, PHC and UHC are thought of in overlapping ways, but they are never seen to be identical.

PHC is operationalized through integrated first-contact care, emphasizing continuity, prevention, and community participation as the organizing principle of health systems, while UHC is operationalized through three dimensions: population coverage (who is covered), service coverage (which services are covered), and financial protection (the share of costs covered). Over time, PHC has been identified as one of the key pathways to UHC, enabling universal access and equity by delivering people-centred care.

The two concepts are mutually reinforcing: without strong PHC systems, UHC cannot be achieved, while without the systemic outcomes of UHC, PHC risks remain fragmented and under-resourced. However, often in measurement, PHC and UHC overlap, in terms of domains, sub-domains, and indicators, causing definitional ambiguity and clouding exclusive analytical inferences.

Within this complex landscape, the specific role of Primary Health Care (PHC) as part of the pathway to UHC is relatively unexplored.

Why measure PHC? What are the PHC driven pathways to UHC?

  • The relationship between PHC and UHC is often conceptualized as a structured pathway, where PHC serves as the organizing strategy that translates systemic goals into tangible health outcomes.
  • At the foundation of the PHC–UHC pathway lie critical inputs: physical infrastructure, trained health workers, essential medicines and technologies, and governance and financing arrangements. These ensure that services are functional, available, and equitable, thereby creating the conditions necessary for population coverage, financial protection, and quality service delivery—the core dimensions of UHC.
  • This framing holds particular significance in decentralized health systems, where responsibilities for planning, financing, and service delivery are devolved to subnational levels, especially when national averages often conceal significant local variation in PHC performance, making inequities difficult to detect.
  • Crucially, the operationalization of this pathway depends on robust, context-sensitive measurement of PHC. Without systematic monitoring of both inputs and service delivery outputs at district or facility levels, policymakers lack the evidence required to track progress and ensure that UHC commitments are translated into equitable, high-quality, and people-centred care at the community level.

What is the India story?

  • India’s strategy for UHC has followed a two-fold approach: expanding access to quality PHC through HWCs (renamed as Ayushman Arogya Mandirs) and enhancing financial protection via publicly funded health insurance schemes. Therefore, PHC inputs, such as the availability of functional infrastructure, trained health workers, essential drug supplies, and effective facility-level governance, are the primary levers through which UHC goals are operationalized at different levels of governance.
  • UHC levels vary considerably across India. A district-level adaptation of the WHO-World Bank index found that priorities across state-level health systems have resulted in multiple models of, and pathways to, UHC across India.
  • However, a consolidated framework establishing the pathways from PHC to UHC is often missing, marked by definitional ambiguity and measurement overlaps.
  • Hence, a holistic framework is critical for enabling national and sub-national policymakers to monitor progress, identify regional disparities, and implement targeted reforms.

Team

The PHC4UHC India consortium brought together a multi-disciplinary team with expertise in health economics, anthropology, epidemiology, and social action, and with strong experience in applying mixed methods approaches to health systems research. While each partner contributed distinct expertise, all project activities were carried out collaboratively, with one partner designated as the anchor for management purposes.

Arnab Mukherji

Arnab Mukherji

Professor
IIM Bangalore

Sapna Desai

Sapna Desai

Senior Fellow at the Population Council Institute

Prashanth N Srinivas

Prashanth N Srinivas

Medical Doctor & Public Health Researcher

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