Strengthening and Enlarging Primary Health Care as an evidence-based public health option under resource constraints: the case of opioid addiction

This article discusses the evolution in the concept of primary health care from the introduction of its principles, priorities and organizational structure at the WHO Alma Ata World Health Assembly 1978 to the current shift to primary care enlargement to encompass service provision across all health care sectors. It assesses specific characteristics of primary care such as decentralization of service provision, underlining its benefits in terms of achieving balance in managing health expenditures with available health resources to meet population health needs, given its responsiveness to local circumstances and flexibility in decision making. The article also addresses basic primary health care organization and function issues as well as contemporary trends, such as reimbursement for services on the basis of achieved outcomes, definition of specific patient access processes and focus on chronic diseases, due to an increasing prevalence and consequent cost. Overall, it builds a case for enlarging the primary health care agenda to cover mental health and substance use disorders, where the current focus on primary care delivery of services constitutes not only a literature review finding but also a key recommendation of international health policy bodies and institutions.