Strengthening Primary Healthcare: From Curative to Promotive Care

Editorial

Abstract

Introduction

Primary healthcare (PHC) is the foundation of prevention, health promotion, continuity of care, equity, and universal health coverage (UHC). It integrates primary care with public-health services, community participation, and action on social determinants of health. [1] Despite advances in hospital-based medicine, many communicable and non-communicable diseases, maternal and child health problems, malnutrition, and mental health conditions remain preventable through timely community-level interventions, emphasizing a shift toward promotive and preventive care [1].

 Situation in Pakistan

The need to strengthen PHC is particularly relevant to Pakistan, where health systems face a combination of communicable diseases, NCDs, maternal and child health challenges, and substantial inequalities in access to healthcare [2]. A 2024 assessment of PHC facilities in Punjab identified important gaps in medicine availability, equipment functionality, infrastructure, sterilization practices, and staffing. [3] These findings demonstrate that strengthening PHC requires more than policy statements; it requires sustained investment in the infrastructure and workforce necessary to deliver reliable services. A recent review of Pakistan's PHC system similarly identified persistent challenges affecting the quality and effectiveness of PHC and emphasized the importance of strengthening primary-level services as a pathway toward improved population health [4]. Pakistan has also implemented PHC-oriented initiatives aimed at improving access to essential services and advancing UHC. WHO reporting describes PHC-oriented models of care implemented in Islamabad and Charsadda, incorporating essential health-service packages and attention to maternal-child health and NCDs. These experiences suggest that PHC strengthening should involve coordinated action across government, healthcare institutions, communities, and other sectors [5].

 From Curative to Promotive Care

One of the most important priorities for strengthening PHC is to shift healthcare systems from a predominantly curative approach toward promotive, preventive, and early-intervention strategies. Primary-care facilities are ideally positioned to identify health risks before they progress to serious disease. Blood-pressure measurement, diabetes screening, vaccination, nutritional assessment, maternal and child health services, tobacco-cessation counseling, and lifestyle interventions can be incorporated into routine primary-care services. However, prevention should not simply mean adding more screening activities to already overstretched facilities [6]. Effective preventive care requires trained healthcare workers, appropriate diagnostic capacity, essential medicines, referral mechanisms, follow-up systems, and reliable health information. The WHO PHC measurement framework emphasizes monitoring PHC through a comprehensive approach that includes health promotion, disease prevention, diagnosis, treatment, rehabilitation, and community participation. The distinction between PHC and primary care is also important. Primary care provides essential first-contact clinical services, whereas PHC represents a broader approach involving multisectoral policies, empowered communities, public-health functions, and integrated healthcare [7].