Many countries, particularly low- and middle-income countries (LMICs), struggle to scale up effective PHC systems. Consequently, around the world, people still lack access to quality PHC services. Under Sustainable Development Goal (SDG) 3.8, all countries have pledged to “achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.”

PHC plays a key role in ensuring access to essential health services for all – but around the world, people still lack access to high-quality PHC services. For instance, more than 200 million women have inadequate coverage for family planning, almost 20 million infants fail to start or complete the primary series of DTP-containing vaccine, and many more infants miss other recommended vaccines. Meanwhile, expectations of health systems are rising, but satisfaction in them is not. For instance, a recent study showed that only about 42.4 percent of people in 28 sub-Saharan African countries were satisfied with the availability of high-quality health care in their areas of residence.  

Getting PHC right is complex and challenging. A number of problems face decision makers who are working on PHC. These are a few core challenges associated with building and implementing a PHC system: