What is PHC? Understand its principles and importance

Primary health care is the first level of contact between the population and the health system. It is where most health problems should be resolved: routine visits, chronic disease follow-up, vaccination, prenatal care, mental health, prevention. When this level works well, the other levels (hospitals, specialists, ICUs) receive the cases that truly need them.

For hospital managers, understanding PHC is important to know the hospital’s demand profile, the volume of avoidable hospitalizations and the revenue cycle.

What primary health care is

Primary health care (PHC) is the level of care closest to the population, focused on health promotion, disease prevention and continuous follow-up of people over time. The concept was formalized internationally by the Declaration of Alma-Ata in 1978, when the World Health Organization and UNICEF defined PHC as essential to achieving health for all.

In Brazil, PHC is regulated by the National Primary Care Policy (PNAB), established by Ministry of Health Ordinance GM/MS No. 2,436/2017. The policy defines primary care as the main entry point to the SUS (Brazil’s public health system) and establishes the Family Health Strategy as the priority model for organizing care.

The terms “primary care” (atenção primária) and “basic care” (atenção básica) are used as synonyms in Brazil because they refer to the same level of care: the difference is that “basic care” is the terminology adopted by the Ministry of Health, while “primary care” is the term established internationally by the WHO.

PHC principles and attributes

The PNAB defines four essential attributes that characterize primary care and two derived attributes that broaden its social role.

First-contact access

PHC should be the preferred entry point to the health system. Patients with any health need should be able to receive care at the basic health unit before being referred to other levels. When this access fails, the pressure shifts to emergency departments and hospitals.

Longitudinality

Longitudinal care is what sets PHC apart from any other level of care. It means following the same people over time, knowing their history, their family and their risk factors. Without longitudinality, PHC turns into a low-complexity urgent care service.

Comprehensiveness

PHC should offer a broad spectrum of care: prevention, promotion, treatment, rehabilitation. The patient should not be broken down into isolated complaints. The team needs to see the person as a whole and in the context of their life.

Care coordination

When the patient needs a specialist or a hospital service, the PHC team is responsible for organizing that referral and maintaining continuity of care. Without coordination, the patient gets lost in the system and higher-complexity services receive demands that could have been resolved earlier.

How PHC works in Brazil

The main PHC structure in Brazil is the Family Health Strategy (ESF), which turned 30 in 2024 with coverage of 92.5% of the national population. ESF teams are made up of a physician, a nurse, a nursing technician and community health workers, and they work in defined territories, with assigned populations of up to 3,000 people per team.

In 2024, 99% of Brazil’s health regions reached the national benchmark for PHC professionals per capita, according to a survey by the Ministry of Health’s PHC Panel (Painel APS). It is a significant advance, but distribution is still uneven: states with lower GDP per capita have higher physician turnover and greater difficulty retaining professionals on their teams.

Federal PHC funding was restructured by Ordinance GM/MS No. 3,493/2024, which linked part of the transfers to team performance. In May 2025, the Ministry of Health launched 15 new Quality Component indicators, organized into three blocks (family health teams, multidisciplinary teams and oral health teams), to monitor and drive improvements in the quality of care provided.

The difference between PHC and medium and high complexity care

The Brazilian health system is organized into three levels of care. PHC is the first, responsible for the care closest to the population. Medium complexity covers procedures and specialties that require specific technology and professionals (visits with cardiologists and orthopedists, imaging tests, minor surgeries). High complexity concentrates the most serious cases: long hospital stays, major surgeries, ICUs, oncology, transplants.

The ideal scenario is for each level to resolve what falls within its scope, referring to the next level only what it cannot resolve. When PHC is weak, this flow breaks down: cases that should be resolved at the basic health unit (UBS) end up in the emergency department, cases that should go to a specialist end up in the hospital, and the whole system becomes congested with demands that are inappropriate for the level that receives them.

A direct indicator of this imbalance is hospitalizations for conditions sensitive to primary care (ICSAP): diseases such as diabetes, hypertension and pneumonia that, when well managed in PHC, do not progress to hospitalization.

High ICSAP rates in a territory signal weakness in the primary care network and represent an avoidable cost for hospitals and payers. At the center of clinical work is the family and community physician.

PHC and hospital planning

Hospital managers who track the PHC indicators in their territory have a strategic advantage. The coverage and quality of primary care directly influence the hospital’s demand profile: the more robust the primary care network, the lower the volume of avoidable hospitalizations and the greater the concentration of medium- and high‑complexity cases.

This dynamic has a direct effect on the revenue cycle. Hospitals in territories with strong PHC tend to receive a more complex case mix, with a higher average claim and less exposure to disputes over clinical appropriateness. On the other hand, hospitals that absorb cases that should have been resolved in primary care face greater pressure on beds, lower-value claims and a growing risk of denials.

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Frequently asked questions about primary health care

What is the difference between primary care and basic care?

In practice, the two terms refer to the same level of care. “Basic care” is the terminology adopted by Brazil’s Ministry of Health, while “primary care” is the term established by the WHO and used internationally. The PNAB uses “basic care” as the official name, but recognizes its equivalence with PHC.

What is the Family Health Strategy?

The Family Health Strategy (ESF) is the main model for organizing PHC in Brazil. Created in 1994, it organizes multidisciplinary teams in defined territories, focused on a longitudinal bond with families and integration with the community. With 32 years of existence and coverage of 92.5% of the population, the ESF is considered one of the country’s most successful public health policies.

How does PHC affect hospitals?

Strong PHC reduces the volume of avoidable hospitalizations, reorganizes the flow of care and concentrates in hospitals the cases that truly need hospital care. For hospital managers, this means a more appropriate case mix, less pressure on beds and a lower risk of disputes over clinical appropriateness. The opposite is also true: weak PHC creates inappropriate demand for hospitals and puts pressure on the entire revenue cycle.