What is ‘primary’ about primary health care?

In many countries health policy and health system reforms are giving primary health care (PHC) a more prominent role in the health system. As a result, policy towards PHC is becoming more contested and is posing bigger and more contradictory demands of PHC (e.g. that PHC should at once be more accessible and of higher quality and cheaper). International and professional bodies have responded to the debates about what the role of PHC should be partly by promulgating redefinitions of ‘primary health care’. However, such definitions tend simply to assert a policy standpoint of their own, thereby begging the policy questions noted above. This paper tests some better-known current definitions of ‘primary health care’ against various criteria of validity, including the requirement not to prejudge the aforementioned policy debates. It then constructs a fresh definition from the materials which survive that test and from a general theory of the function of health care. The resulting definition is: Primary health care: goods or services which individuals obtain for maintaining their personal functioning or preventing pain; which they can access directly and receive in settings which allow them to continue their other normal activities of daily life at home and (when applicable) at work. Whilst its present conclusions relate specifically to PHC, the paper’s method for generating and testing definitions applies to health services research generally.