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Enormous shortfalls in infrastructure, supplies, and procedures undertaken are common at district-level health facilities in LMICs.

Increasing focus on health inequities has brought renewed attention to two related policy discourses - primary health care and the social determinants of health. Both prioritise health equity and also promote a broad view of health, multisectoral action and the participation of empowered communities. Differences arise in the lens each applies to the health sector, with resultant tensions around their mutual ability to reform health systems and address the social determinants. However, pitting them against each is unproductive. Health services that do not consciously address social determinants exacerbate health inequities. If a revitalised primary health care is to be the key approach to organise society to minimise health inequities, action on social determinants has to be a major constituent strategy. Success in reducing health inequities will require ensuring that the broad focus of primary health care and the social determinants is kept foremost in policy - instead of the common historical experience of efforts being limited to a part of the health sector.

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At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.

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