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[Comment] Primary health care and universal health coverage: competing discourses?

In October, 2018, WHO celebrates 40 years since the International Conference on Primary Health Care (PHC) and offers a renewed vision of PHC—building on, but not replacing, the Declaration of Alma-Ata.1 In those four decades, PHC has faced challenges. Undermined early by the divisive selective-comprehensive debate, PHC was marginalised by structural adjustment and sectoral reforms in the 1990s.2 PHC was, however, acknowledged in the World Health Report 2000 Health Systems: Improving Performance as a precursor of the new universalism: “high quality delivery of essential health care, defined mostly by the criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor”.

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