Doctrinal & Principles Framework Surrounding Extending Primary Health Care in Underserved Communities

Below is a complete, structured, authoritative list of all core doctrines, principles, pillars, and frameworks associated with the Extension of Primary Health Care (PHC) in underserved communities or countries.

This integrates WHO frameworks, Alma-Ata (1978), Astana (2018), UHC doctrine, Community Health Systems doctrine, Social Determinants of Health, and Health Equity Principles.

I. FOUNDATIONAL DOCTRINES OF PRIMARY HEALTH CARE (GLOBAL)

1. The Alma-Ata Doctrine (1978)

This is the original, foundational doctrine of PHC. It established:

Health as a fundamental human right
Governments’ responsibility to ensure accessible health care
PHC as the first level of contact with the health system
Community participation as a requirement
Emphasis on prevention, promotion, and basic curative care
Priority to vulnerable and underserved populations

Core Alma-Ata components:

Health education
Nutrition support
Safe water and sanitation
Maternal and child health
Immunization
Prevention & control of endemic diseases
Treatment of common diseases
Essential drugs

2. The Astana Doctrine (2018) / PHC for Universal Health Coverage (UHC)

A modern reaffirmation of PHC with three pillars:

Primary Care Services
Multisectoral Policy & Action
Empowered people & communities

Key Astana principles:

Quality & safety standards
Person-centered care
Financial protection & UHC
Strengthened health systems
Use of digital health technologies
Resilient community health workforce

II. HEALTH SYSTEM DOCTRINES FOR EXTENDING PHC TO UNDERSERVED AREAS

3. The Universal Health Coverage Doctrine (UHC)

The PHC extension framework for global health equity:

Access to essential health services for everyone
No financial hardship
Equity-driven coverage expansion
Prioritization of poor, rural, marginalized populations

5. Health Equity Doctrine

Frequently called the Equity-First PHC Doctrine.

Principles:

Allocate more resources to areas with highest need
Use of equity-based targets, indicators, and budgets
Removal of structural barriers: cost, culture, geography, discrimination
Prioritizing Indigenous groups, refugees, the disabled, minorities

4. Community Health Systems Strengthening Doctrine

(Used by WHO, UNICEF, USAID, Global Fund)

Guiding principles:

Community Health Workers (CHWs) as a formalized workforce
Task-shifting / task-sharing to extend services
Community-based surveillance
Integrated community case management (iCCM)
Home-based care
Community participation in governance
Door-to-door service extension
Local health committees as core structures

6. Social Determinants of Health Doctrine (SDOH)

PHC extension must address:

Poverty, unemployment, hunger, education
Gender inequality
Water, sanitation, housing
Environmental health
Transport and geography
Social protection systems

PHC extension integrates health + social services for underserved areas.

III. HEALTH DELIVERY DOCTRINES SPECIFIC TO EXPANDING PHC ACCESS

7. Community-Based PHC Delivery Doctrine

Focus:

Bringing services out of clinics and into communities
Outreach clinics
Health posts, mobile teams, and community medicine boxes
Home visits
Village health committees

9. Task-Shifting Doctrine (WHO Task Shifting Guidelines)

Redistribution of tasks from doctors to:

Nurses
Midwives
Community health workers
Pharmacy technicians
Lay counselors

Goal: Expand PHC coverage where professionals are scarce.

8. Mobile Health & Outreach Doctrine

Used by MSF, UNICEF, WHO in rural/remote areas.

Includes:

Mobile clinics
Mobile maternal care
Mobile immunization units
Emergency outreach
Seasonal outreach for nomadic populations
Integrated outreach health days

10. Public Health Promotion Doctrine

Core principles:

Behavior change communication (BCC)
Community awareness on hygiene, nutrition, MCH
School health programs
Village health education
Risk communication