When most health providers talk about the origin of primary health care (PHC), they typically make reference to the Alma Ata Declaration that was promulgated at the International Conference on Primary Health Care convened by WHO in Alma-Ata, USSR from 6‑12 September 1978.  This is disputable because the concept of PHC had existed long before Alma-Ata (White et al., 1961).

Between 1960s and 1970s, towards the end of the Cold War, the United States faced a crisis of hegemony, and it was in the political quagmire that the PHC concept emerged (Boerma., 2006). At that point, U.S. government in partnership with the WHO and donor agencies was using the ‘vertical health approach’ in its fight against malaria. Although the primary care strategy had existed since 1950s, there was widespread criticism on the care model which stirred John Bryant’s effort towards the formulation and implementation of new health development policies in the publication titled ‘Health and the Developing World.’ The study analysed lack of preventive health care strategies in the American care model and how developing countries can adapt hospital-based health care system. The scholar noted that more than half of the world’s population at that time had not access to health care at all. He also emphasized that a large segment of the rest received health care that did not provide remedial solutions to their health problems. Bryant openly criticized the U.S. health system for using personnel with vaccinating syringes and spray guns who cannot provide effective answers to the most serious health needs—beyond malaria—ravaging the continent (Cueto., 2004)

Similar to the argument from Bryan, another renowned researcher Carl Taylor (the chairman and founder of the Department of International Health at Johns Hopkins University) reviewed and edited a literary work that analysed Indian rural medicine with the suggestion that less-developed countries should adopt the Indian care model to achieve country-specific health objectives. Another WHO employee Kenneth W. N. (1967) authored an influential book ‘Health for the People’ after collecting and examining data from the Health Council of the Netherlands (2004) to understand the experiences of medical auxiliaries in developing countries. In his argument, he stated that adapting ‘a strict health sectorial approach’ as a general model of care would be highly ineffective and totally unproductive (Macinko et al., 2003). In the same perspective, a 1974 Canadian Lalonde Report that was named after the minister of health downplayed the importance attached to the establishment of more health organizations/medical institutions and suggested that global health systems should concentrate on improving determinants of health—such as lifestyles, environment, health services, biology etc (Shi et al., 2002; Atun et al., 2006).

Other evidence-based studies from domains outside the public health community were also impactful in the widespread criticism of an assumption that primary care started with the transfer of technology (Ewan et al., 2005; Blank & Valdmanis., 2015)., training of more doctors, and expansion of health services (Longest et al., 2000). Thomas McKeown (a British historian) also argued that positive developments in the overall health of a given population are not totally dependent or related to medical advancement. However, he emphasized on the quality of nutrition and living standards. Ivan Illich took a bolder stance in the masterpiece titled ‘Medical Nemesis’ where he argued aggressively that medicine was irrelevant and detrimental to everyone’s health for the fact ‘medical doctors expropriated health from the public.’ Illich’s best-selling book was translated in different languages—including Spanish (Cueto., 2004; Kringos et al., 2006a; Mosadeghrad., 2015).

Another remarkable study on the origin of primary health care identified influence from the experience of missionaries. According to Kringos et al (2008b), the Christian Medical Commission (CMC)—an arm of the World Council of Churches (WCC)—and the Lutheran World Federation (LWF) was established in late 1960s by medical practitioners serving as missionaries in developing countries. The specialized organization made significant contributions towards training community members at the grassroots level on simple care methods and equipping them with essential drugs. By 1970s, the CMC publication (journal) garnered over 10,000 purchases after it was translated into Spanish and French.

Despite the individual and organizational contributions to the establishment of PHC around the globe, it is pertinent to note that John Bryant and Carl Taylor belonged to the CMC before the 1974 agreement between the organization and WHO was officially proclaimed and acknowledged by the European Commission (EC) (2013). Additionally, the formal collaboration was published in Newell’s Health by the People, which mentioned CMC programs while others were brought to the attention of the WHO by commission members. However, the partnership between WHO and CMC was brought to life because WHO headquarters in Geneva was located very close to CMC’s main office, so it was easy to communicate with the World Council of Churches and at least 50 staff members of WHO.

But a milestone for PHC was the global buzz created by the massive change in primary care model implemented by Communist China (Koppel et al., 2013). The groundbreaking expansive involved expansion of rural medical services through ‘barefoot doctors’ at a time when the Asian Tiger coincidentally earned recognition as a member of the United Nations (UN) and WHO. The number of local doctors quickly increased in early 1960s and the Cultural Revolution (1964–1976). After the political upheaval, a large number of community health workers living in the community they served clamoured for health care services centred on rural rather than urban areas. In their argument, a larger segment of the population lives in rural areas and are in need of preventive rather than curative services. The traditional care model encouraged use of both Western and locally made medicines to achieve national health goals. This marked the golden era of the PHC systems around the world (Ros et al., 2000; Koppel et al., 2003; van der Zee et el., 2004).