Primary health care (APS): Alma-Ata, Astana and Colombia's APS strategy
- Fundamental
Primary health care brings care close to where people live, joins health services with other sectors and gives communities a real voice.
What it is
Primary health care (atención primaria en salud, APS) is not just the first level of care. WHO describes it as a whole-of-society approach that seeks the highest possible level of health and well-being, focused on people's needs, as early as possible and as close as possible to their daily life. It was set out at the 1978 Alma-Ata conference (Almaty, Kazakhstan) as the key to Health for All, and renewed in the Declaration of Astana in October 2018, on its 40th anniversary. Colombia signed Alma-Ata and adopted the APS strategy by law in 2011 (Law 1438, art. 12–16) with three integrated components: health services, intersectoral action for health, and social, community and citizen participation. Basic health teams are how the strategy reaches families.
Key points
- Law 1438, art. 12 defines APS as the intersectoral coordination strategy that allows comprehensive, integrated care, from public health to rehabilitation, at all levels of complexity.
- Art. 13 lists its principles, among them universality, interculturality, equality and the differential approach, intersectoral action, social participation and progressiveness.
- Art. 13 also stresses health promotion and prevention, a culture of self-care, an individual, family and community focus, multidisciplinary teams and a territorial approach.
- Art. 14: a national policy to strengthen low-complexity services so they can solve the most frequent health needs.
- Art. 15 and 16: basic health teams as a functional and organisational concept that eases access, with tasks such as the family diagnosis and risk identification.
Components
- Health services: comprehensive and integrated, with a resolutive primary level as the point of first contact.
- Intersectoral and transsectoral action: health works with other sectors on the determinants of health.
- Social, community and citizen participation: people take part in organising, overseeing and co-managing the services in their territory.
- Attributes described by MinSalud (2026): first contact, accessibility, comprehensiveness, relevance, timeliness, continuity, safety and sustainability.
What it is for
- Makes the right to health real by bringing care to the settings where people live, study and work.
- Reduces inequities by acting on social and economic determinants, not only on disease.
- Organises the network so that the primary level solves most needs and refers the rest.
In nursing practice
- The nurse is often the first contact: every encounter is a chance to review the whole family's promotion and prevention needs.
- Look for the five kinds of barriers MinSalud names: geographic, economic, administrative, cultural and social, and lack of information.
- Use extramural care, home visits and the basic health team to reach people who do not come.
- Activate referral and counter-referral so care continues between the primary and complementary levels.
- Involve community leaders and organisations: participation is a component of APS, not an extra.
Common mistakes
- Confusing APS with the first level of care or with «basic» low-quality care.
- Running health services alone, without other sectors or the community.
- Measuring only consultations and forgetting access, continuity and participation.
- Treating participation as informing the community instead of deciding with it.
Test yourself
Think of the answer, then tap the question to see it.
What are the three components of APS in Colombia's Law 1438 of 2011?
Health services, intersectoral/transsectoral action for health, and social, community and citizen participation.
In which year and place was the Declaration of Astana endorsed?
In October 2018, at the Global Conference on Primary Health Care in Astana, Kazakhstan, 40 years after Alma-Ata.
Is APS the same as the first level of care?
No. APS is a whole-of-society strategy; the primary level is its structured entry door, linked to the rest of the network.
Which two kinds of access barriers does MinSalud ask the team to look for?
Any two of: geographic, economic, administrative, cultural and social, and lack of information.
Elsewhere in DurgiPedia
- Colombia's General System of Social Security in Health (SGSSS)
- The Statutory Health Law (Law 1751 of 2015)
- Comprehensive health care pathways (RIAS)
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Primary health care (fact sheet) (World Health Organization, 2025); Declaration on Primary Health Care (Astana, 2018) (World Health Organization, 2018); Ley 1438 de 2011, por medio de la cual se reforma el Sistema General de Seguridad Social en Salud (arts. 12 a 16) (Ministerio de Salud y Protección Social, Colombia, 2011); Atención Primaria en Salud: componentes y atributos (presentación técnica, 12 de marzo de 2026) (Ministerio de Salud y Protección Social, Colombia, 2026).
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Representative model, for educational purposes only.