[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Family and community nursing](https://durgical.com/en/nursing/areas/community/) › Primary health care (APS): Alma-Ata, Astana and Colombia's APS strategy # 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. Updated Nov 13, 2026 ## Key points - WHO: PHC is a whole-of-society approach, centred on people's needs and close to their daily life. - WHO's three components: integrated services (primary care plus public health), multisectoral policy, and empowered people and communities. - Alma-Ata 1978: PHC as the key to Health for All; Astana, October 2018: renewed commitment. - Law 1438 of 2011, art. 12: APS = health services + intersectoral/transsectoral action + social, community and citizen participation. - MinSalud: first contact is not just the first place, but the structured entry door to comprehensive care. - WHO estimates that about 75% of the projected health gains of the SDGs could be achieved through PHC. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/primary-health-care-alma-ata-astana-and-colombia-s-aps-strategy/) ## Elsewhere in DurgiPedia - [Colombia's General System of Social Security in Health (SGSSS)](https://durgical.com/en/epidemiology/colombia-s-general-system-of-social-security-in-health/) - [The Statutory Health Law (Law 1751 of 2015)](https://durgical.com/en/epidemiology/the-statutory-health-law/) - [Comprehensive health care pathways (RIAS)](https://durgical.com/en/epidemiology/comprehensive-health-care-pathways/) ## Connections ## Related 3 - [Community and public health nursing: roles, levels of prevention and settings](https://durgical.com/en/nursing/community-and-public-health-nursing-roles-levels-of-prevention-and-settings/) - [Colombia's basic health teams (equipos básicos de salud): territory, families and the nurse's role](https://durgical.com/en/nursing/colombia-s-basic-health-teams-territory-families-and-the-nurse-s-role/) - [Colombia's health promotion and maintenance route (Res. 3280 de 2018) from the nursing side](https://durgical.com/en/nursing/colombia-s-health-promotion-and-maintenance-route-from-the-nursing-side/) [← All of nursing](https://durgical.com/en/nursing/) 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)](https://www.who.int/news-room/fact-sheets/detail/primary-health-care) (World Health Organization, 2025); [Declaration on Primary Health Care (Astana, 2018)](https://www.who.int/teams/primary-health-care/conference/declaration) (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)](https://www.minsalud.gov.co/Normatividad_Nuevo/LEY%201438%20DE%202011.pdf) (Ministerio de Salud y Protección Social, Colombia, 2011); [Atención Primaria en Salud: componentes y atributos (presentación técnica, 12 de marzo de 2026)](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PSA/atributos-aps-12032026.pdf) (Ministerio de Salud y Protección Social, Colombia, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/primary-health-care-alma-ata-astana-and-colombia-s-aps-strategy/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/primary-health-care-alma-ata-astana-and-colombia-s-aps-strategy/