The World Health Report 2003 ortant gains, for example in immunization coverage and child mortality reduction, but were at odds with the comprehensive vision of primary health care developed at Alma-Ata, notably its emphasis on tackling the socioeconomic determinants of ill-health. In the 1990s, the World Bank recommended a set of core public health interventions and a package of essential clinical services influenced by primary health care models, though critics questioned whether these strategies responded adequately to the messages of equity and community tion delivered at Alm Originally, primary health care and the health-for-all movement represented an effort to change practices and structures in the health sector based on population health criteria. Subsequent health sector reform efforts have often been steered by criteria largely extrinsic to health(for xample, broad commitments to decentralization or civil service reform, or the need to re- duce government spending). Reaffirmation of primary health care principles by global health stakeholders signals a recognition of the need to return to population health criteria as the basis for decisions affecting how health care services are organized, paid for and delivered. Principles in a systems perspective This report reinforces an important conceptual shift towards the model of health systems based on primary health care. In a systems perspective, the potential conflict between pri- mary health care as a discrete level of care and as an overall approach to responsive, equitable health service provision can be reconciled. This shift emphasizes that primary health care is integrated into a larger whole, and its principles will inform and guide the functioning of the em A health system based on primary health care will build on the Alma-Ata principles of equity, universal access, community participation, nd intersectoral approaches take account of broader population health issues, reflecting and reinforcing public health functions: create the conditions for effective provision of services to poor and excluded groups organize integrated and seamless care, linking prevention, acute care and chronic care across all components of the health system continuously evaluate and strive to improve performance. Intervention across the disease continuum is needed to achieve the comprehensive care en visaged by such a system. To deal with the increasing burden of chronic diseases, both noncommunicable and communicable, requires upstream health promotion and disease pre- vention in the community as well as downstream disease management within health care services. Two integrated health care models, the chronic care model and its extension-WHO innovative care for chronic conditions framework- promote primary health care concepts intersectoral partnerships, community participation and seamless population-based care Evidence supports the use of these integrated models as a means of implementing primary health care principles, with demonstrated reduction in health care costs, lower use of health care services, and improved health status(6-9) ded Hiviaids treatment and health challenge. No blueprint exists, but valuable examples are emerging. Since May 2001, Medecins Sans Frontieres has provided antiretroviral therapy for HIVIAIDS through primary health care centres in the township of Khayelitsha, South Africa(10). The delivery of HIV/AIDS treatment in a primary health care setting underscores the potential for integration of differ ent types of care and begins to show how scaling up treatment could fit into-and help drive108 The World Health Report 2003 important gains, for example in immunization coverage and child mortality reduction, but were at odds with the comprehensive vision of primary health care developed at Alma-Ata, notably its emphasis on tackling the socioeconomic determinants of ill-health. In the 1990s, the World Bank recommended a set of core public health interventions and a package of essential clinical services influenced by primary health care models, though critics questioned whether these strategies responded adequately to the messages of equity and community participation delivered at Alma-Ata (5). Originally, primary health care and the health-for-all movement represented an effort to change practices and structures in the health sector based on population health criteria. Subsequent health sector reform efforts have often been steered by criteria largely extrinsic to health (for example, broad commitments to decentralization or civil service reform, or the need to re￾duce government spending). Reaffirmation of primary health care principles by global health stakeholders signals a recognition of the need to return to population health criteria as the basis for decisions affecting how health care services are organized, paid for and delivered. Principles in a systems perspective This report reinforces an important conceptual shift towards the model of health systems based on primary health care. In a systems perspective, the potential conflict between pri￾mary health care as a discrete level of care and as an overall approach to responsive, equitable health service provision can be reconciled. This shift emphasizes that primary health care is integrated into a larger whole, and its principles will inform and guide the functioning of the overall system. A health system based on primary health care will: – build on the Alma-Ata principles of equity, universal access, community participation, and intersectoral approaches; – take account of broader population health issues, reflecting and reinforcing public health functions; – create the conditions for effective provision of services to poor and excluded groups; – organize integrated and seamless care, linking prevention, acute care and chronic care across all components of the health system; – continuously evaluate and strive to improve performance. Intervention across the disease continuum is needed to achieve the comprehensive care en￾visaged by such a system. To deal with the increasing burden of chronic diseases, both noncommunicable and communicable, requires upstream health promotion and disease pre￾vention in the community as well as downstream disease management within health care services. Two integrated health care models, the chronic care model and its extension – WHO’s innovative care for chronic conditions framework – promote primary health care concepts: intersectoral partnerships, community participation and seamless population-based care. Evidence supports the use of these integrated models as a means of implementing primary health care principles, with demonstrated reduction in health care costs, lower use of health care services, and improved health status (6–9). Linking expanded HIV/AIDS treatment and health care systems development is a crucial challenge. No blueprint exists, but valuable examples are emerging. Since May 2001, Médecins Sans Frontières has provided antiretroviral therapy for HIV/AIDS through primary health care centres in the township of Khayelitsha, South Africa (10). The delivery of HIV/AIDS treatment in a primary health care setting underscores the potential for integration of differ￾ent types of care and begins to show how scaling up treatment could fit into – and help drive