Primary Health Care or Primary Care? Rethinking the Relationship Between Primary Care and Public Health in Transitional Health Systems

Abstract Since the Alma-Ata Declaration (1978), primary health care (PHC) has been widely promoted as the philosophical foundation of global health systems. Its comprehensive framework intentionally combines preventive, promotive, curative, rehabilitative, and community-based interventions. While this holistic vision remains influential, its operational interpretation in low- and middle-income countries has frequently created structural ambiguity regarding the boundaries of clinical primary care and population-based public health functions. International literature increasingly distinguishes primary care as person-centered clinical services and public health as population-focused preventive services. Using Libya as an illustrative case study of a transitional health system, this article examines how historical commitment to undifferentiated PHC contributed to poor gatekeeping, hospital bypassing, and fragmented preventive programs. Recent legal frameworks—including Law No. 20 of 2010—and emerging reforms through the Public Health Insurance Fund suggest movement toward strategic purchasing and functional differentiation. This viewpoint argues that transitional health systems may benefit from separating primary care from public health at governance and financing levels while maintaining coordination at the service delivery level.