0.0
Billion people
not fully covered by essential health services in 2023
Global Primary Health Forum · Chennai and San Francisco
Half the world livesoutside essentialhealth care.
The other half is the exception, not the rule.
We are a research and system design institution for primary health care. We study what works, build the measures that show where a system leaks, and work with governments and providers to redesign the parts that fail.
See the map →Scroll
0.0
Billion people
facing financial hardship from out of pocket health costs
0.0
Million health workers
the shortfall the world is projected to carry into 2030
Source: WHO and World Bank, Tracking Universal Health Coverage, Global Monitoring Report 2025, December 2025. Workforce shortfall from WHO, World Health Statistics 2025, May 2025.
The thesis
Most of what fails in primary care is not medicine. It is logistics.
A person is never screened. A positive screen is never confirmed. A confirmed diagnosis never starts treatment. Treatment starts and is never sustained.
Every one of those steps can be counted. Once counted, it can be costed. Once costed, it can be redesigned and funded. That is the whole of our method, and it is why we publish the number before we publish the recommendation.
Hypertension makes the case on its own. One point four billion adults live with it. The medicine is off patent and costs cents a month. Twenty-three in a hundred have it under control.
How we map it →Our work
Five activities, run in sequence and rarely alone.
Evidence without measurement is an opinion. Measurement without design is a scoreboard. We carry a question from study through to a system that keeps running after we leave.
01Research
Study what makes primary healthcare effective, affordable and scalable.
Field studies, cohort analysis and evidence reviews, published with named sources and a dated method.02Policy
Develop frameworks, recommendations and policy guidance for governments.
Recommendations are addressed to systems, budgets and programmes, and every one of them carries its cost.03Measurement
Build indicators, scorecards and tools to assess PHC performance.
Indicators a district can actually collect, scored the same way twice, so a change in the score means a change on the ground.04System design
Help countries redesign care delivery, workforce, financing and referral systems.
Care pathways, staffing models, payment design and the referral chain, redrawn against real capacity rather than intended capacity.05Implementation
Work with governments and providers to test, scale and evaluate PHC models.
Pilots with a stopping rule, scale with a budget line, and an evaluation agreed before the first site opens.The most pressing
Seven burdens where the world already knows what to do.
Ranked by how much of the burden sits untreated inside the reach of a primary health system. Not by how many people it affects, and not by how many people it kills.
01Hypertension1.4 billion adults. Detection is a cuff, the medicine is off patent, and 23 percent have it under control.23%controlled02Vision loss2.2 billion impaired. A billion of those cases were preventable or are still unaddressed, mostly by glasses or half an hour of surgery.1 in 2get cataract surgery03Cancer20.6 million new cases a year. Four in ten linked to preventable risk. Five year breast cancer survival runs 87 percent in high income countries and 42 in low.42%survival, low income04Mental healthMore than a billion people. Second largest cause of long term disability, running on 2 percent of health budgets.9%adequately treated05Diabetes589 million adults. A finger prick finds it. More than half of everyone with it was on no medication at all.43%undiagnosed06Hearing loss1.5 billion people, rising to 2.5 billion by 2050. Scaling ear and hearing care is costed at under a dollar forty a person a year.nonepublished cascade07Epidemic riskMeasles coverage sits at 84 percent against the 95 needed to stop outbreaks. Preparedness is routine immunisation, not a parallel programme.57countries, outbreaks 2025
The ranking is the Forum's assessment, not a measured index, and it is stated as one. Three system conditions cap all seven: 4.6 billion people not fully covered by essential services, 2.1 billion facing financial hardship, and a projected shortfall of 11.1 million health workers by 2030.
All thirteen, with the numbers →Where we start
These are not the biggest. They are the ones we can measure end to end.
A new institution that tries to work on all seven works on none of them. We begin where screening is inexpensive, the condition is common in an older cohort, the treatment is well understood, and a single district study can follow one person through all five links of the chain. What fails there is the journey, not the medicine.
Programme · EyeHealthline
Eye health
Cataract, glaucoma and diabetic retinopathy. One billion people have a vision impairment that was preventable or is still unaddressed.
See the cascade →ScreeningDiabetes
Detection at the primary level, and the follow up that decides whether detection changes anything. More than four in ten cases are undiagnosed.
See the cascade →ScreeningHearing
One and a half billion people live with hearing loss. No one publishes how many are identified, fitted and followed up.
See the cascade →SystemsThe referral chain
The stretch between a positive screen and a completed procedure. The most measurable failure in primary care, and the least measured.
See the chain →Founded 2026
We would rather publish nothing than publish a number we cannot source.
Nothing is out there yet. This is the first year, and the honest position is that the archive is empty and the method is not.
Every figure on this site names its publisher and its date. Where a number is our own field observation rather than a published study, it will say so in those words. Where the evidence does not exist, we say that too, because an absence is a finding.
What we are building →Work with us
If you run a district, a hospital or a screening budget, we would like the numbers.
We work with state health departments, district administrations, hospital groups and corporate buyers of screening programmes. Tell us what you are trying to fix, and what you already measure.
Start a conversation →