Primary Health Care (PHC) and Sector-Wide Approaches (SWAps) to health development are among the major health sector reforms that have been undertaken in Uganda. Both reforms are aimed at building strong and cohesive health systems for delivering health services to improve the health status and well being of the people.

At Alma Ata in 1978, PHC was declared as a strategy to be adopted by all countries.

PHC was defined as essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through participation and at a cost that communities and country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination.

Four basic principles underlie the PHC approach. These are universal accessibility and coverage in relation to need; community and individual involvement and self-reliance (establishing firm roots within the community with active involvement of the people); Intersectoral action for health (coordination and collaboration with other sectors) and appropriate technology and cost-effectiveness in relation to the available resources.

PHC was an innovative approach with the main thrust of strengthening health systems to provide comprehensive health services but with emphasis on preventive, promotive and rehabilitative health services, to address the main health problems in the community. The PHC approach is therefore more than the provision of "primary level services". It envisaged a seamless referral system from the community all the way to the most sophisticated health care available.

Implementation of PHC required an extensive network of functional health infrastructure, with referral networks to provide a continuum of care. It required comprehensive planning and a lot of resources, which most developing countries didn’t do or have.

With the assistance of multi/bilateral agencies, many countries established vertical programmes, mainly disease specific interventions, as a way of providing the preventive and promotive health services. At that time, another argument about whether to adopt selective PHC or comprehensive PHC raged on. For Uganda, the preference tended to be selective PHC, which effectively introduced many vertical programmes. These vertical programmes were piecemeal interventions, which did not result in the envisaged improvements in peoples' health. Instead, these programmes fragmented health services.

After 20 years, since the inception of PHC at the Alma Ata conference, the Sector Wide Approaches (SWAps) were born in an attempt to address some of the shortcomings of PHC.

SWAps are defined as a sustained partnership, led by national authorities, involving different arms of government, groups in civil society, and one or more donor agencies, with the goal of achieving improvements in people’s health and contributing to national human development objectives and in the context of a coherent sector, defined by an appropriate institutional structure and national financing programme through a collaborative programme of work.

For the health sector, the policy objective of adopting SWAps was to provide an enabling environment that would allow for effective coordination of efforts among all partners in Uganda’s national health development, increase efficiency in resource application, achieve equity in the distribution of available resources for health and effective access by all Ugandans to essential health care (MoH 1999).

SWAps are bound by the following principles: all investments in the health sector would follow an agreed programme of work; all the partners in the SWAps arrangement should agree on common management arrangements (i.e. on a framework for monitoring sector performance, on financial management, and on procurement of goods and services); funding for the implementation of the programme of work should be channelled through government systems (central budget support), in effect and crucially, this discourages project funding; and lastly, there should be partnership agreements and working arrangements amongst the different partners.