Primary care for low-resource and humanitarian settings
Clear, practical guidance for the people who deliver most of the world's primary care: one-page protocols, short courses that earn a CPD certificate, guidance for emergencies and conflict, and ready-to-run packs for trainers.
Everything here is adapted from WHO global guidance: WHO PEN and PEN-Plus, IMCI, mhGAP, HEARTS, the WHO Model List of Essential Medicines, the consolidated TB, HIV and malaria guidelines, Basic Emergency Care, antenatal and postnatal care recommendations, WHO and UNHCR humanitarian guidance, the Sphere standards and the Interagency Emergency Health Kit. Each page names the WHO document and year it draws on.
- Doctors and clinical officersProtocols you can follow in a busy clinic, with clear points to refer.
- Nurses and midwivesTask-sharing friendly: assessment, treatment and follow-up in plain steps.
- Community health workersWhat to look for, what to say, and when to send someone on.
- Trainers and supervisorsSession plans, cases with answers, quizzes and handouts to print.
Protocols
One page per condition: who it is for, red flags, assess, classify, treat with essential medicines, follow-up, counselling and when to refer. Each prints on a single A4 sheet.
WHO Basic Emergency CareABCDE and triage for the acutely ill (Basic Emergency Care)Triage everyone on arrival as red, yellow or green, then assess and treat in ABCDE order, fixing each problem before moving on, and arrange transfer early.OpenWHO wasting guidelineAcute malnutrition in a childMeasure MUAC and check both feet for oedema in every sick child; complications or a failed appetite test mean inpatient care; otherwise RUTF, amoxicillin and weekly or fortnightly review.OpenWHO mhGAPHarmful alcohol use (mhGAP)Ask everyone about alcohol, give a brief motivational intervention for harmful use, recognise dependence and withdrawal, give thiamine, treat withdrawal with diazepam, and support recovery.OpenWHO antenatal careAnaemia in pregnancyCheck Hb at the first contact and look for pallor at every contact; classify by Hb and symptoms; double the iron dose for anaemia; treat malaria and worms; refer severe anaemia.OpenWHO antenatal careRoutine antenatal contactsAt least eight contacts, the first by 12 weeks: check for danger signs, measure BP and Hb, test, give iron and folic acid, prevent malaria and tetanus, and plan the birth.OpenWHO PENAsthma in adults (WHO PEN)Tell asthma from COPD, check control at every visit, step inhaled treatment up or down, and treat attacks with prednisolone, high-dose salbutamol and oxygen.OpenWHO chronic pain guidanceChronic pain in adultsLook for a serious cause first, then treat the whole person: explanation, staying active and structured exercise, psychological support, and cautious short courses of medicine. Opioids are not routine.OpenWHO PEN and HEARTSChronic kidney disease in first-level careTest people with diabetes or high blood pressure once a year, confirm on repeat, control BP below 130/80 with an ACE inhibitor, avoid kidney-harming medicines, and refer by eGFR and albuminuria.OpenWHO MEC and Family Planning HandbookContraception: choosing and starting a methodHelp her choose freely, check eligibility with the WHO MEC categories, rule out pregnancy with the checklist, start today, and know the backup and emergency rules.OpenWHO PENCOPD (WHO PEN)Suspect COPD in smokers and people exposed to smoke or dust, confirm a poor salbutamol response, relieve breathlessness step by step, and treat flare-ups early.OpenWHO HEARTSCardiovascular risk and statins (HEARTS)Estimate 10-year risk with the 2019 WHO charts, counsel everyone, treat by risk band, and give a statin at 20% or more and to people with diabetes aged 40 and over.OpenWHO mhGAPDepression (mhGAP)Two weeks of low mood or lost interest with other symptoms and poor functioning: check for suicide risk, mania and physical causes, then psychosocial care, with fluoxetine or amitriptyline when needed.OpenWHO HEARTS-D and PENDiabetic foot: examine, classify, protectLook at the feet at every visit, check pulses and sensation once a year, classify risk, treat pre-ulcer lesions, and refer every active foot problem urgently.OpenWHO IMCIDiarrhoea and dehydration in a child under 5 (IMCI)Check danger signs, classify dehydration from four signs, then Plan A, B or C with low-osmolarity ORS and 14 days of zinc; look for blood and persistent diarrhoea.OpenWHO mhGAPEpilepsy and seizures (mhGAP)Stop a convulsion with a benzodiazepine (no more than two doses), look for an acute cause, diagnose epilepsy after two unprovoked seizures, then one medicine at the lowest effective dose.OpenWHO primary eye and ear careRed eye, poor vision and ear problemsMeasure vision in every eye complaint, refer sudden loss of vision and painful red eyes urgently, wick and treat discharging ears, and refer any ear infection with swelling behind the ear, headache or facial weakness.OpenWHO IMCIFever in a child under 5 (IMCI)Check danger signs and stiff neck, decide the malaria risk, test for malaria, look for another cause and for measles, then treat and give a clear follow-up day.OpenWHO PEN and PEN-PlusHeart failureRecognise breathlessness with swelling, treat severe fluid overload and refer, find the cause, then keep people well with a diuretic, an ACE inhibitor, a beta-blocker, daily weights and less salt.OpenWHO HIV guidelinesHIV: testing and starting ARTOffer testing widely, confirm with the national three-test algorithm, retest before ART, screen for TB and advanced disease, then start dolutegravir-based ART within 7 days, the same day if the person is ready.OpenWHO HEARTSHypertension in adultsMeasure well, confirm on a second day, start a protocol medicine within four weeks, step up monthly to target, then review every 3 to 6 months.OpenWHO malaria guidelinesUncomplicated malariaTest every suspected case, look for danger signs, then a full 3-day artemisinin-based combination (ACT) by weight, first dose observed, with clear return advice.OpenWHO palliative carePalliative symptom controlAsk about every symptom, treat pain by mouth and by the clock with oral morphine when needed, always give a laxative with an opioid, and support the family as well as the patient.OpenWHO IMCICough or difficult breathing in a child aged 2 months to 5 yearsCheck danger signs, count breaths for a full minute, look for chest indrawing, classify, then oral amoxicillin at home or first dose and urgent referral.OpenWHO postnatal carePostnatal care of mother and babyAt least four postnatal contacts (first day, day 3, days 7 to 14, week 6): check mother and baby for danger signs, support breastfeeding, screen mood, and offer contraception.OpenWHO maternal healthHypertension in pregnancy and pre-eclampsiaMeasure BP at every contact, check protein when it is 140/90 or more, classify, give magnesium sulfate and lower severe BP before urgent referral, and prevent with aspirin and calcium.OpenWHO mhGAPPsychosis (mhGAP)Rule out delirium and other medical causes, recognise psychosis or mania, start one antipsychotic at a low dose, keep people safe without restraint, and support families.OpenWHO RF/RHD guideline and PEN-PlusRheumatic heart disease (PEN-Plus)Treat strep sore throat with penicillin, suspect rheumatic fever with the Jones criteria, refer for echo, and keep every diagnosed person on 4-weekly benzathine penicillin.OpenWHO mhGAPSelf-harm and suicide risk (mhGAP)Treat any medically serious self-harm first, ask directly about suicide, never leave a person at imminent risk alone, remove means, build a safety plan and follow up closely for 2 years.OpenWHO malaria guidelinesSevere malaria: recognise and pre-referral careRecognise severe malaria from simple bedside signs, give one dose of artesunate (IM, or rectal in a child under 6), prevent low blood sugar, and transfer at once.OpenWHO IMCIThe sick young infant up to 2 monthsLook for the seven signs of possible serious bacterial infection, separate critical illness from clinical severe infection and fast breathing alone, give first-dose antibiotics and refer, or treat as an outpatient when referral is not possible.OpenWHO skin NTDsCommon skin conditions and skin NTDsTreat scabies, tinea, impetigo and eczema confidently, treat the whole household for scabies, and test every pale patch for loss of sensation so leprosy and other skin NTDs are not missed.OpenWHO snakebite guidanceSnakebite: first aid and referralReassure, keep the person still, splint the limb, no tourniquet or cutting, check the 20-minute clotting test, watch for bleeding, paralysis and shock, and get antivenom-capable care fast.OpenWHO STI guidelinesSexually transmitted infections: syndromic careTreat on the same visit: use tests where results come back the same day, otherwise treat by syndrome (urethral discharge, vaginal discharge, genital ulcer, lower abdominal pain), offer HIV and syphilis tests, and treat partners.OpenWHO TB guidelinesPresumptive TB: screen, test and referAsk about TB symptoms at every chance, send a rapid molecular test (not just a smear), test for HIV, use urine LAM in people with HIV, and link every diagnosis to treatment the same day.OpenWHO PEN and HEARTS-DType 2 diabetes in adultsDiagnose on plasma glucose or HbA1c, rule out an emergency, then metformin, add gliclazide, then insulin, with BP, statin and foot care every time.OpenWHO IMCIWorms and anaemia in childrenLook at the palms of every sick child: severe pallor means urgent referral, some pallor means iron, deworming from 1 year, a malaria test where needed and review every 14 days.Open
Short courses with CPD
Short courses in several lessons, each with objectives, worked cases and key points. Pass the final quiz to get a printable CPD certificate.
8 lessons · 5 CPD hoursBasic emergency care for first-level facilitiesEight lessons on the ABCDE and SAMPLE approach, triage, breathing, shock, the unconscious patient, the trauma primary survey, burns, poisoning, children in emergencies and safe transfer, based on WHO-ICRC Basic Emergency Care.Open8 lessons · 5 CPD hoursClinical examination skills for first-level careEight step-by-step skills lessons: vital signs and the MUAC tape, chest and heart, abdomen, a 10-minute neurological check, feet, skin and lymph nodes, the IMCI child examination, the antenatal examination, and eyes and ears with simple tools.Open7 lessons · 4.5 CPD hoursType 2 diabetes in primary care (WHO PEN and HEARTS-D)Seven lessons on finding, diagnosing, treating and following up type 2 diabetes with the WHO PEN and HEARTS-D protocols, including emergencies, sick days, the diabetic foot, insulin without a reliable fridge, and diabetes in pregnancy.Open6 lessons · 4 CPD hoursHypertension and cardiovascular risk in primary care (WHO HEARTS)Six lessons on finding, treating and following up high blood pressure and total cardiovascular risk with the WHO HEARTS approach, including accurate measurement, pregnancy and follow-up systems.Open6 lessons · 4 CPD hoursThe sick child: IMCI in practiceSix lessons on the IMCI charts: danger signs, cough, diarrhoea, fever and malaria, malnutrition and feeding counselling, and the sick young infant and HIV-exposed infant, with worked cases.Open8 lessons · 4 CPD hoursLeadership and running a primary care clinicEight practical lessons for the person in charge: leading a team, task sharing, supervision, quality improvement, triage and patient flow, medicines, data, patient safety and the community.Open7 lessons · 4.5 CPD hoursMental health essentials (mhGAP)Seven lessons on essential mental health care in non-specialist settings using the WHO mhGAP approach: communication, psychological first aid and self-care, depression, self-harm and suicide, psychosis and epilepsy, children and adolescents, dementia and drug use.Open7 lessons · 5 CPD hoursNCD extension: kidneys, heart failure, lungs, stroke, cancer and severe NCDsSeven lessons that go beyond hypertension and diabetes: chronic kidney disease, heart failure, asthma and COPD in depth, stroke, cancer early diagnosis, polypharmacy, and severe NCDs under PEN-Plus.Open8 lessons · 5 CPD hoursRunning NCD services: clinics, medicines, registers and qualityEight lessons on the systems behind good NCD care: planning a clinic, essential medicines and forecasting, cohort registers and the HEARTS control rate, task-sharing, follow-up and tracing, quality improvement, HIV and TB integration, and what to do when supply fails.Open8 lessons · 4 CPD hoursNCD care in humanitarian settingsEight lessons on keeping people with diabetes, hypertension, heart disease, asthma, COPD, epilepsy and mental health conditions safe in a crisis: priorities, triage, interrupted treatment, kits, organising care, insulin and the cold chain, and people who depend on dialysis and specialist care.Open8 lessons · 5 CPD hoursPain management and palliative care in primary careEight lessons on assessing pain, the WHO approach to cancer pain, safe oral morphine, neuropathic and chronic pain, symptom control, the last days of life, talking with families, and palliative care in crises.Open8 lessons · 4 CPD hoursSafe pregnancy and birth: antenatal and postnatal contactsEight lessons on the WHO eight-contact antenatal model, the preventive package, pre-eclampsia, anaemia, postnatal care and contraception, postpartum haemorrhage, maternal sepsis and the newborn at birth.Open8 lessons · 5 CPD hoursSexual and reproductive health and family planning in primary careEight lessons on rights-based contraceptive counselling, the WHO MEC, every method from pills to IUDs, emergency, postpartum and post-abortion contraception, PrEP, adolescents and infertility.Open
Humanitarian and conflict
Keeping primary care going in emergencies, displacement and conflict, based on WHO, UNHCR and Sphere guidance and the emergency health kits.
Sphere, WHO and IAWG guidanceThe first 72 hours: setting up primary care in a crisisTriage, priority services, the Interagency Emergency Health Kit and the minimum package for the first days of a response.OpenWHO, UNFPA and UNHCR guidanceClinical care after sexual violenceSurvivor-centred care, first-line support, emergency contraception and HIV post-exposure prophylaxis, with the time limits that matter.OpenSphere and WHO SSAWorking safely when health care is under attackStaff safety, protecting patients and records, keeping the clinic neutral, and documenting attacks on health care.OpenWHO and Sphere guidanceMalnutrition in emergenciesScreening with MUAC and oedema checks, deciding between outpatient and inpatient care, and the medical care malnourished children need.OpenIAWG MISP and SphereMaternal and newborn care in a crisis (MISP)Safe birth, emergency obstetric referral, essential newborn care and contraception, built on the Minimum Initial Service Package.OpenIASC, WHO/UNHCR mhGAP-HIG and SphereMental health and psychosocial support (mhGAP-HIG)Psychological first aid, the priority mental, neurological and substance use conditions, and keeping psychotropic medicines going in a crisis.OpenWHO, UNHCR and Sphere guidanceContinuity of NCD care in emergenciesKeeping people with hypertension, diabetes, heart disease and chronic lung disease on treatment when a crisis disrupts health services.OpenWHO, GTFCC and Sphere guidanceCholera, measles and other outbreaks in campsCase definitions, rehydration plans, oral rehydration points, isolation and vaccination for the outbreaks that kill most in crowded settings.OpenSphere and WHO guidanceRapid health assessment and surveillanceWhat to count, what to report, and how to give early warning of outbreaks in the first weeks of a crisis.Open
Diagnostic reasoning cases
Undifferentiated presentations reasoned step by step, the way they arrive at a health centre: what to ask, look for and do next, a differential that narrows as you go, the conditions you must not miss, and the decision to treat, observe or refer. No investigations beyond a malaria test, haemoglobin, a urine dipstick or a glucose.
WHO Basic Emergency Care and MCPCAbdominal pain in an adultA young woman who fainted with lower abdominal pain: shock recognised early, the pregnancy test that changes everything, signs of a surgical abdomen, and an immediate transfer.OpenWHO Basic Emergency CareAn adult who is short of breathA woman seven weeks after giving birth, breathless and pale: an ABCDE start, the history and signs that sort lung, heart and blood causes, two bedside tests, and an urgent referral done safely.OpenWHO Basic Emergency Care and HEARTSChest pain in an adultA man with an hour of crushing chest pain and no ECG: the ABCDE start, the history that separates heart, lung, aorta and gut, the aspirin decision, and an immediate transfer.OpenWHO Basic Emergency Care and mhGAPAn older adult who is confusedA 79-year-old woman, confused for two days: glucose first, the questions that separate delirium from dementia, a medicine that made it worse, signs of sepsis, and an immediate referral.OpenWHO IMCI and Pocket book of hospital care for childrenA child who had a fitA 2-year-old with fever who had a fit at home and now seems better: why a convulsion in this illness is a danger sign, the bedside checks for low sugar, malaria and meningitis, and pre-referral treatment.OpenWHO IMCICough and fast breathing in a toddlerA girl of 18 months with cough and fever: counting breaths properly, the signs that make pneumonia severe, a pulse oximeter, and amoxicillin at home with a 3-day review.OpenWHO consolidated TB and HIV guidelines and WHO PENCough for three weeksA man with a cough that will not go away: when a cough is presumptive TB, what to ask and look for, which samples and tests to arrange, and why HIV changes the plan.OpenWHO diarrhoea treatment guidelines and SphereAcute watery diarrhoea in a cholera outbreakA man in a displacement camp with rice-water stools during a declared cholera outbreak: the dehydration assessment, oral rehydration by weight, when to switch to IV fluids and antibiotics, and protecting everyone else.OpenWHO IMCIDiarrhoea and vomiting in a babyA 10-month-old with two days of watery diarrhoea and vomiting: the four signs that grade dehydration, Plan B in the clinic over four hours, zinc, and the reassessment that decides home or referral.OpenWHO malaria guidelines and Basic Emergency CareFever in an adultA young woman with three days of fever in a malaria area: triage, the questions that matter, one rapid test, and the decision to treat at the health centre.OpenWHO maternal health: PCPNC and MCPCFever after childbirthA woman five days after a long labour at home, with fever, abdominal pain and foul-smelling lochia: spotting organ dysfunction, finding the source, first-dose antibiotics and fluids, and an urgent transfer with her baby.OpenWHO IMCIFever in a 3-year-oldA boy of three with two days of fever in a high malaria area: the IMCI danger-sign check, the questions and signs that find a cause, a malaria test, and treatment at the health centre.OpenWHO HEARTS, IMAI and meningitis guidelinesHeadache in an adultA woman with five days of headache and blurred vision: the questions that find meningitis, a bleed or pre-eclampsia, a blood pressure of 186/118, and a same-day referral.OpenWHO maternal health: MCPC and pre-eclampsia recommendationsHeadache in late pregnancyA first pregnancy at 35 weeks with a headache that will not go and blurred vision: two blood pressure readings, a urine dipstick, the signs of severe pre-eclampsia, magnesium sulfate and a safe urgent transfer.OpenWHO IMAI and hepatitis guidanceJaundice in an adultA man with yellow eyes and dark urine after a week of feeling unwell: sorting hepatitis, malaria, alcohol, medicines and obstruction at the bedside, the signs of liver failure, and safe care at home.OpenWHO rheumatic fever guideline and IMAIJoint pain in a young adultA 19-year-old with fever and swollen joints that move from one to the next, three weeks after a sore throat: septic arthritis, gonococcal arthritis and rheumatic fever compared, a new murmur, and a same-day referral.OpenWHO mhGAPLow mood and poor sleepA woman who asks for sleeping tablets: the mhGAP questions that find depression behind the sleep problem, asking about suicide, ruling out physical causes and bipolar disorder, and a treatment plan at the health centre.OpenWHO IMCI and sickle-cell disease guidelineA pale childA 3-year-old who is pale again after two courses of iron: palmar pallor and haemoglobin, ruling out malaria and worms, the history that points to sickle cell disease, and a planned referral for diagnosis.OpenWHO IMCI (young infant)A newborn who is not feeding wellA 3-week-old whose mother says she is not feeding well: sorting a sign of serious infection from a feeding problem by watching a breastfeed, and treating the feeding problem, thrush and low weight at home.OpenWHO IMCI and Pocket book of hospital care for childrenFever and rash in a childA 4-year-old with fever and a new rash during a measles outbreak: what makes a rash measles, the glass-or-finger test for a rash that does not fade, and why a drowsy child with purpura is treated and sent at once.OpenWHO IMAI and PENSwollen legsA young woman with three weeks of swollen legs and a puffy face: one leg or two, heart, kidney, liver or pregnancy, a dipstick showing heavy protein, and a planned referral for kidney assessment.OpenWHO IMCI, wasting guideline, TB and HIV guidelinesA child who is not growingA 2-year-old who is thin and has stopped growing: MUAC and the appetite test, the clues to HIV and TB behind the malnutrition, testing mother and child, and a same-day referral after starting care.OpenWHO MCPC and PCPNCBleeding in pregnancyA woman at 32 weeks with painless bright red bleeding: why there is no vaginal examination, the signs that separate placenta praevia, abruption and uterine rupture, and an immediate transfer done safely.OpenWHO PEN, HEARTS-D and TB screening guidelinesWeight loss in an adultA man who has lost 10% of his weight in three months: TB, HIV, diabetes and cancer each considered in turn, three bedside tests, and treatment started at the health centre.Open
Trainer packs
Everything a facilitator needs to run a session: timed plan, objectives, notes, case discussions with answers, a quiz and a one-page handout.
120-minute sessionThe antenatal contact: a skills sessionA ready-to-run 2-hour session: BP and urine protein skills station, the preventive package by role-play, a pre-eclampsia drill with magnesium sulfate, anaemia cases, a quiz and a one-page handout.Open120-minute sessionType 2 diabetes: a 2-hour sessionA ready-to-run 2-hour session with a glucose and foot-check skills station, protocol practice, a hypoglycaemia drill, a quiz and a one-page handout.Open150-minute sessionTriage and ABCDE: a simulation sessionA ready-to-run 2.5-hour simulation session: a triage sorting exercise, ABCDE skills stations, four emergency scenarios, SBAR handover practice, a quiz and a one-page handout.Open120-minute sessionHypertension and cardiovascular risk: a 2-hour HEARTS sessionA ready-to-run 2-hour session with a BP measurement skills station, protocol practice, risk-chart cases, a quiz and a one-page handout.Open90-minute sessionCounting breaths and classifying cough: an IMCI skills sessionA ready-to-run 90-minute session: danger signs, counting breaths for a full minute, spotting chest indrawing, classifying with the IMCI chart, amoxicillin dosing, a quiz and a one-page handout.Open120-minute sessionRecognising and managing depression (mhGAP)A ready-to-run 2-hour session on depression with communication practice, assessment role-plays, a self-harm question drill, treatment planning, a quiz and a one-page handout.Open90-minute sessionKeeping NCD care going in an emergencyA ready-to-run 90-minute session on NCD care in crises: who cannot miss treatment, NCD triage, restarting medicines, kits and records, with a tabletop exercise, a quiz and a one-page handout.Open
Free to use
Every page in Global Primary Care is free to read, with no account needed. A free account is only needed to issue a CPD certificate after a course quiz, so that the certificate carries your name.
Pages are written to work on a phone and on a slow connection, and every protocol and handout prints on one sheet of A4.
Why this section exists
Primary Care International (PCI) closed on 31 March 2026. Over many years it trained more than 10,000 primary care workers in low-resource, humanitarian and conflict-affected settings across Africa, the Middle East, Asia and the Caribbean. Its online academy continues under Amref Health Africa at jibu.africa, and we encourage learners to use it.
This section is written by Dr Bassam Mohamed, a UK GP and former PCI Clinical Associate, to keep free, WHO-based primary care guidance available alongside that work. It is an independent resource: it is not part of, endorsed by or affiliated with PCI, Amref Health Africa or WHO.
Adapted from WHO guidance; not endorsed by WHO. This page paraphrases and adapts the WHO publications listed under Sources, which are licensed CC BY-NC-SA 3.0 IGO; the adapted text is shared under the same licence for non-commercial education. Reasoning GP is not affiliated with WHO or any other organisation named here. Use it alongside your national guidelines, essential medicines list and formulary, and your clinical judgement. Doses are given only where they come from a WHO source; otherwise follow your national guideline or formulary.