Global Primary Care

Protocols

One-page protocols adapted from WHO guidance for first-level care. Each one follows the same order (who and when, red flags, assess, classify, treat, follow-up, counsel, when to refer, sources) and prints on one A4 page.

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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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.Open WHO 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

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.