Evaluating the strength of primary care in the Kingdom of Saudi Arabia: a review of structure, process, and outcomes using the PHAMEU framework

According to the World Health Organization (WHO), primary healthcare serves as the fundamental approach to achieving universal health coverage. In Saudi Arabia, the Ministry of Health (MOH) has been committed since 1984 to primary care development, and recent political leadership in the region has brought on a renewed effort to strengthen primary care as part of the Vision 2030 mandate. Few studies have systematically applied international validated benchmarking tools to assess the current strength of primary care in Saudi Arabia, and this stands out as a notable gap in the literature. To evaluate the strength of Saudi Arabia’s primary care system using the Primary Health Care Activity Monitor for Europe (PHAMEU) framework, identify its main strengths and challenges, and assess progress towards the primary care objectives of Vision 2030. A framework-guided qualitative desk review based on secondary analysis of publicly available peer-reviewed and grey literature was undertaken. Evidence was synthesized according to the PHAMEU dimensions of structure, process, and outcomes. Saudi Arabia has made substantial structural progress toward building a strong primary care system: there is demonstrable government commitment and clear national strategies under Vision 2030. At the process level, improvements in access and coordination have been driven by digital health expansion and the integration of urgent and mental health services. However, gaps remain in continuity, coordination, and comprehensiveness of care, and systematic outcome measurement data is limited. This study demonstrates a critical gap between structural investment and outcome performance, emphasizing the need for stronger implementation strategies to deliver measurable health system improvements. Strengthening continuity, coordination, and outcome measurement will be critical to translating structural reforms into sustained improvements in health system performance.