Equitable access to safe, effective and affordable medicines and vaccines is key to primary health care (PHC). Yet the cost of medicines prescribed in primary care is a main driver of out-of-pocket expenditure in many countries, jeopardizing financial protection. Making appropriate, quality medicines and pharmaceutical services accessible depends on supply-chain management, prescribing and dispensing and, above all, on coverage policies. Ensuring affordable access to medicines in PHC requires the use of public financing (benefit packages) to pay for essential medicines and systematic use of generic and biosimilar medicines to keep costs down. Medicines are more easily available if they are dispensed closer to patients and if community pharmacies can be integrated into primary care services. Improved stock management and procurement practices support access and efficiency. Closer coordination between community pharmacies and prescribers facilitates access to medicines and encourages responsible consumption. The appropriateness and acceptability of services can be strengthened by clear treatment guidelines; routine prescribing of generics; and shifting prescribing from specialized settings to primary care, all of which also support effective PHC. Training staff and strengthening processes will improve the quality of pharmaceutical services and help them respond better to population need. Involving patients, care-givers and communities; education programmes that foster medicine and vaccine literacy; and efforts to encourage responsible self-care and self-management of medication, all increase the effectiveness of PHC and foster community empowerment with all its associated benefits.