Primary healthcare

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Primary Health Care, or PHC, refers to "essential health care" that is based on scientifically sound and socially acceptable methods and technology, which make universal health care accessible to all individuals and families in a community. It is through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. [1] In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. [2] [3] PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle. [4] Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems. [5] The World Health Organization, or WHO, elaborates on the goals of PHC as defined by three major categories, "empowering people and communities, multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services[1]." Based on these definitions, PHC can not only help an individual after being diagnosed with a disease or disorder, but actively prevent such issues by understanding the individual as a whole.

Health care Prevention of disease and promotion of wellbeing

Health care, health-care, or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Universal healthcare is a health care system that provides health care and financial protection to all residents of a particular country or region. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.

Health equity synonymous with health disparity refers to the study and causes of differences in the quality of health and healthcare across different populations. Health equity is different from health equality, as it refers only to the absence of disparities in controllable or remediable aspects of health. It is not possible to work towards complete equality in health, as there are some factors of health that are beyond human influence. Inequity implies some kinds of social injustice. Thus, if one population dies younger than another because of genetic differences, a non-remediable/controllable factor, we tend to say that there is a health inequality. On the other hand, if a population has a lower life expectancy due to lack of access to medications, the situation would be classified as a health inequity. These inequities may include differences in the "presence of disease, health outcomes, or access to health care" between populations with a different race, ethnicity, sexual orientation or socioeconomic status.

Contents

This ideal model of healthcare was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata, Kazakhstan in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the World Health Organization's goal of Health for all . [6] The Alma-Ata Conference mobilized a "Primary Health Care movement" of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the "politically, socially and economically unacceptable" health inequalities in all countries. There were many factors that inspired PHC; a prominent example is the Barefoot Doctors of China. [4] [7] [8]

The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC), Almaty, Kazakhstan, 6–12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of the World Health Organization (WHO) as the key to achieving the goal of "Health For All" but only in developing countries at first. This applied to all other countries five years later. The Alma-Ata Declaration of 1978 emerged as a major milestone of the twentieth century in the field of public health, and it identified primary health care as the key to the attainment of the goal of "Health for All" around the globe.

World Health Organization Specialized agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

Goals and principles

A primary health care worker in Saudi Arabia, 2008 Ahmed-mater-phcc-aseer.jpg
A primary health care worker in Saudi Arabia, 2008

The ultimate goal of primary healthcare is the attainment of better health services for all. It is for this reason that the World Health Organization (WHO), has identified five key elements to achieving this goal: [9]

Public policy is the principled guide to action taken by the administrative executive branches of the state with regard to a class of issues, in a manner consistent with law and institutional customs. There has recently been a movement for greater use of evidence in guiding policy decisions. Proponents of evidence-based policy argue that high quality scientific evidence, rather than tradition, intuition, or political ideology, should guide policy decisions.

Behind these elements lies a series of basic principles identified in the Alma Ata Declaration that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and in coordination with other sectors: [1]

Equity (economics) fairness in economics

Equity or economic equality is the concept or idea of fairness in economics, particularly in regard to taxation or welfare economics. More specifically, it may refer to equal life chances regardless of identity, to provide all citizens with a basic and equal minimum of income, goods, and services or to increase funds and commitment for redistribution.

Primary care day-to-day health care given by a health care provider

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a nurse practitioner, or a physician assistant. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or a Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Health human resources (HHR) – also known as human resources for health (HRH) or health workforce – is defined as "all people engaged in actions whose primary intent is to enhance health", according to the World Health Organization's World Health Report 2006. Human resources for health are identified as one of the core building blocks of a health system. They include physicians, nursing professionals, midwives, dentists, allied health professions, community health workers, social health workers and other health care providers, as well as health management and support personnel – those who may not deliver services directly but are essential to effective health system functioning, including health services managers, medical records and health information technicians, health economists, health supply chain managers, medical secretaries and others.

In sum, PHC recognizes that healthcare is not a short-lived intervention, but an ongoing process of improving people's lives and alleviating the underlying socioeconomic conditions that contribute to poor health. The principles link health, development, and advocating political interventions rather than passive acceptance of economic conditions. [4]

Approaches

The hospital ship USNS Mercy (T-AH-19) in Manado, Indonesia, during Pacific Partnership 2012. The hospital ship USNS Mercy (T-AH 19) June 6, 2012, in Manado, Indonesia, during Pacific Partnership 2012 120606-N-CW427-402.jpg
The hospital ship USNS Mercy (T-AH-19) in Manado, Indonesia, during Pacific Partnership 2012.

The primary health care approach has seen significant gains in health where applied even when adverse economic and political conditions prevail. [10]

Although the declaration made at the Alma-Ata conference deemed to be convincing and plausible in specifying goals to PHC and achieving more effective strategies, it generated numerous criticisms and reactions worldwide. Many argued the declaration did not have clear targets, was too broad, and was not attainable because of the costs and aid needed. As a result, PHC approaches have evolved in different contexts to account for disparities in resources and local priority health problems; this is alternatively called the Selective Primary Health Care (SPHC) approach.

Selective Primary Health Care

After the year 1978 Alma Ata Conference, the Rockefeller Foundation held a conference in 1979 at its Bellagio conference center in Italy to address several concerns. Here, the idea of Selective Primary Health Care was introduced as a strategy to complement comprehensive PHC. It was based on a paper by Julia Walsh and Kenneth S. Warren entitled “Selective Primary Health Care, an Interim Strategy for Disease Control in Developing Countries”. [11] This new framework advocated a more economically feasible approach to PHC by only targeting specific areas of health, and choosing the most effective treatment plan in terms of cost and effectiveness. One of the foremost examples of SPHC is "GOBI" (growth monitoring, oral rehydration, breastfeeding, and immunization), [4] focusing on combating the main diseases in developing nations.

GOBI and GOBI-FFF

GOBI is a strategy consisting of (and an acronym for) four low-cost, high impact, knowledge mediated measures introduced as key to halving child mortality by James P. Grant at UNICEF in 1983. The measure are:

Three additional measure were introduced to the strategy later (though food supplementation had been used by UNICEF since it#'s inception in 1946), leading to the acronym GOBI-FFF.

These strategies focus on severe population health problems in certain developing countries, where a few diseases are responsible for high rates of infant and child mortality. Health care planning is used to see which diseases require most attention and, subsequently, which intervention can be most effectively applied as part of primary care in a least-cost method. The targets and effects of selective PHC are specific and measurable.[ vague ] The approach aims to prevent most health and nutrition problems before they begin: [12] [13]

PHC and population aging

Given global demographic trends, with the numbers of people age 60 and over expected to double by 2025, PHC approaches have taken into account the need for countries to address the consequences of population ageing. In particular, in the future the majority of older people will be living in developing countries that are often the least prepared to confront the challenges of rapidly ageing societies, including high risk of having at least one chronic non-communicable disease, such as diabetes and osteoporosis. [14] According to WHO, dealing with this increasing burden requires health promotion and disease prevention intervention at the community level as well as disease management strategies within health care systems.

PHC and mental health

Some jurisdictions apply PHC principles in planning and managing their healthcare services for the detection, diagnosis and treatment of common mental health conditions at local clinics, and organizing the referral of more complicated mental health problems to more appropriate levels of mental health care. [15] The Ministerial Conference, which took place in Alma Ata, made the decision that measures should be taken to support mental health in regard to primary health care. However, there was no such documentation of this event in the Alma Ata Declaration. These discrepancies caused an inability for proper funding and although was worthy of being a part of the declaration, changing it would call for another conference.

Individuals with severe mental health disorders are found to live much shorter lives than those without, anywhere from ten to twenty-five-year reduction in life expectancy when compared to those without [16] . Cardiovascular diseases in particular are one of the leading deaths with individuals already suffering from severe mental health disorders. General health services such as PHC is one approach to integrating an improved access to such health services that could help treat already existing mental health disorders as well as prevent other disorders that could arise simultaneously as the pre-existing condition.

Background and controversies

Barefoot Doctors

The "Barefoot Doctors" of China were an important inspiration for PHC because they illustrated the effectiveness of having a healthcare professional at the community level with community ties. Barefoot Doctors were a diverse array of village health workers who lived in rural areas and received basic healthcare training. They stressed rural rather than urban healthcare, and preventive rather than curative services. They also provided a combination of western and traditional medicines. The Barefoot Doctors had close community ties, were relatively low-cost, and perhaps most importantly they encouraged self-reliance through advocating prevention and hygiene practices. [4] The program experienced a massive expansion of rural medical services in China, with the number of Barefoot Doctors increasing dramatically between the early 1960s and the Cultural Revolution (1964-1976).

Criticisms

Although many countries were keen on the idea of primary healthcare after the Alma Ata conference, the Declaration itself was criticized for being too “idealistic” and “having an unrealistic time table”. [4] More specific approaches to prevent and control diseases - based on evidence of prevalence, morbidity, mortality and feasibility of control (cost-effectiveness) - were subsequently proposed. The best known model was the Selective PHC approach (described above). Selective PHC favoured short-term goals and targeted health investment, but it did not address the social causes of disease. As such, the SPHC approach has been criticized as not following Alma Ata's core principle of everyone's entitlement to healthcare and health system development. [4]

In Africa, the PHC system has been extended into isolated rural areas through construction of health posts and centers that offer basic maternal-child health, immunization, nutrition, first aid, and referral services. [17] Implementation of PHC is said to be affected after the introduction of structural adjustment programs by the World Bank. [17]

See also

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References

  1. 1 2 World Health Organization. Declaration of Alma-Ata. Adopted at the International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978.
  2. ↑ Starfield, Barbara. "Politics, primary healthcare and health." J Epidemiol Community Health 2011;65:653–655 doi : 10.1136/jech.2009.102780
  3. ↑ Public Health Agency of Canada. About Primary Health Care. Accessed 12 July 2011.
  4. 1 2 3 4 5 6 7 8 9 10 Marcos, Cueto (2004). "The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care". Am J Public Health. 22. 94: 1864–1874. doi:10.2105/ajph.94.11.1864. PMC   1448553 .
  5. ↑ White F. Primary health care and public health: foundations of universal health systems. Med Princ Pract 2015 doi : 10.1159/000370197
  6. ↑ Secretariat, WHO. "International Conference on Primary Health Care, Alma-Ata: twenty-fifth anniversary" (PDF). Report by the Secretariat. WHO. Retrieved 28 March 2011.
  7. ↑ Bulletin of the World Health Organization (October 2008). "Consensus during the Cold War: back to Alma-Ata". World Health Organization.
  8. ↑ Bulletin of the World Health Organization (December 2008). "China's village doctors take great strides". World Health Organization.
  9. ↑ "Health topics: Primary health care". World Health Organisation. Retrieved 28 March 2011.
  10. ↑ Braveman, Paula; E. Tarimo (1994). Screening in Primary Health Care: Setting Priorities With Limited Resources. World Health Organization. p. 14. ISBN   9241544732 . Retrieved 4 November 2012.
  11. ↑ Walsh, Julia A., and Kenneth S. Warren. 1980. Selective primary health care:An interim strategy for disease control in developing countries. Social Science & Medicine. Part C: Medical Economics 14 (2):145-163
  12. ↑ Rehydration Project. UNICEF's GOBI-FFF Programs. Accessed 16 June 2011.
  13. ↑ World Health Organization. World Health Report 2005, Chapter 5: Choosing Interventions to Reduce Specific Risks. Geneva, WHO Press.
  14. ↑ World Health Organization. Older people and Primary Health Care (PHC). Accessed 16 June 2011.
  15. ↑ Department of Health, Provincial Government of the Western Cape. Mental Health Primary Health Care (PHC) Services. Accessed 16 June 2011.
  16. ↑ "Meeting Report on Excess Mortality in Persons with Severe Mental Disorders" (PDF). World Health Organization. 18–20 November 2015.CS1 maint: date format (link)
  17. 1 2 Pfeiffer, J. 2003. International NGOs and primary health care in Mozambique: the need for a new model of collaboration. Social Science & Medicine 56(4):725-738.

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