Health and nursing paper on: Primary health care 

Primary Health Care “reflects and evolves from the economic conditions and socio-cultural and political characteristics of the country and its communities and is based on the application of the  relevant results of social, biomedical and health services research and public health experience” (Declaration of Alma Ata).

Introduction

The Declaration of Alma-Ata in the year 1978 proved to be groundbreaking phenomenon because it helped in creating a link between the health and rights-based approach through development of a viable strategy for attaining it. According to the outcome document of the International Conference on Primary Health Care, the declaration which was given primary health care has been identified as the sole method which can be sued for the reduction of health inequalities within and between the countries. This will finally help in achieving the highly ambitious yet unrealized goal by the year 2000 “Health for All” (Global strategy for health for all by the year 2000, 1981).

 Definition of Primary Health Care

 According to this document primary health care has been defined as the as “essential health care” services which are totally based upon the scientifically proven interventions. Thus primary health care (PHC) covers curative, promotive, rehabilitative and preventive care. The fundamental aim of PHC is to  provide the health care to the society which is  equal and fair ( means  available to in equal manner),  affordable ( priced in reasonable manner and free care for those who cannot afford to pay), effective ( able to accomplish the main aim of caring),  accessible ( within the reach of all the communities),  available (  able to meet the primary health requirements  of the whole community),  efficient(  Provides a very good value for the money), multidisciplinary (  involve teamwork amongst the  various levels and types of health care, so that community gets all kinds of care without wasteful duplication), decentralised (  allowing each and every district to take decision regarding how in the best manner they can  meet the health needs of their area),  participative ( encourages people  to participate in activities which helps in managing them their own health),  and collaborative ( working in association with other public services like public, agriculture and  water so that all the basic needs  for health can be met) (Kyriacos et al., 2008). Primary health care lays its main focus on providing accessible, appropriate and affordable services for the prevention, treatment and management of the processes of disease.

Alternatives of Primary Health Care

 A suggested by Wass ( 2000) the underlying philosophy which is very central to the  primary healthcare encompasses the  concepts related to social justice and  community  participation which also covers responsiveness to the local population’s health needs and equity also. In order to be effective the primary health care approach should be applied to all the levels of the health care systems and to every interaction which take place between the community members and the health care workers (Wass, 2000). IN the recent years however the term ‘primary health care’ has been used in interchangeable manner with ‘primary nursing care’ and ‘primary medical care’ (Douglas et al., 2009).There have been the need for alternative strategies for providing the personal health services regarding the community are in relation to Israel where there is a widespread network of community-based curative clinics as well as preventive family health centres. The major alternative strategy which has emerged for the primary health care is the Community-oriented primary health care (C-OPHC). It has been developed and has been critically evaluated also by Hadssah Teaching and Research centre based in Kiryat Hayovel. COPHC works through proper coordination between the individual clinics and the community medicine and it needs drastic changes in both the skills as well as orientation (Kark and Kark, 1983) . Another alternative which can be thought for PHC is progressive and advanced  rolling out of primary health care, district-by-district through a widespread network of  health centres as done in South Africa through the support from hospital (Primary Health Care: The world Health REport 2008, 2008).

Reasons for Primary Health Care Movement

The  “ Primary Health Care Movement” was being mobilised  through the Alma-Ata Conference which included the professionals and institutions, researchers and grassroots organizations,  governments and civil society organizations which joined together to handle  health inequalities in all the countries politically, economically and  socially unacceptable. The values pursued by the  Declaration of Alma-Ata conference were totally clear like they were social justice, participation , solidarity and  right to better health for all the p-people in the community (Primary Health Care: The world Health REport 2008, 2008). This is the reason why the Declaration of Alma-Ata has been regarded as an important and very vital milestone in the promotion of healthy all across the world. The movement for PHC, the Alma-Ata rose from the movement for social justice which led to the 1974 Declaration on the establishment of the New International Economic Order. Both the movements laid the main stress on  the interdependent association  between  global economy and both the movements also supported and encouraged the process of transferring the knowledge and  aids in order to reverse the  economical and technological gaps which were existing and growing between the  developing and the industrialised countries.

 The rare examples existing in the poorer nations regarding the community-based innovations just after World War II also gave huge inspiration for the PHC Movement. The advancements in the health sector can also occur without the  highly advanced facilities and infrastructure  available in the industrialised countries was proved by the countries like Nigerian under-five clinics, Cuba’s and Vietnams’ health systems and  China’s bare-foot doctors (Primary health care: 30 years since Alma-Ata, n.d.).  The best example which can be quoted for Primary Health Care is the model which is implemented in Cuba which is highly successful primary health care model which came into being after the Cuban Revolution in 1959. This world famous model of PHC came into being amongst very dramatic social, political and economical changes which led to the creation of a preventive care system which was very much effectual in providing equal access to health care which earned huge acclaims from world famous organizations like World Health Organization, Pan American Health Organizations and UNICEF (Whiteford, Branch and Chapel, 2009).

Existing Models of PHC in Cuba

 The Cuban Primary Health care Model is mainly dependent upon the citizen as well as governmental participation and contains an extensive network comprising a whole family of medical practitioners, epidemiological surveillance and widespread preventive services too. The subsequent support economically from Soviet Union along with 1959 Revolution, the US’s trade embargo against Cuba and Fidel Castro’s unflagging commitment and longevity towards achieving  public health  through human rights , all these factors separately and acting together have shaped the development  of the successful health policy flourishing in Cuba (Whiteford, Branch and Chapel, 2009).

Central Features of PHC

Primary health care is an essential perspective of society which is made universally accessible to all the people in the community and is accepted by the individuals along with their full participation too and at a minimal cost which the country as well as the community can afford. Some of the features of Primary Health Care are listed below:

• Educating the community regarding the prevailing health problems and teaching them the methods of prevention and control too.
•  Providing adequate supply of basic amenities like safe drinking water and basic sanitation facilities
• Promoting the proper supply of food to the people and  giving proper nutrition to them
•  Maternal as well as child health care which includes FP
•  Prevention and control of the local endemic diseases
•  Provision of supplying the basic and essential drugs like for polio vaccination, malaria drugs etc.
•  Immunization against the major infections and diseases etc.
•  Appropriate and the right time treatment of the common diseases likes cold and cough, fever etc.

Some of the main Principles which have been found related to Primary health care are:

•  Equitable Distribution
•  Intersectoral Coordination
•  Decentralisation
•  Community participation
•  Appropriate Technology

Some of the basic requirements which are vital for the right application of PHC are (the 8 A’s and the 3C’s) which are listed below:

• Appropriateness
•  Adequacy
•  Acceptability
•  Assessability
•  Availability
• Accessibility
• Affordability
• Accountability
•  Continuity
•   Completeness
•  Comprehensiveness

PHC Handling the Question of Social Justice

 Primary Health care along with health promotion tries to seek very far-reaching solutions to the major problems which pose grave challenges to the biochemical, genetic or biological solutions (Mittelmark, 2000), various kinds of problems which need new thinking, carries varied kinds of innovative ideas as well as approaches and one of the best approaches which have been found out is universalism. This clearly suggests that primary health care is very important for public health and therefore as a result it should be given universally so that the objectives of affordability and accessibility of PHC can be met. Thus these services should not have any financial obligations or burdens through the process of copayments by consumer the reason being in our society the people who are in vital need of  PHC are least likely to access these services with a price tag or a cost attached to them (Keleher, 2001).

If we see characteristically the  PHC practitioners basically work in order to bring about  changes which are social, political , economic and  environmental determinants of illness in the society so that better health can be spread and developed in not just communities but also in regions and cities too. That is why it is said that PHC very effectively handles the question of social justice for the society. There are varied health related  social determinants which are included  like the  wealth and income distribution ,  discrimination ( sexism and racism),  inter-related circumstances of poverty, powerlessness,  socio-ecological environments, psycho-social deprivation ,  health service and literacy utilisation and the factors  which are concerned with age, gender, ethnicity and  race. Thus not just one sector can deal  with all the health determinants we need  lot of governmental efforts and not just the efforts of health system for social justice (Podger and Hagan, 2000) (World Bank, 1993).

PHC’s Implementation and Demise

 The main obstacles which proved to be major hindrances in  the implementation of the PHC strategy are  firstly the misinterpretation of the concept of PHC which lead to the birth of misconception that primary health care is basically meant for  the poor because it is 2^nd  rated health care system. Then the another reason which proved as barrier in the implementation of PHC  strategy was found to be  selective or just chosen PHC strategies and the lack of political will and support to implement them as soon as possible. The obstacle for implementation of PHC strategies which proved as barrier was centralised planning and management which should have been decentralised to extend the scope.

 There have been clear evidences from the existing remote PHC services as well as the effective rural PHC, which have given clear the need for reform in the health care agenda in Australia and various other nations too. The evidences have shown that there is great amount of requirement for improving  the governance,  management and community involvement and along with that there is dire need for  visionary and strong leadership in the political arena so as to reach a better coordinated and responsive primary health care system which will definitely help in  elimination of the  differential health status which exists right now between the rural areas and the cities (Wakerman et al., 2009). Specially in Australia it has been found that the establishment of a single or unique  National Health System which should be operational at the regional level will be helpful in obviating great amount of inefficiency which is existing right now and decreasing the poor coordination which is present in the current PHC system (Wakerman et al., 2009).

 In today’s scenario there is a call for renewed PHC dedication and the new trends for the implementation of primary health care movement which should aim at reduction of disparity amongst the whole gamut starting from the primary care services delivery to the process and ways to handling and the underlying or the hidden social determinants related to health (Primary Health Care, Now More Than Ever, 2008). In a comprehensive report prepared by the Secretariat of the World Health Organization, the Member States suggested there should be renewal of the primary health care. Even the States agreed because after the passing of 30 years since the  Alma-Ata, the healthy systems still do not foster the required optimal care and the reason being they do not encourage  the right kind of balance  as required in the areas of health promotion, cure and palliation and diseases prevention , in the efforts done by them (Glasser M, 2009)They also highlighted the fact that even the global stakeholders have now started  looking and recognizing the  requirement rather necessity for enhanced performance in the healthcare systems, which should occur in the framework provided by the  Primary health care. Even the report of the Commission on Special determinants of health (Peters, Cristancho and M., 2009) after analysing political ,social and economic  causes of ill health creates  strong case for  and strongly endorses  a renewed focus on PHC (Commission on Social Determinants of Health, 2008).

The Politics of Health

Although the international Conference of Primary health care has been a milestone in itself. And at that time it was the largest conference which was totally dedicated to a single and unique topic of International health and development covering a huge span and participation of 134 countries worldwide and 67 non-governmental organizations which attended the conference. But there were few discord and obstacle politically which hindered the Alma-Ata conference or the PHC’s results. The one barrier was that the declaration was non-binding. Then there has always been a conceptual disagreement on how to define the fundamental terms like the ‘universal access’ which exist today and are very vital in PHC. Due to cold war there were severe ideological differences which existed between the capitalistic and communist economies in the world. The political discord reached a new height because of the fact that the Alma-Ata conference was being held in the then called the Union of Soviet Socialist Republics the major force against the world super powers.

Conclusion

Therefore  the insufficient amount of progress  towards the Millennium Development Goals along with the threats which are existing  to the human security due to climatic changes and   global health ,  global food influenza and pandemic influenza , have created a fresh and strong interest  in the comprehensive primary health care. The entire health sector needs to be reconsidered while planning allocation of resources in the PHC Reshaping of the resources distribution is more concerned with allocation of the new resources rather than the redistribution of the existing resources which is completely in accordance with the priorities of PHC. In order to reduce the health care inequalities the resource allocations should be done in geographical manner and this should be done by developing an appropriate mix of different levels of care then only a successful and renewed PHC can be created as desired by the whole world (Segall, 1983). Thus strengthening the basics of PHC means creating and developing an approach towards “Health for All” (HFA).

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