INTRODUCTION TO PRIMARY HEALTH CARE
Professor
Mustapha Mukhtar
Bayero
University, Kano-Nigeria
mmukhtar.eco@buk.edu.ng
http//:www.mustaphamuktar.blogspot.com
Introduction
Health
is one of the major determinants of human socioeconomic development. It is also
one of the major components of human capital development as well. Individual
health is composed of many parts ranging from biological, social and physical wellbeing.
Health is a fundamental human right.
Article 25 of the Universal Declaration of Human Rights grants everyone: the
right to a standard of living adequate for the health and well-being of himself
and his family, including food, clothing, housing, medical care and necessary
social services. Health is the state of complete
emotional and physical wellbeing. Healthcare exists to help people maintain an
optimal state of health. In 1948, the World Health Organization WHO defined health as a state of complete physical,
mental and social wellbeing and nor merely the absence of disease or infirmity.
Healthcare is the prevention,
treatment, and management of illness and the preservation of mental and
physical well-being through the services offered by the medical, nursing, and
allied health professions.
Health
care is a fundamental human good because it affects our opportunity to pursue
life goals, reduces our pain and suffering, helps prevent premature loss of
life, and provides information needed to plan for our lives. Society therefore,
has an obligation to make access to an adequate level of care available to all
its members, regardless of ability to pay.
Primary Health Care (PHC)
Primary
health care is a means of protecting this right. Primary health care: is essential
care based on practical, scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in the
community through their full participation and at a cost that the community and
country can afford to maintain at every stage of their development in the self-reliance
and self-determination: it forms an integral part both of the country’s health system, of which it is
the central function and main focus, and of the overall social and economic development
of the community. It is the first level of contact of individuals, the family
and the community with the national health system, bringing health care as
close as possible to where people live and work and constitutes the first
element of a continuing health care process.(Alma Ata 1978 primary Health Care
Conference, Geneva; WHO, UNICEF)
"PHC
is a whole-of-society approach to health that aims at ensuring the highest
possible level of health and well-being and their equitable distribution by
focusing on people’s needs and as early as possible along the continuum from
health promotion and disease prevention to treatment, rehabilitation and
palliative care, and as close as feasible to people’s everyday
environment." WHO and UNICEF.
A vision for primary health care in the 21st century: Towards UHC and the SDGs.
PHC
entails three inter-related and synergistic components, including:
comprehensive integrated health services that embrace primary care as well as
public health goods and functions as central pieces; multi-sectoral policies
and actions to address the upstream and wider determinants of health; and
engaging and empowering individuals, families, and communities for increased
social participation and enhanced self-care and self-reliance in health. PHC is
rooted in a commitment to social justice, equity, solidarity and participation.
It is based on the recognition that the enjoyment of the highest attainable
standard of health is one of the fundamental rights of every human being
without distinction.
For
universal health coverage UHC. (UHC means that all individuals and communities
receive the health services they need without suffering financial hardship. It
includes the full spectrum of essential, quality health services, from health
promotion to prevention, treatment, rehabilitation, and palliative care across
the life course) to be truly universal, a shift is needed from health systems
designed around diseases and institutions towards health systems designed for
people, with people. PHC requires governments at all levels to underscore the
importance of action beyond the health sector in order to pursue a whole-of
government approach to health, including health-in-all-policies, a strong focus
on equity and interventions that encompass the entire life-course.
PHC
addresses the broader determinants of health and focuses on the comprehensive
and interrelated aspects of physical, mental and social health and wellbeing.
It provides whole-person care for health needs throughout the lifespan, not
just for a set of specific diseases. Primary health care ensures people receive
quality comprehensive care ranging from promotion and prevention to treatment,
rehabilitation and palliative care as close as feasible to people’s everyday
environment.
The
basic points in the above definition are:
i.
Essential health care: Group of functions
essential for the health of the people given at lower level of health service.
E.g. Medical care, MCH, school health, environmental health, control of
communicable diseases, health education, referral, etc.
ii.
Scientifically sound: Scientifically explainable
and acceptable socially acceptable methods and technology: intervention should
consider the local value culture and belief.
iii.
Universally accessible: Because of the
inequitable distribution of the available resources, the services are not
reachable by all who need them. Only a few can afford or within the reach to
use them, while the majority are excluded from the service. Therefore, PHC
being health care as close as possible to
where people live and work, guarantee universal accessibility
Evolution of Primary Health Care
The
definition of health, in the Charter of WHO as a complete state of physical,
mental, and social well-being is demanding and irrelevance to states struggling
to provide even minimal care in adverse economic, social and environmental
conditions.
i.
Despite health being a fundamental human right
the health status of hundreds of millions people in the world was unacceptable.
ii.
In spite of the tremendous efforts in medicine
and technology, the health status of people in disadvantaged areas of most
countries remained low.
iii.
The organized limited health institutions failed
to meet the demands of those most in need who are usually too poor or
geographically or socially remote to benefit from such facilities
(Accessibility).
iv.
The health services often created were in
isolations, neglecting other sector (Agriculture, Education, Water Supply etc),
which are relevant to the improvement and development of health.
v.
Health institutions stressed curative services
with insufficient priority to preventive, promotive and rehabilitative care.
vi.
The community has already been given the
opportunity to play an active role in deciding the types of activities they
want and have not participated in the actual services they receive.
The
above reasons led WHO and UNICEF to evaluate and reexamine the existing policies
in 1978, Alma-Ata, and the concept of Primary Health Care emerged.
An
important preparatory meeting was held in Halifax, Nova Scotia, where nongovernmental
organizations (NGOs), ranging from large, internationally active humanitarian
organizations to small religious groups active in only one country, were able
to review the final draft of the actual conference document. After such extensive
preparation, delegates from 134 nations of the world, plus representatives from
those NGO‟s officially accredited by WHO, met during
September 1978 in what was then known as Alma Ata, USSR (now Almaty,
Kazakhstan). In that historic meeting, the nations of the world committed
themselves and their resources to the achievement of health for all the year
2000 through PHC
The Alma Ata Conference
In 1978, at an international conference convened by the World
Health Organization (WHO) and UNICEF (United Nations Children’s Fund) in
Kazakhstan, the 134 members of the World Health Assembly of World Health
Organization ratified the Declaration of Alma-Ata (World Health
Organization, 1978).
The declaration committed member states to supporting Primary Health Care (PHC)
as a policy to achieve the WHO definition of health as a “state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity” (WHO, 2006a).
PHC was grounded in the concern for social justice created by the devastation
in Europe and rapid decolonization of Asia and Africa following the end of the
Second World War.
The
motivation to support the policy arose out of the belief of most of the
national governments of the victorious countries that it was imperative to
eradicate pervasive poverty and ensure human rights. PHC was built on the
principles of equity in access to health services and the right of people to
participate in decisions about their own healthcare. Underpinning these
principles was support for preventive and promotive health services,
appropriate technology, and intersectoral collaboration. It has been argued
that PHC began a shift in health paradigms from a definition of health as
limited to biomedical research, the provision of health services by
professionals, and institutional care in hospitals and sub health units such as
health centers to a broader focus that included the social determinants of
health. This was a visionary concept
that pushed the conventional understanding of how health improves from the
realm of biomedicine into a realm of social, economic, and political
investigation and action.
To
implement the declaration, WHO declared “Health for all by the Year 2000,” creating a goal for national governments that
coincided with other UN efforts to address the global and political situation
in the 1970s. These efforts included recognizing that health was an integral
part of other national development strategies, addressing peoples’ basic needs,
and calling for a “new economic order” that was focused on restructuring the
world economy to ensure more participation for the developing countries
Extracts from Alma Ata Conference
- The Conference strongly reaffirms that health, which is a state of
complete physical, mental, and social well-being, and not merely the
absence of disease or infirmity, is a fundamental human right and that the
attainment of the highest possible level of health is a most important
world-wide social goal whose realization requires the action of many other
social and economic sectors in addition to the health sector.
- The existing gross inequality in the health status of the people, particularly
between developed and developing countries as well as within countries, is
politically, socially, and economically unacceptable and is, therefore, of
common concern to all countries.
- The people have a right and duty to participate individually and
collectively in the planning and implementation of their health care.
- Primary health care is essential health care based on practical,
scientifically sound, and socially acceptable methods and technology made
universally accessible to individuals and families in the community
through their full participation and at a cost that the community and
country can afford to maintain at every stage of their development in the
spirit of self-reliance and self-determination. It forms an integral part
both of the country's health system, of which it is the central function
and main focus, and of the overall social and economic development of the
community. It is the first level of contact of individuals, the family,
and community with the national health system bringing health care as
close as possible to where people live and work, and constitutes the first
elements of a continuing health care process.
- An acceptable level of health for all the people of the world by
the year 2000 can be attained through a fuller and better use of the
world's resources, a considerable part of which is now spent on armaments
and military conflicts. A genuine policy of independence, peace, détente,
and disarmament could and should release additional resources that could
well be devoted to peaceful aims and in particular to the acceleration of
social and economic development of which primary health care, as an
essential part, should be allotted its proper share.
Objectives of Primary Health Care
1. To make health
services accessible and available to everyone
wherever they live or work.
2. To tackle the health
problems causing the highest mortality and morbidity at the cost that the
community can afford
3. To ensure that
whatever technology is used, must be within the ability of the community to use
effectively and maintain
4. To ensure that in
implementing the health program, the community must be fully involved in
planning the delivery and evaluation of the services in the spirit of self reliance
5. To increase the
programs and services that affect the healthy growth and development of
children and youth.
6. To develop community satisfaction
with the primary health care system.
7. To support and advocate for healthy
public policy within all sectors and levels of government.
8. To provide reasonable and timely
access to primary health care services.
9. To apply the standards of
accountability in professional practice.
10. To establish, within available
resources, primary health care teams and networks.
11. To support the provision of
comprehensive, integrated, and evidence-based primary health care services.
Importance
of Primary Health Care
Primary health care is the first level of healthcare that
forms the foundation for the formal health care system. Provision for this can
be through a variety of settings from community clinics to private practices.
Primary health care helps to promote health and prevent illness. It also helps
to identify, treat, and refer patients to specialists when appropriate
According to the World Health Organization, primary health
care can address most of an individual’s health needs throughout their life.
This includes prevention, treatment, rehabilitation, and palliative care. With
proper usage, primary health care is also able to provide empowering education.
This ensures that people are able to take timely health-related decisions about
themselves and their family members. Also, it reduces deaths and disability
PHC is the most inclusive, equitable,
cost-effective and efficient approach to enhance people’s physical and mental
health, as well as social well-being. Evidence of wide-ranging impact of
investment in PHC continues to grow around the world, particularly in times of
crisis.
Across the world, investments in PHC improve equity
and access, health care performance, accountability of health systems, and
health outcomes. While some of these factors are directly related to the health
system and access to health services, the evidence is clear that a broad range
of factors beyond health services play a critical role in shaping health and
well-being. These include social protection, food systems, education, and
environmental factors, among others.
Primary Health Care is also critical to make health
systems more resilient to situations of crisis, more proactive in detecting
early signs of epidemics and more prepared to act early in response to surges
in demand for services.
Access to Primary Health Care therefore, is a way of achieving the
Universal Health Coverage (all people have access to the health services they
need)
