INTRODUCTION TO PRIMARY HEALTH CARE

 

 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)