Physician Assistants (PAs),The Driving Force Of Primary Health Care (PHC) In Ghana

The concept of Primary Health Care is derived from the declaration of the 1978 international conference in Alma Ata, Kazakhstan (known as “Alma Ata Declaration”) which became a core concept of the World Health Organization arriving at the goal “Health for All by the year 2000”.

Primary health Care is essential health care based on practically, 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 at every stage of their development in spirit and self-reliance and self-determination. PHC brings health care to the doorstep of its clients and it’s also the first level of contact of individuals, families and the community as a whole, which sees to the promotion of health, development of community, prevention and treatment of illnesses.

Primary Health Care focuses on providing comprehensive, coordinated and ongoing care by suitably trained workforce which includes the physicians, physician assistants, nurses and among others. Primary Health Care doesn’t focus only on the mere provision of health but is also interested in providing quality healthcare to its clients, just as it was stated by Arlen Specker, “there’s nothing more important than our good health that’s our principal capital assert”. Hence, Primary Health Care is keen at providing quality healthcare and making it accessible to everybody irrespective of the status, economic or educational background.

It also focuses on the provision of the eight essential elements which includes; education on prevailing health problems, water and sanitation, nutrition, maternal and child health, immunization, prevention and treatment of endemic diseases and drug availability, all of which helps to improve and promote the quality of life of its clients. The main goal of Primary Health Care is to make health care available and accessible for everyone (health for all), in such a way that whosoever or wherever one finds him or herself, that individual can attain quality health care of which the Physician Assistant becomes the anchor to this health care delivery. It must be noted that Primary Care (PC) seen to be distinct on its own is rather a constituent of Primary Health Care.

Statistics indicates that about seventy percent (70%) of the health needs of the rural and marginalized population groups are taken care of by physician assistants since they form the bedrock for Primary Health Care throughout the country. (Nadia Cobb,2014)

Physician assistants are health care professionals who practice medicine as part of health care team with collaborating physicians and other providers. The profession was introduced in the united states in the 1960’s to address doctor shortage. In Ghana, the Rural Health College at Kintampo, was the first school to have started such training program in the late 1960’s, and was then called the Medical Assistant program with a diploma certificate upon completion. Now known as Physician Assistant program and has a degree Certificate upon completion, several schools are pursuing this course including the University of Cape Coast. The inauguration of physician assistant program has helped dwindle down the workload on doctors in that, as at 2014 the doctor patient ratio was about 1: 9,043 but in 2015 it reduced to about 1: 8,953 indicating that physician assistants have been undoubtedly instrumental in providing health care. PAs have several roles to play when it comes to primary healthcare delivery. These many roles include:

• Administrative and management role. PAs manage health centers, supervise health stations, prepare budget plans and report ongoing activities within the health facility. This mostly happens in the remote areas where PAs take absolute charge of the hospital setting and deliver the care to expectation with or without supervision from a physician.
• They conduct physical examinations, diagnose and treat illnesses, order and interpret laboratory tests, and counsel clients on preventive measures of diseases.
• They participate in outreach programs to sensitize the members of the community on any health issue of importance.

In as much as physician assistants help in promoting Primary Health Care, they are faced with varying challenges of which includes:

• Inadequate logistics to be used by physician assistants to provide healthcare to clients, thereby exposing them (PAs) to various risk.
• Low level of motivation by the government. Since PAs normally provide care in the remote areas, they should be incentivized by the government in order to boost their morale in providing health to her clients.
• Inability of PAs to prescribe some vital medications in the absence of physicians in some parts of the country which discourages most patients from accessing these health centers where PAs are the managers, leading to the collapse of many health centers.
• Discrimination between PAs and Physicians. Most Physicians look down upon the efforts of PAs and sees this profession as inferior to them. This discrimination gap even extends to the huge margin between the monthly/annual salary of a Physician and a Physician Assistant, whereby the salary of the PA is almost thrice that of the Physician.

The above challenges of PAs in providing health can be addressed through:

Provision of logistics to the various remote health facilities in order to ensure smooth running of Primary Health Care by the physician assistants, provision of incentives so as to help physician assistants work their hearts out no matter where they find themselves, ensuring that at least, physician assistants in remote areas prescribe vital medications since they mostly work autonomously in order to ensure proper care of clients. Also, ensuring equity between physician assistants and physicians especially closing the gap of salary between these two professions. PAs accept postings to every part of the country be it remote or rural at the expense of having proper and quality education for their children and also not having access to some social amenities in the urban areas. Meanwhile a Physician will refuse to be sent to the remote areas. Even if they do accept, they make demands for certain allowances that the PA will not be offered.

In conclusion, the Physician assistant is always with the community to provide health care services. This indicates that without the PAs, Primary Health Care cannot achieve its maximum goal, that is bringing health care to the doorstep of its members.

Written by:
Dora Addai-Kwakye (MISS)
Email-doraaddai1998@gmail.com .
(Physician Assistant Student, (level 200 U.C.C))