Primary Health Care (PHC) is a conceptual model which refers to both processes and beliefs about the ways in which health care is structured. PHC encompasses primary care, disease prevention, health promotion, population health, and community development within a holistic framework, with the aim of providing essential community-focused health care (Shoultz & Hatcher, 1997; World Health Organization [WHO], 1978). The cornerstones of PHC are access, essentiality, equity, appropriate technology, multi-sectorial collaboration, and community participation and empowerment (WHO). This has been the basic aim of PHC over the past years. Today, there is a recognition that populations are left behind and a sense of lost opportunities that are evocative of what gave rise, forty years ago, to Alma-Ata’s paradigm shift in the perception about health. The Alma-Ata Conference mobilized a “Primary Health Care movement” of professionals and institutions, governments and civil society organizations and indigenous organizations that undertook to tackle the “politically, socially and economically unacceptable” health inequalities in all countries. The Declaration of Alma-Ata was clear about the values pursued: social justice and the right to better health for all, participation and solidarity. There was a sense that progress towards these values required fundamental changes in the way health-care systems operated and harnessed the potential of other sectors. The manifestation of these values into tangible reforms has been uneven till now.
Nevertheless, today, health equity suffers increased eminence in the discourse of our political leaders and ministries of health, as well as of local government structures, civil society organizations and professional organizations. Some common shortcomings of Primary Health Care are;
To begin with, as part of the Declaration of Alma Ata held in 1978 in Alma Ata, USSR (Kazakhstan), Primary Health Care should involve, in addition to the health sector, all related sectors and aspects of national and community development: in particular agriculture, animal husbandry, food, industry, education, housing, public workers, communications and other sectors; and demands the coordinated efforts of all those sectors. This has not been the case since then and has led to the limited care given to people. The multi-sectorial collaboration in improving health has weakened affecting the health status and living standard of the people.
Secondly, Inverse care is another shortcoming of the PHC. People with the most means, whose needs for health care are often less – consume the most care, whereas those with the least means and greatest health problems consume the least. The health needs of the large population dwelling in the hinterlands are poorly catered for and as such they always travel to urban centers in order to benefit from quality healthcare delivery. Public spending on health services most often benefits the rich more than the poor in high- and low income countries alike.
Furthermore, impoverishing care has gained grounds worldwide. Wherever people lack social protection and payment for care is largely out-of-pocket at the point of service, they can be confronted with catastrophic expenses. A large number of people fall into poverty annually because they have to pay for health care. The Health Insurance Policy incorporated by the Universal Health Coverage which was known to have settled the score now operates on limited coverage and capacity leaving people with debts they cannot afford.
Also, healthcare is now unsafe. Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital-acquired infections clinically known as nosocomial infections, along with medication errors and other avoidable adverse effects that are an underestimated cause of death and ill-health.
Moreover, misdirected care has also played a major role in running PHC down. Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.
However, having said much about the shortcomings of PHC, below are some of the reforms that could be adapted to put PHC back on its toes in order to achieve its purported aims and objectives.
Universal coverage should be restructured in order to ensure that health systems contribute to health equity, social justice and the end of exclusion, primarily by moving towards universal access and social health protection.
Service delivery reforms should be inducted so as to reorganize health services as primary care that is around people’s needs and expectations, in order to make them more socially relevant and more responsive to the changing world while producing better outcomes.
Again public policy reforms should be done to secure healthier communities, by integrating public health actions with primary care and by pursuing healthy public policies across sectors. The PHC purports to attain health for all require health systems that: “Put people at the center of health care”. What people consider desirable ways of living as individuals and what they expect for their societies, that is what people value – constitute important parameters for governing the health sector.
Lastly, leadership reforms should be done, replacing disproportionate reliance on command and control on one hand, and laissez-faire disengagement of the state on the other, by the inclusive, participatory, negotiation-based leadership required by the complexity of contemporary health systems.
In conclusion, Primary Health Care had suffered shortcomings despite its substantive role in our healthcare system and I strongly affirm that the proposed reforms could serve as an up lifter and put PHC back on track.
BSC. PHYSICIAN ASSISTANT STUDIES
UNIVERSITY OF CAPE COAST
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