Primary health care as adopted from the Alma Ata declaration 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 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.
And this forms an integral part of both 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 individual s, the family and community with 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.
From the definition of PHC, its main aim is to provide basic quality and scientifically approved and socially acceptable care for the people by seeking their participation. This was also the dream of the ministers from more than 100 countries who attended the international conference held in Alma Ata, USSR ( Kazakhstan) in 1978. Their dream was to provide health for all by the year 2000, but that dream as at that time till now has not yet been achieved.
The declarations were made alright, but if I may asked once again, were these declarations strictly followed and implemented?. In order for PHC to be sustained in Ghana, there is the need to revisit the ‘Alma Ata declarations’ and implement them. The following adjustments could be made.
To start with, there should be community participations, during the Alma Ata declarations, they thought of involving the community members in making decisions regarding their own health. And if I may asked again are we really involving the people in taking decisions concerning their health? If the people are involved to charge of their own health issues, then they will be able to make decisions concerning their well-being and hence stay healthy. What do we even see in Ghana when it comes to building hospitals or health centres for a community, the people are not involved as to where would be appropriate to raise the building .The government would just build the hospital and in the end these health facilities are covered by the bush without people patronizing them due to the place of location. When the people are allowed to take part in simple decision making processes in the end they would go for it since they themselves made those decisions. To add to this, there may not be enough, physicians, physician assistances and other health workers to cover every body, in order to sustain the health needs of the people the community itself must needs to be involved in maintaining its own health. Some community volunteers could be trained to take up some minor issues that do not need a doctor’s attentions. Also involving the traditional birth attendants and other herbal medicine practitioners from the community would be necessary. For instance, in some communities where the nearest health centre would be some far away distance (about 5 km) which when there is any emergency before the patient could be transported there, he/she may have given up the ghost already. There would be the need to train these local herbalists and traditional birth attendants which the people have faith in them and may use their services no matter what we do so that they can use scientific and socially acceptable methods to treat them and to stabilized them.
To top it up, there is the need to re-enforce the objectives of the Community-base Health Planning and Services (CHPS). Ever since the Alma Ata Conference, Ghana had a policy of making community-based services available to all through community-based services care and hence the CHPS was adopted after the Navrongo Experiment was successfully conducted on how to implement this policy. When this model was also conducted in Nkwanta in the Volta Region, it finally came to stay in 1999. The CHPS was to provide basic and holistic care for the community people by bringing health care to their doors-steps.
Some of the objectives of the CHPS is to target and involve the community but that is not what we are seeing in the present Ghana. As I pointed it out earlier, since the community are not involved, some health facilities have been covered by the bush without anyone attending or patronizing.
Also, since the communities are sometimes not involved and hence given the opportunities to express their views and ask questions and get the appropriate feed backs or answers to their questions, they refuse to patronise the services of the CHPS, simply because they feel their services are not of good quality. The CHPS was created with many initiatives and objectives and to include the local people, educate them, bring health care to their doors-steps but there has been some sort of setbacks and dysfunctions in it, there is therefore the need to recheck the loop holes and fill them up. If this is done, then the CHPS initiatives would have been one of the best ways to ensure quality health care of the rural people.
One of the Alma Ata declarations was to achieve good health through a multi-sectoral approach. What this basically means is that, there is the need to involve other sectors than only the health sector. The economic sector will have to come into play, there must be a good economy to ensure that the standard of living of every Ghanaian is above average. In this case the government must also come in to make jobs available, avoid high taxes on businesses which is collapsing individually financed businesses. The Agricultural sector must also contribute to providing food for the people. Also the government is at fault when the roads leading to food production towns and communities are left unconstructed in such a way that there are difficult for vehicles to go there and bring the food stuffs to the market. The efforts of farmers are left unreward when foods are left to rot in the farms and some bought at a very cheaper prices, when this happens, foodstuffs become expensive we tend to import food from other countries rather exporting and hence foreign income, and this may also affect the economy.
As the economy is affected, the standard of living of people too may be affected and hence this in turn will affect the health of the people. Most people are getting sick due to the economic constraints put on them. Some are not even able to afford a two square meal and hence children become malnourished predisposing them to many other health conditions due to weakened immune system. Some parents are educated to breast feed their children for at least six months but they ignore this not out of ignorance but for the fact that, if they are to stay at home for that six months with only that baby the rest of the family may die out of hunger since they are the only breadwinners. A sad true story was seen in a book written by Sheila Zurbrigg, Rakku’s story. This mother wished to have breastfed her baby for the full her could not due to the fact if she does not go for her by-day work at the fields the rest of the children will not eat. It became sad the more when she could not leave her job and take the baby to the hospital when the baby became sick till the baby’s condition became worse for the fear of being sack. These younger ones are therefore not breastfed well and even left in the care of their older siblings while the parents go out to struggle for what they will eat.
In this case people do not even have time to make decisions concerning their health because some are even psychologically not well due to the pressures of the economy. It is therefore necessary to include all the other sectors if PHC is to be sustained just as declared in Alma Ata.
To sum it up, to sustain PHC, there should be a change on the attitudes of health care workers or health Providers. Some health workers just insult patients who stay in the house for their sickness to advance to a serious level before coming to the hospital. Some patients may not be able to gather the courage to attend the hospitals because they may not have resources in terms of monetary issues, others think they can manage it on over-the counter drugs and others thinking of leaving their by-day jobs to go and be in long queues, they therefore wait till their situations aggravate and when they finally gather the courage to attend the hospital, what they get is scoldings from the health providers.
One similar true story was seen in a book written by Sheilla Zurbrigg tittled ‘Rakku’s Story’ which took place in India. Rakku was scolded by the doctor for staying home till her baby’s condition has worsened. Eventhough, this true story happened in India, some health workers in Ghana show similar attitudes of insulting and scolding patients and parents without inferring on the reason why they have stayed home till that late and hence the need to seek medication attention on the earliest possible time. Some patients may not even have the money to buy food not to talk of what to be used to patronise drugs prescribed. Health workers must hence change this attitude and create conducive atmosphere and relationship for patients to bring out their needs. They should know more about their conditions of living before uttering words of insults or scolding. Some leave the hospital without buying the drugs prescribed because they may not have the means and the Physician in his anger couldn’t asked if the patient would be able to afford the drugs or not. What would be the good of going to the hospital if a patient is not able to buy the prescribed drugs, isn’t it the same as not going? There is the need to find out if other alternatives could be done for them.
In conclusion, to sustain PHC in Ghana there is the need to address the underlying social, economic and political causes of poor health through equitable distribution of resources. There should be involvement of all and open forums must be organised frequently to seek the ideas of the people on how to improve on the quality of health and I believe in doing this, they may bring out good and remarkable ideas. In this case, all hands must be on deck ranging from the government, politicians, the people and everybody whose contributions would help make our health system a better one.
Werner, D; Sanders, D; Weston, J; Babb, S; and Rodviguez, B. (1997). Questioning the Solution. The politics of primary Health Care and Child Survival. New York; Health Wrights.
Disclaimer: "The views/contents expressed in this article are the sole responsibility of the author(s) and do not neccessarily reflect those of Modern Ghana. Modern Ghana will not be responsible or liable for any inaccurate or incorrect statements contained in this article."