Making Primary Healthcare In Ghana Better. Possible?

Primary health-care basically refers to essential healthcare that is based on scientifically accepted approach, which makes universal healthcare available and accessible to all individuals and families in a community. The primary healthcare was adopted in the declaration of the international conference held in Alma Ata, Kazakhstan in 1978. It then became a core concept in the world health organization’s goal of “health for all”. In Ghana, many people believe that the primary healthcare policy hasn’t gotten a full shape yet. This claim looks very true. That is, there are many challenges facing the implementation of the primary healthcare fully in the country. This text, however tends to highlight four ways of making the primary healthcare policy strong as declared in the Alma Ata conference.

THEY ARE; ensuring that health systems contribute to health equity, social justice and the end of exclusion, primarily by moving towards universal access and social health protection (universal coverage reforms); reorganizing health services as primary care, i.e. around people’s needs and expectations, so as to make them more socially relevant and more responsive to the changing world while producing better outcomes (service delivery reforms); securing healthier communities, by integrating public health actions with primary care and by pursuing healthy public policies across sectors (public policy reforms); 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 ( leadership reforms).

The universal coverage reforms aims at making sure that there are no exclusions and social disparities in health. Ultimately, the determinants of health inequality require a societal response, with political and technical choices that affect many different sectors. Health inequalities are also shaped by the inequalities in availability, access and quality of services, by the financial burden these impose on people, and even by the cultural and gender-based barriers that are often embedded in the way in which clinical practice is conducted. If health systems are to reduce health inequities, a precondition is to make services available to all, i.e. to bridge the gap in the supply of services. Supply gaps are still a reality in many parts of the country, Ghana. This has made extension of their service networks a priority concern. As the overall supply of health services has improved, it has become more obvious that barriers to access are important factors of inequity: user fees, in particular, are important sources of exclusion from needed care. Moreover, when people have to purchase health care at a price that is beyond their means, a health problem can quickly precipitate them into poverty. As such, the extension of the supply of services has to be backed with an active social health protection, through pooling and pre-payment instead of out-of-pocket payment of user fees. Ensuring universal coverage will constitute a necessary condition to improved health equity. Hence, universal coverage must be complemented with another set of proactive measures to reach the unreached: those for whom service availability and social protection does too little to offset the health consequences of social stratification. This is where the service delivery reforms come in.

These service delivery reforms are meant to transform conventional health-care delivery into primary care. That is, primary care should be based solely on the people. Here we say, the primary healthcare should be people-centered. Care that exhibits these features requires health services that are organized accordingly, with close-to-client multidisciplinary teams that are responsible for a defined population, collaborate with social services and other sectors, and coordinate the contributions of hospitals, specialists and community organizations. Primary care can do much to improve the health of communities, but it is not sufficient to respond to people’s desires to live in conditions that protect their health, support health equity and enable them to lead the lives that they value. People also expect their governments to put into place an array of public policies to deal with health challenges, such as those posed by urbanization, climate change, gender discrimination or social stratification.

This is the third reform. These public policies should encompass the technical policies and programs dealing with priority health problems. These programs can be designed to work through, support and give a boost to primary care, or they can neglect to do this and, however unwillingly, undermine efforts to reform service delivery. Health authorities have a major responsibility to make the right design decisions. Programs to target priority health problems through primary care need to be complemented by public health interventions at national or international level. These may offer scale efficiencies; for some problems, they may be the only workable option. The evidence is overwhelming that action on that scale, for selected interventions, which may range from public hygiene and disease prevention to health promotion, can have a major contribution to health. Yet, they are surprisingly neglected, across the country, regardless of income level. This is particularly visible at moments of crisis and acute threats to the public’s health, when rapid response capacity is essential not only to secure health, but also to maintain the public trust in the health system. Public policy-making, however, is about more than classical public health. Primary care and social protection reforms critically depend on choosing health-systems policies, such as those related to essential drugs, technology, human resources and financing, which are supportive of the reforms that promote equity and people centered care. In order to bring about such reforms in the extraordinarily complex environment of the health sector, it will be necessary to reinvest in public leadership in a way that pursues collaborative models of policy dialogue with multiple stakeholders – because this is what people expect, and because this is what works best.

This is the last reform covered in this text (leadership reforms). Health authorities can do a much better job of formulating and implementing PHC reforms if the mobilization around PHC is informed by the lessons of past successes and failures. The governance of health is a major challenge for the ministry of health and the other institutions, governmental and nongovernmental, that provide health leadership. They can no longer be content with mere administration of the system: they have to become learning organizations. This requires inclusive leadership that engages with a variety of stakeholders beyond the boundaries of the public sector, from clinicians to civil society, and from communities to researchers and academia. Strategic areas for investment to improve the capacity of health authorities to lead PHC reforms include making health information systems instrumental to reform; harnessing the innovations in the health sector and the related dynamics in all societies; and building capacity through exchange and exposure to the experience of others within and across borders.

Acknowledgment
Dr. Kingsley Pereko
Mr. Emmanuel Kings Asare
Mr. Edward Kings Asare
Text by
Ama Gyasiwaa Dadzie
A level 200 physician assistant student
University of Cape Cast, Ghana
[email protected]