Primary Health Care: Problems It Faces

Good health forms a greater part in achieving national goals and objectives, as well as international goals such as the Millennium Development goals 4, 5, and 6 (which are reducing child mortality, improving maternal mortality and combatting HIV/AIDS, malaria and other diseases respectively). It is therefore necessary for health facilities and its services to be made available to every individual in a country. Over the years, the Ghanaian government have put in measures to ensure that every individual gets access to health care through programmes including Primary Healthcare (PHC), National Health Insurance Scheme (NHIS) and the Village Health Workers Initiative.

Health is mostly administered by physicians, physician associates and other health professionals. Healthcare is the maintenance of health via the prevention, diagnosis and treatment of disease, illness, injury and other physical and mental impairments in human beings. Primary healthcare is mainly directed at health problems in the community, providing primitive and preventive services to individuals. It also encompasses primary care, population health and community development with a holistic framework aiming at providing essential community-focused healthcare.

Primary healthcare is a frontline of the care system and usually the first level of contact for individuals, family and community with the national health system. Primary healthcare, as a concept in delivering basic healthcare to citizens of the country, was coined on the 6^th-12^th September, 1978 with the sole aim of making health accessible to everyone universally. In Ghana, the concept of Primary healthcare started from the implementation of the NHIS through to the introduction of Community-based Health Planning and Services (CHPS) in various districts. This was aimed at getting all citizen to access healthcare at their doorstep as well as making healthcare free for all through the NHIS initiative. Notwithstanding all these implementations, PHC is currently facing several problems which have caused the incline of the goals the system aims to achieve. That is healthcare being accessible, essential, promoting equity, promoting appropriate technology use, improving multisectoral collaboration and community participation and empowerment.

The healthcare system in Ghana is coupled with specific functions, challenges and results of inadequate practices involved in the practice of primary health care in the country. The following are some highlighted challenges facing Primary healthcare in Ghana:

First is misplaced priority in the health sector. Not long ago, Ghana implemented the drone emergency medical delivery system which was worth $12.5 per 4 years of its services. This brought up questions as to whether the health sector condition permits the implementation of the drone, or whether the country really needs these drone services now, and other concerns about the health sector needing hospital beds, medicines (drugs), ambulances for transporting patients from one hospital to another among others. A question is left unanswered with the priority setting of promoting the core objectives of PHC than with promoting that of the drone service. On priority, the issue is how does the drone service promote the core objectives the PHC seeks to achieve.

Inadequate staffing of CHPS is another headache of PHC. The ratio of patient-healthcare personnel plays an important role in the quality of healthcare delivery. Inadequate health personnel at various health center undermines the progressive care that the PHC aims to achieve. This issue has led to the diversion of all the core aspects of PHC to only curative care. That is promoting other preventive healthcare activities that turn to decrease morbidity and mortality rates in the country. Now individuals have to walk long distances to health facilities just for some preventive vaccines which was initially administered on a door to door basis by healthcare practitioners.

Community participation is also a challenge facing the PHC. Community participation in healthcare delivery system creates an avenue for the healthcare practitioners to extend care to a particular geographical and social periphery of the country and is a very cost effective system. It enables health practitioners to educate community members, which turns to increase their understanding of the status objectively rather than fatalistically. The involvement of the community in healthcare has decreased because of lack of resource personnel and the requisite equipment needed to embark on community-based health care activities. This has led to the increase of the morbidity and mortality rates in the country because the preventive and promotive aspect of the PHC is lost in the healthcare delivery, especially in the deprived areas (villages).

Primary healthcare was established to bring liberation to the health sector and so with this, I think it would be very prudent that stakeholders of the health sector revisit the objectives to which the PHC concept was established. In order to be able to correct the current problems facing the PHC system which include the shifting of most of its resources to the primary healthcare rather than the tertiary healthcare providers because these preventive diseases often tend to develop into emergency cases which demand huge sums of money in treating these diseases and also healthcare should be channeled to communities to encourage community participation in order to decrease the incidence and prevalence of morbidity and mortality in Ghana.

Acknowledgement
Mr. William Mintah Hayford
Mr. Frank Mensah
Miss Dorothy (legon)
Article written by
Acquah Donkor Felix
Physician Assistant Student- UCC
[email protected]