There is today a recognition that populations are left behind and a sense of lost opportunities thatmare reminiscent of what gave rise, thirty years ago, to Alma-Ata’s paradigm shift in thinking about health. The Alma-Ata Conference mobilized a “Primary Health Care movement” of professionals and institutions, governments and civil society organizations, researchers and grassroots 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 translation of these values into tangible reforms has been uneven. Nevertheless, today, health equity enjoys increased prominence in the discourse of political leaders and ministries of health, as well as of local government structures, professional organizations and civil society organizations.
The PHC values to achieve health for all require health systems that “Put people at the centre of health care”. What people consider desirable ways of living as individuals and what they expect for their societies – i. e. what people value – constitute important parameters for governing the health sector. PHC has remained the benchmark for most countries’ discourse on health precisely because the PHC movement tried to provide rational, evidence-based and anticipatory responses to health needs and to these social expectations. Achieving this requires trade-offs that must start by taking into account citizens.
Moving towards health for all requires that health systems respond to the challenges of a changing world and growing expectations for better performance. A short definition to Primary health Care. Primary health care, often abbreviated as “PHC”, has been defined as “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 full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.
In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. This ideal model of health care was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata in 1978 (known as the “Alma Ata Declaration”), and became a core concept of the World Health Organization’s goal of Health for all.
The Alma-Ata Conference mobilized a “Primary Health Care movement” of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the “politically, socially and economically unacceptable” health inequalities in all countries. A PHC philosophy recognizes that health and health services occur within particular physical environments and their historical, socio-political, economic, and cultural contexts that shape the social determinants of health for individuals, families, groups, communities, regions, or countries.
Each discipline contributes to health and health services delivery within a PHC model, both in a unique sense, and through collaborative interdisciplinary practice. Conceptual Definition of Primary Health Care: Primary Health Care 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 (World Health Organization [WHO], 1978).
The cornerstones of PHC are access, equity, essentiality, appropriate technology, multisectoral collaboration, and community participation and empowerment . Primary health care is an approach to health care that: • is evidence-based • uses appropriate technology • promotes community participation in decisions about health services • is provided at a cost the community can afford • encourages self-care and empowerment of community members • is the first level of contact with the health-care system • brings health care as close as possible to where people live, work, and play.
Primary Health Care in India Primary healthcare in India is very diverse—both public sector and private (not for profit and for profit) and provided by a variety of healthcare workers including “allopathic” doctors trained in UK style medicine, practitioners trained in the indigenous systems of medicine (ayurveda, unani, siddha, and homeopathic medicine—AYUSH), and traditional healers delivering care without any form of training.
There are major differences between states in urbanisation, economic resources, availability of healthcare workers, and primary care related health outcomes. For example, in 2009, Kerala had an infant mortality rate of 12/1000 and a supply of locally well trained nurses to staff their primary care facilities while Bihar had an infant mortality rate of 51/1000 and no nurse training facility. The variation in progress towards the targets despite significant public investment in health is at least partly attributed to the overall low quality and achievement of the primary care system in some parts of the country.
This is compounded by poor access—primary care may not be provided free of charge even in public facilitiesand many people cannot afford to pay for care. The NRHM integrates AYUSH practitioners into the PHCs to “optimise the utilization of these resources to meet the needs of the population as well as to reflect the growing interest in integrative care. ” However, the planning commission in its mid-term appraisal of the 10th five year plan in 2005 reported that, in general, there was much room for improvement of the quality of care in rural areas, whilst noting that there were some exceptions .
Continuing efforts are being made to improve service provision under the NRHM, and in 2009, 75% patient satisfaction was reported in Andhra Pradesh, but satisfaction with the service remained unacceptably low in the other three states surveyed (Uttar Pradesh 49%, Rajasthan 39%, Bihar 23%). Principles of Primary Health Care. The primary health care approach is both a philosophy of health care and a model for providing health services. The focus of this approach is on preventing illness and promoting health.
WHO identifies four main principles of primary health care- Equitable distribution, community participation , intersectoral coordination and appropriate technology. 1) Equitable Distribution The first key principle in Primary Health Care Strategy is equity or equitable distribution of health services, i. e. health services must be shared equally by all people irrespective of their ability to pay and all must have access to health services. A continuing and organized supply of essential health services should be available to all people with no unreasonable geographic or financial barriers.
The flagship in the public sector is the government funded National Rural Health Mission (NRHM). Care is delivered by a three tier structure with subcentres at the level of the Gram Panchayat (5-6 villages), primary health centres (PHCs) for 30-40 villages, and community health centres (CHCs) serving about 100 villages. The CHCs are polyclinic style, staffed by hospital specialists with about 30 inpatient beds and radiography facilities. At present health services are mainly concentrated in the major towns and cities resulting in inequality of care to the people in rural areas.
The worst hit are the needy and the vulnerable groups of the population in rural and urban slums. this has been termed as social injustice. The failure to reach the majority of the people is usually due to inaccessibility. In many rural areas of our country it is impossible for the patients to travel and reach the PHCs due to the faulty roads and unavailability of means to move from one area to another(vehicles ) thus making the accessibility an issue. Component| Shift from >| >
To|all health services are universally accessible to individuals and families in the community| • physician as gatekeeper and ‘authorizer’ of access to and exit from most health-care services • fragmentation, duplication of care with weak linkages among primary care providers and between primary and secondary/tertiary levels of care| • multiple points of access to health services; an individual may directly access an RN, physiotherapist, physician or dietician based on their needs • integrated service delivery by inter-disciplinary teams who “together” address the healthcare needs of defined.
2) Community Participation Individuals and communities have the right and responsibility to be active partners in making decisions about their own health care and the health of their communities. It points out that the decision and the delivery of health care is flexible and responsive. The primary health-care model encourages ‘full participation’ of the public. Implementing this component of the primary health-care model means that there must be a shift to ensure that people are given consistent information that is fully discussed with them.
Increasingly, clients come to health-care providers with information and knowledge, having researched the Internet or other sources of information. In the primary health-care model, the client becomes a partner in care and the public becomes more involved in making decisions about how scarce health resources should be allocated. The public needs to be involved in and take responsibility for decision-making on the health system itself as well as their own individual health.
A well-informed public will be able to: • take responsibility for their own health • understand the implications of the health-care decisions they are making • support the appropriate use of technology • be involved in planning for health services the extent to which the population is aware of PHO functions and services is questionable , and it seems that people continue to relate first and foremost to their general practice or community provider. Component| Shift from >| >
To|community participation| • perception of public as incapable of making complex decisions about health care • control, especially of information, is in the hands of providers| • meaningful and informed public participation in decision-making about personal health care and health system issues (e. g. , funding priorities)| 3) Intersectoral Co-ordination This principle recognises that the components of primary health care cannot be provided by the health sector alone.
Providing care to a vulnerable population may involve working with other sectors such as justice, labour, social services, mental health, housing and education. Formal and informal partnerships among community agencies and resources support the integration of services across the many sectors that influence the health of populations. Failure to establish smooth referral mechanisms among professionals and agencies will impact the health of all clients, especially vulnerable groups. Component| Shift from >| >
To|link between health and determinants of health| • health-care services seen to be the sole responsibility of the health-care system with no links to other sectors • individually focused on person presenting for care| • better integration with other sectors that impact on health such as education, labour, justice, social services • population focus in understanding individuals in a broader context and tying health determinants to analysis of health-care outcomes| 4) Appropriate Technology.
Technology can refer to the structure and delivery of health services, human resources, medical equipment, pharmaceutical agents or new interventions and techniques. There is a need to ensure that interventions and technologies used in health care are proven to be effective and affordable. Health technology assessment can provide decision-makers with scientific evidence about the technology and the benefit to the patient, or help them determine that the technology would be of benefit, but no more than one that is less expensive.
It Includes methods of care, service delivery, procedures and equipment that are socially acceptable and affordable. Many PHCs in our country do not have the even the basic necessities to address an emergency. In many cases even the doctors in the PHC are illiterate as to how these medical equipment needs to be put to use. Component| Shift from >| > To|
evidence-based decision-making and appropriate technology| • using new technologies without appropriate health technology assessment which assess the benefits and costs| • appropriate use of technology based on evidence • valuing alternative and low tech therapies or interventions that have a proven benefit to health| Bibliography: Greehalgh, T. (2007). Primary Health Care- Theory and practice. BMJ Books. Park, P. a. (1970). Preventive and Social Medicine. Bhanot Publishers. Redneil, T. (2000). Achieving Health For All. Loadstar Publications.