Primary health care
Primary health care (PHC) is "essential health care" that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC initiatives allow for the full participation of community members in implementation and decision making.[1] Services are provided at a cost that the community and the country can afford at every stage of their development in the spirit of self-reliance and self-determination.[2] In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy.[3][4] PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle.[5] Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems.[6] The World Health Organization, or WHO, elaborates on the goals of PHC as defined by three major categories, "empowering people and communities, multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services[1]." Based on these definitions, PHC cannot only help an individual after being diagnosed with a disease or disorder, but can actively contribute to preventing such issues by understanding the individual as a whole.
This article is about an approach to providing universal health care. For the sector of the health care system, see Primary care.This ideal model of healthcare was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata, Kazakhstan in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the World Health Organization's goal of Health for all.[7] 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. There were many factors that inspired PHC; a prominent example is the Barefoot Doctors of China.[5][8][9]
The ultimate goal of primary healthcare is the attainment of better health services for all. It is for this reason that the World Health Organization (WHO), has identified five key elements to achieving this goal:[10]
Behind these elements lies a series of basic principles identified in the Alma Ata Declaration that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and in coordination with other sectors:[2]
In sum, PHC recognizes that healthcare is not a short-lived intervention, but an ongoing process of improving people's lives and alleviating the underlying socioeconomic conditions that contribute to poor health. The principles link health, development, and advocating political interventions rather than passive acceptance of economic conditions.[5]
Background and controversies[edit]
Barefoot Doctors[edit]
The "Barefoot Doctors" of China were an important inspiration for PHC because they illustrated the effectiveness of having a healthcare professional at the community level with community ties. Barefoot Doctors were a diverse array of village health workers who lived in rural areas and received basic healthcare training. They stressed rural rather than urban healthcare, and preventive rather than curative services. They also provided a combination of western and traditional medicines. The Barefoot Doctors had close community ties, were relatively low-cost, and perhaps most importantly they encouraged self-reliance through advocating prevention and hygiene practices.[5] The program experienced a massive expansion of rural medical services in China, with the number of Barefoot Doctors increasing dramatically between the early 1960s and the Cultural Revolution (1964-1976).
Criticisms[edit]
Although many countries were keen on the idea of primary healthcare after the Alma Ata conference, the Declaration itself was criticized for being too “idealistic” and “having an unrealistic time table”.[5] More specific approaches to prevent and control diseases - based on evidence of prevalence, morbidity, mortality and feasibility of control (cost-effectiveness) - were subsequently proposed. The best known model was the Selective PHC approach (described above). Selective PHC favoured short-term goals and targeted health investment, but it did not address the social causes of disease. As such, the SPHC approach has been criticized as not following Alma Ata's core principle of everyone's entitlement to healthcare and health system development.[5]
In Africa, the PHC system has been extended into isolated rural areas through construction of health posts and centers that offer basic maternal-child health, immunization, nutrition, first aid, and referral services.[19] Implementation of PHC is said to be affected after the introduction of structural adjustment programs by the World Bank.[19]