The World Health Organization View of Primary Health Care - Essay Example

The Central Concepts of the WHO View of Primary Health Care Main concepts of the primary health care are stipulated in a Declaration of Alma-Ata (1978). WHO (the World Health Organization) underlines that the general concept is that health care resources should be allocated on the basis of need as opposed to ability to pay. Policy makers in all jurisdictions have also become increasingly aware of a body of economic literature emphasizing that there is no evidence of the cost-effectiveness or even effectiveness of many primary health care services supplied. A general concern has arisen that prioritization of primary health care needs and the supply of health care services has unduly emphasized acute care and expensive technologies over primary and preventive care. This allocation pattern, it is argued, reflects what is optimal from the medical profession's perspective as opposed to what is optimal for society. HIV/AIDS epidemic in developing countries is one of the main health care concerns. Many of the HIV/AIDS programs in developing countries have been carried out with considerable support from international donors. Somalia is one of the developing countries affected by HIV/AIDS problems. Over the years, proponents of HIV/AIDS programs have seen the benefits of these programs as similar to those of other development efforts-e.g., in education, or disease prevention through immunizations-in helping to bring about improvements in the wellbeing of individuals and societies. The critics have included, at varying times, representatives of developing countries, social scientists, interest groups such as feminists and women's rights and health advocates (Chan 2007). The central concepts of the primary health care, highlighted by WHO, are equitable distribution, community participation, inter-sectoral coordination and appropriate technology. The Declaration of Alma-Ata states: "The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries" (The Declaration of Alma-Ata 2007). This is one of the most important concepts for Somalia faced with economic and political crisis. When a civil rights complaint involves alleged discrimination in community services, the Office of Civil Rights usually seeks to obtain voluntary compliance. The equitable distribution of primary health care is crucial for Somalia because not only is AIDS the leading cause of death in Somalia, but it has also eroded decades of progress in reducing mortality and increasing life expectancy. Because of the increased mortality from AIDS, the question has been raised of whether rapid population growth will continue to be a problem in those countries with the highest prevalence rates of the human immunodeficiency virus. Somalia has HIV prevalence rates of 10 % or more, and in Somalia average life expectancy has declined from 58 to 48 years. Policies of international community stipulate that the main priority in 2007 is "scaling up prevention and treatment activities, particularly to more neglected communities" (UNAIDS 2007). Community participation concept is aimed to attract attention of the society and all community members to HIV/AIDS problems and preventive measures. Denial of the problem size and importance at all levels of government has long been a significant constraint in Africa. Despite these initiatives, efforts to date have fallen short of what is needed to tackle the epidemics effectively (Somalia Health Update 2000). Surveillance-the methodical collection of data on disease occurrence and its determinants, a basis for effective programs-is weak in Somalia. "The first site providing antiretroviral therapy in Somalia was established as a pilot project in 2005 in Hargeysa at a time when the numbers of refugees residing near the border between Somalia and Ethiopian and of Somalis with advanced HIV infection were increasing." (Somali 2005). Prevention programs for high-risk groups are also weak or too small. Political commitment is variable, stigmatization remains a common problem, and interventions such as harm reduction face legal restrictions in many countries. Also, WHO stipulates that: "Primary health care 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" (The Declaration of Alma-Ata 2007). In a region going through the upheaval of transition from a command to a market economy, allocating resources to avert a "potential" problem was a difficult proposition. The situation was compounded by the fact that in the early stages, the epidemic was concentrated among marginalized groups, with little or no political clout. The rise of HIV/AIDS thus caught Somalia unprepared to address its impact on the health sector and even less prepared to address its impact on the society at large (Somali 2005). It was admitted that like other regions, Somalia has been slow to make the perceptual leap to begin to see HIV/AIDS as more than "just" health problems. Even today, leaders and governments have all denied that the epidemic of HIV/AIDS would affect not only the health of individuals, but also the welfare and well-being of households, communities and entire societies. The recent reports and economic prognosis concerning AIDS/HIV impact on economic health of African continent has been prepared primarily by Western and American researchers (Emergency and humanitarian action 2001). WHO underlines that the primary health care "reflects and evolves from the economic conditions and socio-cultural and political characteristics of the country; addresses the main health problems in the community; includes at least: education concerning prevailing health problems and the methods of preventing and controlling them" (The Declaration of Alma-Ata 2007). Unfortunately, Somalia is unable to meet most of these requirements and rules because of scarce financial and scientific resources (Emergency and humanitarian action 2001; Somalia Health Update 2000). As the most important, the primary health care should "involve, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry" (The Declaration of Alma-Ata 2007). A recent study from the African countries, provided by International Health Organizations, suggests that local policing strategies may be an important determinant of HIV risk among injecting drug users. Fear of police detainment or arrest among injecting drug users reportedly made users reluctant to carry needles and syringes, a practice associated with needle (Somalia Health Update 2000). Western scientists suggest that structural factors are deep-seated and complex problems. They can be resolved in the medium term or long term, through sustained, pro-poor economic growth and poverty-reduction policies and pro grams; control of drug trafficking. Title VIII stipulates that "all governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system" (The Declaration of Alma-Ata 2007). Lack of political will and recognition of the problem is another area of critique. For years in Somalia, denial of the problem by governments at all levels has been a significant constraint. In a region going through the upheaval of transition, transferring resources to a potential problem was a difficult proposition. Government of Somalia was able to make the case that in an environment of dwindling resources, dealing with HIV/AIDS was not the most urgent priority. Efforts have begun at changing the political and societal landscape. Governments of some South African countries are acknowledging the importance of HIV/AIDS. International financing is increasing, through grants, credits, and loans. But most of this costs does not spend on HIV/AIDS related programs. International organizations are also supporting a range of analytical and advisory services in the region. The developing countries "cooperate in a spirit of partnership and service to ensure primary health care for all people" (The Declaration of Alma-Ata 2007). The discussions and preparation processes leading up to these projects are themselves vital in generating and building commitment among populations. The projects generally rely on a broad battery of actions to address political will, such as media campaigns that increase public awareness, multi-sectoral partnerships, training for workers and government staff, educational programs, and the development of new legal frameworks. These actions help create broader recognition of the threats posed by HIV/AIDS and help build commitment to take action by the many players involved in implementing a program (Chan, 2007). The main problem is that the developing countries lack 'appropriate technology' and treatment methods to provide primary health care. The political will that has to help bring about these projects reflects progress in raising the level of awareness, but it is still only the beginning of a long and challenging process. One reason societies are slow to come to grips with the HIV/AIDS crisis is that many aspects of the problem are considered taboo or are frowned on by large segments of the population (Chan 2007). Government of Somalia does nothing to solve these problems. It is difficult to raise awareness or build consensus on an issue that cannot be discussed openly. The problem is exacerbated by the fact that the majority of people affected by HIV/AIDS belong to groups that are marginalized by society (Somali 2005). It is possible to conclude that a variety of important external constraints affect the success of the objectives and the progress of HIV/AIDS programs and compliance with WHO concepts of primary healthcare. Increased attention should be given to disease surveillance and to estimates and projections of the economic impact of HIV/AIDS. Greater emphasis should be placed on interagency coordination and country leadership. Bureaucratic procedures are common in African countries with complex missions, but the procedures for lending operations remain excessively complex. References 1. Chan, M. (2007). Health spending: getting the balance right Retrieved 17 September 2007 from http://www.who.int/dg/speeches/2007/20070629_oecd/en/ 2. Emergency and humanitarian action (2001). http://www.who.int/mediacentre/factsheets/fs090/en/ 3. Somalia Health Update (2000). Retrieved 17 September 2007 from http://www.who.int/disasters/repo/5541.html 4. Somali (2005). Retrieved 17 September 2007 from www.who.int/hiv/HIVCP_SOM.pdf 5. The Declaration of Alma-Ata. WHO (2007). Retrieved 17 September 2007 from http://www.who.int/en/ 6. UNAIDS (2007). Retrieved 17 September 2007 from www.unaids.org Read More