Comprehensive Primary Health Care System for HIV/AIDS in South Africa - Research Paper Example

Comprehensive Primary Health Care System for HIV/AIDS in South Africa Demographics: South Africa South Africa is located at the southern tip of the African continent. It has a population of about 49 million with most of its numbers spread out in the 15-64 years age range. The population is comprised of 79% black Africans, 9.6% whites, 8.9% colored, 2.5% Indians/Asians. They have a birth rate of 19.93 births/1,000 population and a death rate of 16.94 deaths/1,000 population. Their infant mortality rate is 44.42 deaths/1,000 live births. Only about 39% of South African households have piped water in their residence. A large percentage of their population does not have access to potable drinking water in their residence; “it has to be fetched, sometimes from a distant source, a task usually undertaken by women or younger children” (Department of Health, 1998, p. 17). The major infectious diseases in the nation are food or waterborne diseases like bacterial diarrhea, hepatitis A, and typhoid fever. Schistosomiasis is also common in the country. Adolescents 15 years of age can read and write; the total population literacy rate is 86.4% with males having an 87% literacy rate as compared to 85.7% literacy rate for women (CIA World Factbook, 2009). HIV/AIDS in South Africa Their HIV/AIDS adult prevalence rate is 18% compared to the 4% worldwide rate. There are about 5.7 million people in Africa living with AIDS and annually about 350,000 people die from the disease. The average life expectancy in South Africa is 54, and some analysts claim that without the AIDS factor, this life expectancy may actually be brought up to 64 years. From 1990 to 2003, when the country experienced one of its worst periods in the AIDS pandemic, its ranking in the Human Development Index dropped 35 places; this clearly indicates the large and dire impact of the AIDS issue to their general development as a nation. The poor economic state of South Africa is a major factor in the worsening of the AIDS problem (Averting HIV and AIDS, 2009). The government is struggling mightily against this pandemic. Various government programs have been launched in order to address this problem. One of these programs is the comprehensive primary health care system. This paper shall discuss the role and relevance of the comprehensive primary health care program in addressing the HIV/AIDS issue in South Africa. It shall analyze the different factors facilitating and constraining the effective implementation of the program. The future potential of the primary health system against AIDS shall also be explored in this paper. Role/relevance of Comprehensive Primary Health Care Program for HIV/AIDS A comprehensive primary health care program for HIV/AIDS in South Africa will help achieve the goal of ‘health for all’ alongside other health agencies working in coordination with each other. The program’s relevance is to come up with a strategy that would react fairly and efficiently to the needs of the community and still focus on the socio-economic and political factors affecting their needs (Tarimo & Webster, as quoted by Magnussen, et.al., 2004). This comprehensive primary health care program is based on need, disease prevention, and health promotion. Comprehensive primary health care acknowledges that poverty, social unrest, the environment, and lack of basic resources are causes for poor health status of the population in general. Implementers of the comprehensive primary health care program are hoping that the program will be utilized by the local staff in order to assess their performance and the performance of their clinic; by the community who will be able to note the range and quality of services they can access; as guidelines for the local and provincial health administrators in order to assess the unmet needs of the population; and by the provincial government officials in order to direct resource allocation (Department of Health, 2000). The equitable delivery of health services through primary health care services covers various areas in health delivery. These areas include free health services for children below 5 years, changes in the training of health workers, HIV/AIDS prevention measures in eliminating the personal and social impact of HIV/AIDS, and the Expanded Program of Immunization covering common immunizable childhood illnesses like pertussis, cholera, poliomyelitis, and diphtheria. Primary health care for HIV/AIDS has and is continuing to show a lot of promise in adequately addressing the HIV/AIDS problem in South Africa. In a country where HIV/AIDS is a pandemic, the best way to make a dent on the issue is to go to the grassroots level and to bring the health services to the people. Benefits Some studies conducted by government agencies have established that new investments in the HIV/AIDS treatment program can have a dramatic and long-term impact. But a reshuffling of health resources toward more generalized health services and functions would endanger the progress made against AIDS depriving care and treatment for more than six million individuals afflicted with this disease (Collins, as quoted by Collins, et.al., 2008). The antiretroviral therapy conjured under the comprehensive primary health care program was able to benefit about 3 million people worldwide, and the goals of reduced HIV/AIDs deaths was made possible due to the perseverance of health administrators in the primary health care program. Reports of the United Nations and the World Health Organization have revealed findings that are vital to the AIDS eradication goal. These key findings were able to establish that the HIV/AIDS response has had favorable impact on healthcare in different settings. And this improved response to HIV/AIDS gave way to infrastructures, improved quality of health services, and increased coverage for the poor and the AIDS-afflicted patients. The same report also revealed that the “engagement of health consumers and advocates in AIDS scale up has forced global and national leaders toward a more vigorous sense of accountability and urgency, both critical elements in the success of AIDS programming” (Collins, et.al., 2008). Constraints in the Implementation One of the main constraints in the implementation of the comprehensive primary health care system for HIV/AIDS in South Africa is the increasing migration and brain drain of health workers in South Africa. The migration pattern for health professionals is actually following the migration pattern of all professionals, that is, from rural to urban areas or from poorer to richer countries. Although there is only a small proportion of doctors and nurses actually migrating, their loss still has a crucial and weakening impact on the African health system (Beaglehole, et.al., 2003, pp. 112-113). Of great concern is the loss of nurses, more than doctors. The demand for nurses in developing countries like South Africa is high, but many of them are opting to seek employment in richer and developed nations where they can get higher pay for their work. This makes the implementation of the comprehensive primary health care program, or any health program for that matter, a big challenge. Health professionals are ultimately the ones who will implement health care programs and with limited personnel, the implementation of these programs will be slow, ineffective, and limited. Another barrier to comprehensive primary health care is the underfunding of health programs in South Africa. Many poor countries like South Africa have been “considerably weakened by a combination of conservative macro-economic policies and health policies that constitute health sector reform” (Sanders, et.al., 2008). Underfunding has primarily caused weakening in the delivery of health services, especially health resource personnel. The global economic crisis has also affected the active recruitment of health care professionals; only rich countries are able to offer the best possible deals for health workers. And inasmuch as the HIV/AIDS crisis is a major health problem in South Africa, it has however, severely affected the handling of issues in child health and other areas in healthcare by redirecting attention and valuable funds to numerous HIV/AIDS program that have not been guaranteed to work. (Sanders, et.al., 2008). Primary health care facilities for HIV/AIDS patients are programmed to “emphasize the promotion of healthy lifestyles, the coordination of health services, collaboration with other public sectors affecting health (for example, housing, water, and sanitation), community participation in planning and delivering free primary care…” (Benatar, 1997). A big problem in providing ‘health care for all’ without any corresponding increase in allocation unavoidably leads to the redistribution of the public health budget based on population census. Administrators trying to strengthen the primary health care system end up directing funds away from hospitals and academic centers and allocating them to primary care centers. This is an advantageous move for primary health care, however, is of great detriment to hospitals and academic centers. These adjustments in the budget are causing changes which are not beneficial to the provinces; gradual cutback in healthcare staff and hospital resources usually follows these adjustments. And yet, undeniably, resources are very much needed in order to operate the major services in the provincial hospitals and academic centers (Benatar, 1997). The price of comprehensive primary care is being felt and largely suffered by hospital-based services. Government officials in South Africa point out that budget constraints in their health sector is making it difficult for both primary health care and hospital-based services to be widely implemented. Future Potential In order for the comprehensive primary health care system to work, there should be a focus on the development of comprehensive well-managed programs involving the health sector and the community. The primary level consists of families, villages, and small communities working in conjunction with the set program for HIV/AIDS. Health administrators need to come up with ways of reinstating and retaining health personnel. Sufficient incentives should be offered and made available to them. A vital first step is the development of the capacity of health personnel in primary health centers through adequate training and guidance in crucial government health programs (Sanders, et.al., 2008). Training must be undertaken in conjunction and with the guidance of highly specialized health administrators and sectors. Partnerships with non-governmental organizations which have the expertise in community development are important tools in the implementation of a sustainable and comprehensive primary health care system. Improvement of the health and nutrition of the younger population in South Africa are long-term investments that will greatly help improve the future chances of South Africa in dealing with the HIV/AIDS pandemic. Practitioners and other healthcare analysts emphasize that in order for the implementation of a comprehensive primary health care system for HIV/AIDS in South Africa to succeed, the health administrators need to improve the training and skills of their health workers. “To achieve the goals associated with health care systems driven by primary health care, new options for the education and in-service training of health care workers are required so as to ensure a workforce more closely attuned to the country’s needs” (Beaglehole, et.al., 2003. pp. 111-112). The skills training which health workers need to undergo has to be more specific and specialized to fit the needs of the HIV patients in South Africa. Most of the time, expensive health workers are produced in areas which have a great need for workers trained in primary health care. In this sense, workers being produced do not actually match the needs of the society. By decentralizing the responsibility for health care to the provincial and district levels, more people will be reached and will benefit from health programs being implemented by the government. The national government now acts more like a supervisory agency that overlooks the lower districts in order to make sure that they are complying with national goals and health principles. The provincial and district primary health clinics will now have the responsibility of allocating healthcare workers and other resources to the districts by giving them accessible and cost-effective services. And by delegating the different facets of administration to the lower health agencies, it is possible to increase the democratic participation and control of the local population in the distribution of health services (Lundy & Janes, 2003, p. 135). The comprehensive primary health care program works mainly in cooperation with the community health workers who are burdened with implementing the HIV/AIDS program to the grassroots level. Experts have emphasized how the efforts of the community health workers can improve the health of the people in general and consequently produce long-term social advantages for the community at large (Haines, et.al., 2007, as quoted by Schneider, 2008). However, they also emphasize that there are ideal conditions that have to be seen in order to make possible a successful implementation of the comprehensive primary health care system. This includes political support, community embeddedness, appropriate training, strong supervision and support, and remuneration and incentive systems (Bhattacharyya, et.al., 2001, as quoted by Schneider, 2008). The primary care program also emphasizes that in order to attain future success, an implementation of the following changes have to be undertaken: education regarding prevailing health problems; promotion of adequate food supply and nutrition; establishment of sufficient and safe water and basic sanitation; access to maternal and child health care plus family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and the provision of essential drugs (Magnussen, et.al., 2004). However, with limited funding and support from other nations, the above changes and the health program against HIV/AIDS will have difficulty taking off. Advocates of primary health care emphasize that one of the more progressive ways to effectively battle the HIV/AIDS issue is by allocating more resources to local health centers, by building more primary healthcare centers, and improving those that are already in existence (Kaiser Network, 2009). These advocates emphasize further that primary health centers need to be spread out and be outfitted with adequate equipment in order to give them the capacity to deal with HIV/AIDS. By spreading out and adequately outfitting these health centers, transportation burdens and delays due to long queues in health centers will be avoided. In recognizing the vast benefits that primary health care can do for the AIDS issue in Africa, the chance of possibly minimizing AIDS cases will now be closer to reality. The National AIDS Control Council has reiterated the role of primary health care in addressing the problem and issues related to AIDS in Africa. They have expressed how AIDS care is bigger than just antiretrovirals. AIDS patients need comprehensive healthcare services; and the primary healthcare centers must have the necessary skills and equipment to handle the opportunistic infections that usually go hand-in-hand with the disease (Plus News, 2009). And by giving primary health care centers the capability of handling and treating diseases like TB, diarrhea, malaria, tertiary centers will be free to deal with serious infections like HIV/AIDS. Some critics and analysts have noted that lay people have been trained to be counselors; however the primary health care givers like nurses are not actually being trained in the same skills. The initiative taken by HIV-positive individuals to improve their condition is a momentous undertaking. In their small communities, they have assigned individuals to visit the health center every three months in order to get the drugs that they need. And by enhancing the cooperation of the members of the community through grassroots level activities, the fight against HIV/AIDS can only be improved. Practitioners and healthcare administrators however emphasize the need to engage the private sector and non-government organizations in order to gain a long-term future for primary health services in HIV/AIDS eradication. They note how individuals vulnerable to HIV/AIDS often choose not to be a part of the public health system. And by distancing themselves from the program, they are placing themselves at great risk of being yet another AIDS related death. Experts have now established the importance of the patient-centered or person-centered approach in the HIV/AIDS primary health care program. By focusing on the needs of the individual patient, the health care program can be adjusted and modulated based on what best fits a specific patient. This needs-based approach to HIV/AIDS is also advocated by various health organizations. These organizations note the many HIV/AIDS patients present in comprehensive care facilities and how very few of them are referred for voluntary counseling and testing (VCT). Most health care staff lack the necessary skills to provide VCT to patients. And various health groups with adequate training facilities have offered to help train health care givers in VCT. “This approach of enabling Primary Health Care Facilities to provide VCT and HIV/AIDS health care is a valuable asset in the fight against AIDS in Africa as many more people benefit from knowing their HIV status” (Mandwa & Corrigan, 2002). The education and training of health caregivers helps focus efforts towards the eradication and treatment of the disease. And after facing the reality of AIDS in the communities, the local people will be better motivated in participating in the different strategies to minimize the spread of HIV/AIDS. The comprehensive primary health care system for HIV/AIDS in South Africa is an ideal program in the fight against AIDS. It gives the poor a chance to access health services; it decentralizes health services to the different provinces and districts; and it gives HIV patients fair and equal access to health services. There are various barriers to the implementation of this program; the main problems are inadequate funding and shortage of health workers. The future potential of this approach to AIDS eradication in South Africa depends largely on effective implementation of the program to the grassroots level. The cooperation of the private and the NGO sectors are also important factors in achieving the successful implementation of this program. HIV/AIDS in South Africa is prevalent among the poor citizens of the nation; therefore, we should focus on them; we should focus on their individual needs and conditions; we should treat them as patients, and not just another person, among many, who has AIDS. Works Cited Advocates at Kenya Conference Explore New Strategies to Combat AIDS in Africa, 27 May 2009, Kaiser Network, viewed 12 June 2009 from http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=58596 Beaglehole, R., et.al., 2003, The World Health Report 2003: Shaping the Future, Geneva: World Health Organization Benatar, S. 20 March 1997, Health Care Reform in the New South Africa, New England Medical Journal, viewed 12 June 2009 from http://content.nejm.org/cgi/content/full/336/12/891 Collins, C. & Gonsalves, G., 29 July 2008, New "From-the-Ground" Report Reformulates Simplistic Argument About HIV/ AIDS and Health Care Systems In A Fundamental Way, International Treatment Preparedness Coalition, viewed 12 June 2009 from http://www.africa.upenn.edu/afrfocus/afrfocus080208.html Global: Basic healthcare crucial to beating HIV, study, 27 May 2009, Plus News, viewed 12 June 2009 from http://www.plusnews.org/report.aspx?Reportid=84567 Lundy, K. & Janes, S. 2003, Essentials of community-based nursing, Massachusetts: Jones & Bartlett Magnussen, L., et.al., 2004, Comprehensive versus Selective Primary Health Care, Health Affairs, viewed 12 June 2009 from http://content.healthaffairs.org/cgi/content/full/23/3/167 Mandwa, D., & Corrigan, C. July 2002, Establishing HIV/AIDS primary health care delivery services using the dispensaries supervised by PASADA in Dar es Salaam, Tanzania, Gateway NLM, viewed 12 June 2009 from http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102250375.html Sanders, et.al., 30 May 2008, Millennium Development Goals: Progress & prospects for meeting Child Survival targets in South Africa, Kabissa.org, viewed 12 June 2009 from http://lists.kabissa.org/lists/archives/public/pha-exchange/msg03883.html South Africa: People, 12 May 2009, The CIA World Factbook, viewed 12 June 2009 from https://www.cia.gov/library/publications/the-world-factbook/geos/SF.html South Africa Demographic and health Survey, 1998, Department of Health, viewed 12 June 2009 from http://www.doh.gov.za/facts/1998/sadhs98/chapter2.pdf The Scale of Africa’s AIDS Crisis, 15 May 2009, Averting HIV and AIDS, viewed 12 June 2009 from http://www.avert.org/aidssouthafrica.htm The Primary Health Care Package for South Africa – a set of norms and standards, March 2000, Department of Health, viewed 12 June 2009 from http://www.doh.gov.za/docs/policy/norms/full-norms.html Read More