Reasons for Failure of a Healthcare Goal - Essay Example

The Alma Ata Declaration of 1978 set a target of ‘Health for All by the Year 2000 Subject Code: Student Name Student Number, Tutorial Facilitator Date: Word Count: 2497 Introduction In the year 1978, health international conference held in Alma Ata, USSR declared that a level of health that would allow all individuals across the world to lead to economically and socially productive life should be attained by the year 2000. The Alma Ata health declaration called upon all governments to develop national strategies, policies and action plans to establish and sustain primary health care as part of national health system to be well coordinated with other socially and economically productive sectors. However, the target set by the health international conference has not been attained in almost all countries including Australia. This is because primary health care services are still not accessed by some individuals across the world. Increase in chronic diseases and increase in ageing population are some of the indications of failure of the Alma Ata declaration to attain its target of providing primary health care to all individuals across the world. Various economic, political and social factors have contributed to the failure of the target of the year 2000 to be attained. The Alma Ata declaration has immense impact on community nursing in Australia. In this paper, the factors which contributed to failure of Alma Ata declaration are elaborated and also the implications of the Alma Ata declaration on community nursing in Australian are described (John, 1983). Reasons for the Failure of ‘Health for All by the Year 2000’ Various issues evolving from the declaration and other environmental factors contributed to failure of Alma Ata Declaration to meet its target in the year 2000. To start with, many countries including Australia have continued to focus on single-disease led health care which is linked to relative burden of disease normally through treatment guidelines. Single-disease oriented health care program facilitates specialization thus fragmenting the health care. As a result, such an approach has continued to hinder the ability of both developed and developing countries to deliver effective primary health care for all individuals (Banerji, 2009, p.814). The fragmentation of health within a country goes against the Alma Ata Declaration spirit. According to the principle of the declaration, countries should aim at mitigating all health care issues. Specialization in specific health care issues favours a certain group of individuals and leaves the health care interests of other groups unmet. However, many countries including Australia have decided to invest more on certain health care diseases such as tuberculosis, HIV and malaria ignoring other deadly diseases such as cancer, measles among others. In this regard, single disease oriented health care program in many countries across the world has contributed substantially to inability of Alma Ata Declaration to attain its target (Gunn, 2008). Besides, failure of the Alma Ata declaration to communicate the features necessary for health workers to embrace the new health care service provision framework has also contributed substantially to failure of the declaration to meet its target. Critical rule and involvement of primary medical care providers during the conceptualization of primary health care was articulated poorly in Alma Ata declaration. The definition of primary medical care was not clear thus living space for national interpretation. Moreover, though the declaration indicated that health care services should be provided by “suitably trained physician” to deliver effective services to all people, it failed to define a suitably trained physician. In this regard, countries and other authorities have the opportunity to define a ‘suitably trained physician’ on their own perspective. Such a loophole enabled nations or authorities to compromise qualifications of physicians. As a result, the quality of primary health care in many developing and emerging markets has been compromised thus contributing to failure of the Alma Ata declaration (Gunn, 2008). Moreover, failure of the declaration to provide specific roles and values for specific health care providers has also contributed to failure of the declaration to attain its target. Generalization in defining the roles and values of health care workers dominated the declaration thus creating confusion. Health care sector comprises of many distinct stakeholders thus failure of the declaration to provide roles to be played and values to be exhibited by each and every group of stakeholders was a major weakness of the declaration. The roles and values of all these stakeholders were not specifically defined in the declaration thus causing confusion and shifting of blames from one group of stakeholder to another. Proper definition of the roles and values of each health care stakeholder could have enhanced coordination within the health care sector thus promoting high quality primary health care services (John, 2004, p.284). Besides, many countries including Australia have been facing health care workforce crisis. Countries struggle to attract and retain highly qualified health care providers. The profession of nursing and physician has been perceived by many students across the world as one of the hardest and highly demanding profession. Moreover, the issue of high fees for students studying medicine has also contributed significantly in shunning away people from the profession. Due to low supply and high demand of health care workers, many health care institutions and countries have been unable to attract and retain highly qualified health care workers. Lack of adequate qualified health care services providers has been a major obstacle of obtaining the target of the Alma Ata declaration (John, 2004, p.286). Collision between comprehensive primary health care and selective primary health care also contributed significantly to the failure of Alma Ata declaration to meet its targets. The Alma Ata declaration adopted primary health formally as a way of providing comprehensive, equitable, universal and less costly healthcare services affordable by all people. This approach allowed village primary health care committees to have a central obligation of planning and supervising their respective health care services. However, according to Hall & Taylor (2003), “As soon as the Alma Ata conference was over, PHC was under attack.” Aid experts and politicians from developed countries turned down the orders of the core primary health care principle of giving communities in developing countries the responsibility to plan and implement their own healthcare services. Turn down of this order was a major threat in implementing all other principles since this was the basic principle (Jonah, 2008, p.166). Consequently, politicians in collaboration with aid experts from developed countries formulated a new approach notably “Selective Primary Health Care.” This new approach advocated for provision of only primary health care services that contributed significantly to reducing child mortality in developing countries. The supporters of the selective primary health care approach argued that it was cheap and achievable unlike comprehensive primary health care approach. In effect, selective primary health care committees took the power to make decisions and control primary health care services away from the communities. As a result, local communities were not in a position to raise their views regarding health care service issues. Bearing in mind that communities had better ideas of health issues affecting them, failure to be included in health care committees was a major threat to achievement of the target of the Alma Ata declaration (Jonah, 2008, p.167). Another important factor which led to failure of Alma Ata declaration to achieve its target was the perception of primary health care service as a cheap and undignified form of health care. Many ordinary people especially in developed countries such as Australia, United States and United Kingdom bypassed the primary health care service to attend secondary and tertiary health care centres. Many people believed that primary care service providers had no adequate expertise to handle health care issues effectively. People in developed countries and rich people in all countries across the world were not willing to seek health care services in the primary health care system. This contributed substantially to the failure of Alma Ata declaration to meet its targets since many people failed to seek primary health care services (John, 2004, p.286). In addition, natural disasters, civil war and evolution of HIV posed a major challenge on primary health care system to sustain comprehensive health care services. For instance, many Sub-Saharan countries were faced with massive natural disasters such as floods and earth quakes. These disasters forced primary health care service providers to focus only on health issues caused by the natural disasters. As a result, in many countries, comprehensive primary health care program was forced to change to selective primary health care (Pickles, 2009, p.66). Emergency of many civil wars in both developed and developing countries also contributed substantially to failure of the declaration to meet its target effectively. Due to civil wars, funds were directed to military and health care service providers were overwhelmed with injured patients. Moreover, evolution and rapid spread of HIV also contributed significantly to the failure of the declaration to meet its targets. The drugs for HIV are very expensive thus non-governmental organizations and governments have spent many resources in prevention of rapid spread of HIV and treatment of HIV patients. Once again HIV has rendered primary health care program to a selective primary health care program. Consequently, effective achievement of the Alma Ata declaration target in the year 2000 has been rendered impossible (John, 1983). Lack of sustainability of political commitment after the initial ecstasy of Alma Ata declaration is another major factor which prevented the declaration from attaining the target. In many jurisdictions across the world, primary health care became a healthcare jargon term used only as a slogan but not practiced. For Alma Ata declaration to succeed, intensive reforms in health care sector were supposed to be executed. However, in many jurisdictions, health care reforms were executed at a very slow pace while in other jurisdictions; the reforms were never executed at all. The international health care agencies were satisfied with adoption of primary health care approach as a policy by countries but they did not evaluate the implementation of the policies. Though many jurisdictions adopted the primary health care approach policy, very few countries implemented the policies. Politicians in many countries viewed comprehensive primary health care approach as an effective way to reduce cost of health care but they lacked the political will to ensure equitable distribution of the services. In this regard, most health care resources have been directed to large urban centres ignoring small urban areas and rural areas (Ellen & Sarah, 2008, p.322). Though many countries have provided effective primary health care services in urban centres, rural areas have been ignored (John, 1983). In addition, issues of poor governance and corruption in various countries, especially developing countries discouraged donors from funding comprehensive health care programmes. Moreover, many donors suspended their pledges to countries which could not account for expenditure of the funds. Such a move affected many developing countries since they could not sustain the comprehensive primary health care programmes. Consequently, many governments opted for selective primary health care programmes since they were cheaper. Poor governance also discouraged new donors from contributing to the health care programmes thus posing some countries to financial crisis (John, 1983). Besides, poor economic status of many developing countries also contributed to the inability of the Alma Ata declaration target to be attained. Small economy countries could not give much attention to health issues since they were struggling to satisfy other basic needs of citizens. Since the Alma Ata declaration, many countries have been affected by financial crisis which hinder their ability to provide effective primary health care services to all individuals. Other countries have experienced low rate of economic growth which has also hindered their ability to provide necessary comprehensive primary health care services to all individuals. Poverty has been one of the key factors which have contributed to failure of meeting Alma Ata declaration target. Many countries especially in Asia and Africa continents are struggling to provide adequate food to their citizens rather than health care services. In this case, food security has been prioritized in poor countries as compared to health services (John, 1983). Implications of Alma-Ata Declaration on Community Nursing in Australia The declaration of Alma Ata has had substantial implications on community nursing not only in Australia but also in all countries across the world. According to the Alma Ata declaration, the work of community nurses is supposed to start from the consultation period. In this regard, nurses are supposed to develop effective listening and communications. Moreover, in order for effective community health care to be provided, community nurses should be willing to involve patients in decisions makings. These were major implications in community nursing in Australia since nurses had to undergo special training to acquire effective listening, communication and decision making skills. Practice of effective listening, communication and decision making skills by community nurses have improved their relationships with patients and communities at large. Improved relationship between nurses and the community has led to increased motivation in provision of community nursing activities (Chen, 2009, p.7). Besides, more cooperation between community nurses and community health councils has made the health councils to be well informed and more constructive in their contribution during decision making processes. The Alma Ata declaration presented members of primary care services with many opportunities to carry out preventive work within the community. Such opportunities require community nurses to carry out familiar tasks which are currently done systematically. Community nurses have focused more on measures to prevent diseases and other health complications rather than treatment of affected people. Such an approach has played a major role especially in Australia to minimize spread or evolution of fatal diseases (Chen, 2009, p.7). Since the Alma Ata declaration, community nurses’ knowledge on psychological influence on diseases and health has grown substantially. This has led to delivery of effective health care services which have uplifted the health status of citizens of Australia. In order to make the health care service delivery more satisfactory, community nurses are supposed to understand social and economic factors effectively. In this regard, community nurses have been training not only on health matters but also on health related matters such as social and economic factors affecting health of individuals. Such training has been of great help since the knowledge is applied during consultation to advice patients on the effects of economic and social factors on health. As a result, community nurses continue to play major roles in the affairs of local communities (Chen, 2009, p.8). Conclusion Though the dignitaries who attended and participated in the Alma Ata conference had determination and hope of attaining the declaration target by the year 2000, the target was not met by the year 2000 and even beyond. Various factors including lack of political will, poor economic condition, fragmentation of health services in many countries, unclear health attributes in the declaration, poor definition of roles and obligation for implementation, shortage of health care workers, corruption by governments and introduction of selective health care programmes in many countries are major factors which contributed to failure of the Alma Ata declaration to attain its target by the year 2000 and even beyond. The implications of the Alma Ata declaration on community nursing includes improved quality of services due to enhanced listening, communication and decision making skills, increased focus on disease prevention and increased understanding of the correlation between psychological status and diseases. Though the Alma Ata declaration increased the workload for community nurses, it also provided good working environment. Alma Ata declaration is a very important aspect which all leaders should take into account in order to achieve primary care services for all. References Banerji, D. (2009). Reflections on the twenty-fifth anniversary of the Alma-Ata declaration. International Journal of Health Services, 33(4), p.813-818. Chen, C.M. (2009). Community health nursing development; answering the ICN call. The journal of Nursing, 56(4), p.5-10. Ellen, M. & Sarah, E. (2008). Health for all or health for some? Remembering Alma Ata. Australian Journal of Rural Health, 16(5), p.321-322. Gunn, J.M. (2008). The promise and pitfalls of generalism in achieving the Alma-Ata vision of health for all, Retrieved October 14, 2009, from http://www. mja.com.au/public/issues/189_02_210708/gun10538_fm.html Hall, J. & Taylor, R. (2003). Health for all Beyond 2000: the demise of the Alma-Ata declaration and primary health care in developing countries, Retrieved October 14, 2009, from http://209.85.229.132/search?q=cache:OsJCA07y8YsJ:www. mja.com.au/public/issues/178_01_060103/hal10723_fm.pdf+factors+ contributing+to+Alma+Ata+declaration+failure&cd=2&hl=en&ct= clnk&gl=ke&client=firefox-a John, H. (1983). Alma Ata Declaration. British Medical Journal, 286(6360), p.191-191. John, M. (2004). Primary health care: a global overview. Primary Health Care Research & Development, 5(4), p.284-288. Jonah, S. (2008). Primary health care: Fiji’s broken dream. Bulletin of the World Health Organization, 86(3), p.166-167. Pickles, W. (2009). Thirty years on from Alma Ata: where have we come from? Where are we going? Education for Primary Care Journal, 20(1), p.66-66. Read More