Place of Primary Health Care (PHC) in Health Systems Strengthening - Coursework Example

The place of Primary Health Care (PHC) in health systems strengthening Your name Course Instructor Institution Department The Declaration of Alma-Ata (1978) provides a definition of Primary Health Care as referring to all cost effective and socially acceptable techniques, which are globally accessible to all members of the community, and are aimed at enhancing healthcare service delivery. PHC is an inherent part of Australia’s healthcare system and helps to enhance the overall socioeconomic development of the communities living within its borders. PHC forms the first level of contact between individuals, the family and community with a country’s national health system and helps to ensure that health care is as close as possible to the residences of individuals, as well as their work-places. According to WHO (2010), the concepts and approaches elaborated by the Alma-Ata Declaration, help to form the basis for health systems strengthening in Australia. The Health Systems Action Network (2006) defines Health Systems Strengthening as all health-sector initiatives formulated in order to improve the functions of a country’s health system. These initiatives help to enhance healthcare by instituting improvements in access, quality and efficiency. One aspect of Health Care Systems Strengthening is the improvement of the functions of the health system. To this end, the first principle of PHC is that, it reflects and evolves from the existing socioeconomic conditions and political characteristics of the country and its communities. An understanding of this principle by those concerned will thus ensure that PHC in its evolving nature is meant to address the past, present and future challenges in the provision of healthcare services hence contributing to Health Systems Strengthening in Australia. The WHO (2010) notes that PHC aims to ensure that high quality, all-inclusive healthcare services are provided to all citizens of countries, including Australia, in an affordable and equitable manner. Because of this aspect, PHC is considered an important part of healthcare systems strengthening in Australia and promises to improve the functions of the health care systems in the country. Further still, PHC incorporates the provision of education that enables General Practitioners (GPs) to learn and become acquainted with the prevailing health problems and stipulates the mechanisms of addressing them. Where the service providers receive education that is effective and relevant, then their ability to provide quality healthcare services is enhanced thus strengthening the healthcare system in the country. Health systems strengthening encompass enhancing access to health services. Enhanced access helps to tackle the issue of inequalities in the Australian context. As per the principles of PHC approach, PHC can increase access to health services as one cornerstone of health systems strengthening through its promotion of global healthcare coverage, multi-sector collaboration and community participation, WHO (2010). A number of key elements of PHC as outlined by the Declaration of Alma-Ata (1978) include the promotion of the country’s food security and enhanced nutrition for the population. There is also the need to improve access to adequate and safe supply of clean water and maintenance of high sanitation standards, as well as ensuring the enhancement of mother and child healthcare through family planning as well as immunization against identified infectious diseases. It also spells out the need for the prevention and control of chronic diseases and availing essential drugs to all those affected. Where these key approaches of PHC are adequately implemented and sustained, they promise to conduce the strengthening of Australia’s health system. The concepts and approaches of PHC in form of values and principles of primary health care include equity and universal access to services, multi-sectorial action, as well as community participation. Their objective is to aid the establishment of and strengthening of sustainable national health systems that are capable of meeting the needs of the citizens. As noted by the World Bank (2004), where there is inadequate and insignificant health systems strengthening in the country, then achievement of the Millennium Development Goals (MDGs) will be greatly hampered. The WHO (2010) identifies a number of opportunities that are available to countries to help them strengthen their health systems. These include the health systems strengthening aspects as outlined in the Global Alliance on Vaccines and Immunization (GAVI) and the proposals of the Global Fund to fight diseases such as Malaria, AIDS and Tuberculosis. PHC also promotes the utilization of locally available resources to make health services more accessible and affordable to community members. This coincides with Health systems strengthening motive in health care delivery to the citizens of Australia. Utilization of locally available resources helps to strengthen health care systems by making them more antiphonal and transparent to the community members’ healthcare needs. As per the Commission on Social Determinants of Health (2008), healthcare systems outcomes can be strengthened and enhanced when based on PHC. Alma-Ata Declaration and how attitudes towards PHC have changed over time According to the WHO (2010), although the basic pillars of PHC are still relevant, changes in the political, socioeconomic and demographic circumstances have aroused debate and led to a change in attitudes towards PHC. The World Health Report (2008) elaborates earlier and present attitudes towards PHC. Hall & Taylor (2003) also note that, civil war, natural disasters as well as HIV epidemic considerably hindered the ability of PHC to sustain a comprehensive service delivery. Tarimo & Webster (1997) also state that there was a lack of political good-will for many governments to implement the Alma-Ata declarations. They further state that PHC became a mere political jargon after the initial euphoria regards Alma-Ata declarations. The following table highlights some of the changes in attitudes that have been identified since the Declaration of the Alma-Ata 1978. Table 1: Change of attitudes towards PHC over Time. Adopted from WHO/SEARO 2010 Early Attitudes towards PHC Current Attitudes Towards PHC Emphasized the Health of Mother and Child through family planning and immunizations Emphasizes on the health of everyone in the community Focused on a small number of selected diseases, primarily infectious and acute (AIDS, Tuberculosis and Malaria) Focuses on a comprehensive response to people’s expectations and needs, traversing an expansive range of risks and diseases Focused on the improvement of hygiene, water, sanitation and health education at community level Focuses on the promotion of healthier lifestyles among all the citizens of the country. Health service provision was Government-funded and delivery was through a centralized top–down management approach The health systems are pluralistic including the Government, Not for profit & For Profit Organizations, and are global in scope Healthcare service provision was financed through bilateral aid from developed nations which also provided technical assistance Health service provision is based on global solidarity among all nations in the world Based on the mobilization of locally available community resources that were managed by selected communal health committees Recognizes and encourages the participation of civil societies in health sector policy formulation How we have updated and reassessed the relevance of the Alma-Ata Declaration, over 30 years since the original Declaration The Declaration of Alma-Ata (1978) formally adopted PHC as an approach aimed at providing all-inclusive, universally accessible, as well as cost-effective and equitable healthcare services to all the citizens of the country. However, according to Warren (1998), politicians and aid experts from developed countries were against the core PHC principle that required communities to develop and establishing individual country healthcare systems. They instead opted to develop the Selective Primary Health Care approach (SPHC) in its place. As Hall & Taylor (2003) state, the proponents of SPHC argued that an all-inclusive PHC was too sublime, costly and unachievable hence making the accessibility to healthcare services a challenge. Challenges that necessitate the reassessment and updating of the Alma-Ata Declaration There is an ever increasing demand for primary health care services in Australia. As a result, Australia’s healthcare system has become under sustained pressure that begs for a comprehensive response capable of meeting these new demands. Consequently, there is a need to plan, develop and implement new approaches that effectively change or modify current models of PHC and the way the system works. According to the Australian Capital Territory (2011), Australia’s health care system has performed relatively well, and comprises a qualified and devoted workforce. However, the Australian health authorities are required to institute reforms into the existing system to make it more responsive to new challenges that were not present at the Declaration of Alma-Ata in 1978. Issues such as demographic changes due to an ageing population have brought about changes in the burden of diseases. Consequently, the costs of providing treatments for chronic diseases such as diabetes have increased. Technological advancements in medicine and changing clinical practice coupled with escalating workforce shortages have made it necessary to reassess and update the Alma-Ata Declaration. Increased Burden, as a result of chronic diseases; According to the Department of Health and Ageing (2010), chronic diseases impose a tremendous burden on Australia’s health care system. They note that more than 50 % of all patient consultations with General Practitioners are attributed to people with chronic diseases such as cancer and diabetes. Lack of integration in healthcare service provision; Primary healthcare across Australia has tended to operate in an heterogeneous manner, rather than as unifed service delivery system as stipulated in the Alma-Ata Declaration of 1978, notes the Australian Government Department of Health and Ageing (2010). Consequently, the challenges of effectively addressing emerging problems in healthcare service provision in Australia have been further compounded. The result has been difficulties in coordination among various health system departments, hence hindering the system’s ability to respond to unique needs and priorities of local communities. Increased integration in terms of enhanced collaborations in provision of team based services in consultation with consumers ensures the delivery of effective, appropriate and coordinated healthcare services which are appropriate to the needs of all the consumers. These collaborations include partnerships between consumers, public and private primary health care services providers, as well as the wider sectors tasked with housing, justice, employment, education and planning in the health sector, Australian Government Department of Health and Ageing (2010). For many years the PHC approach was shelved in favor of broader Health Sector Reform methodology, with a focus on disease-specific interventions. The shelving of the PHC approach was necessitated by economic reforms of North America and Europe where governments embarked on reducing their involvement in societal aspects including health care. There was increased focus on adopting market-driven economic reforms even in the health sector leading to the abandonment of the PHC as per the Alma-Ata Declaration. However, according to WHO (2010), the Millennium Development Goals (MDGs) helped to enhance the values of social equity to healthcare services as outlined in the Alma-Ata declaration, makes the declaration relevant over 30 years since it was originally developed and adopted. According to the United Nations General Assembly (2000), the aim of the MDGs was to help reduce the under-five child mortality rate by two thirds by the year 2015. They also committed to reduce the maternal mortality rate by 75% and reverse the spread of AIDS across the world. The governments should revitalize the implementation of the basic pillars of PHC in order for them to achieve the MDGs by 2015. De Maeseneer & Twagirumukiza (2010) state that that achieving the MDGs will be dependent on the reduction of the socioeconomic inequities in health care service provision between continents and countries, and within countries as set out in the Alma-Ata Declaration on PHC. According to Hall & Clayton (2003), the enormous economic and political sway of the World Bank will play out as favoring the Health Sector Reform methodology as an approach for healthcare service delivery in many countries. PHC was anchored on the provision of equitable access to healthcare services whereas the Health Sector Reform methodology was premised on economic and political ideologies, which lay little if any emphasis on ensuring equitable access to healthcare services. Updates to the Alma-Ata Declaration in Australia As a result of these changes, a number of strategies have been formulated to effectively address the emerging challenges facing the healthcare system in Australia. The first was the National Primary Health Care Strategy, notes the Australian Government Department of Health and Ageing (2010). The strategy identified key areas that it considered ripe for reforms such as developing a voluntary enrolment program targeted at managing the healthcare needs of people with diabetes. It also aimed to improve the aged Australians’ access to healthcare services as well as focus on disease prevention, rather that disease cure, notes the Australian Government Department of Health and Ageing (2010). Another strategy though not of the central government was the ACT Primary Health Care Strategy 2006–2009. According to the Australian Capital Territory (2011), the ACT Primary Health Care Strategy 2006 – 2009, set the direction for the efficient and effective delivery of primary health care services in the ACT. It developed links and collaborations with both non-government and government agencies in order to support health related initiatives in a coordinated and collaborative manner. Building on this strategy is the ACT Primary Health Care Strategy 2011–2014, that conceptualizes a broad view of PHC, extending beyond the traditional general practice. This was with the realization that strategies should be responsive to the changing healthcare service provision landscape. According to the Australian Capital Territory (2011), ACT Primary Health Care Strategy 2011–2014 Strategy recognizes the active role that the PHC system should play in order to engage and partner with consumers and service providers. His is in an effort to provide primary health care that is coordinated, responsive to consumer needs, safe and of high quality. References Australian Capital Territory, (2011). ACT Primary Health Care Strategy 2011–2014, Canberra. Available at www.health.act.gov.au accessed May 31, 2014. Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Geneva: World Health Organization. Department of Health and Ageing, Australian Government (2010). Building a 21st Century Primary Health Care System –Australia’s First National Primary Health Care Strategy. De Maeseneer, J. and Twagirumukiza, M. (2010). The contribution of primary health care to global health. British Journal of General Practice. 60 (581), pp. 875-876. Hall, J. J. and Taylor, R. (2003). Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries. Medical Jornal of Australia, 178 (1), pp. 17-20. Tarimo E. and Webster E. G. (1997). Primary health care concepts and challenges in a changing world. Alma-Ata revisited. ARA Paper Number 7 (WHO/ARA/CC/97.1). Geneva: WHO. United Nations General Assembly. (2000). Resolution 55.2. United Nations Millennium Declaration. Available at < http://www.un.org/millennium/declaration/ares552e.pdf> accessed, May 31, 2014. The world health report 2000: health systems: improving performance. Geneva, World Health Organization, 2000. Available at: http://www.who.int/whr/2000/en/whr00_en.pdf, accessed May 31, 2014. World Bank, (2004). The Millennium Development Goals for Health: Rising to the challenges. Washington DC. World Health Organization (2010). Primary Health Care, The Basis for Health Systems Strengthening: Frequently Asked Questions. World Health Organization Regional Office for South-East Asia. Read More