|Year : 2009 | Volume
| Issue : 3 | Page : 429
Renewed Focus on Primary Health Care (PHC)
M Glasser, D Pathman
Co-Editors, Education for Health
|Date of Submission||05-Dec-2009|
|Date of Web Publication||12-Dec-2009|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Glasser M, Pathman D. Renewed Focus on Primary Health Care (PHC). Educ Health 2009;22:429
The World Health Report 2008: Primary Health Care, Now More Than Ever states that:
There is today a recognition that populations are left behind and a sense of lost opportunities that are reminiscent of what gave rise, thirty years ago, to Alma-Ata’s paradigm shift in thinking about health. 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. The Declaration of Alma-Ata was clear about the values pursued: social justice and the right to better health for all, participation and solidarity. There was a sense that progress towards these values required fundamental changes in the way health-care systems operated and harnessed the potential of other sectors (WHO, 2008a).
Today, there is a call for a renewed dedication to and implementation of a primary healthcare movement, one that aims to reduce disparities across the gamut from delivery of primary care services to addressing the underlying social determinants of health (WHO, 2008a). In this editorial, we briefly describe this renewed push for PHC and then point to several education collaborations aimed at diffusing and bolstering the PHC perspective.
In a report by the Secretariat of the World Health Organization (2008b), Member States called for a renewal of Primary Health Care. States agreed that even with 30 years having passed since Alma-Ata, health systems still do not foster optimal care because they do not yet promote an appropriate balance in their efforts in the areas of health promotion, disease prevention, cure and palliation. They pointed out that global stakeholders are increasingly recognizing the need for better performance in healthcare systems and that this should happen based on the values of Primary Health Care. Two recent WHO reports provide support for this perspective. The report of the Commission on Social Determinants of Health (see Book Review, Education for Health, 22:2) (Peters et al., 2009), through analysis of underlying social, economic and political causes of ill health, makes a case for – and endorses – the renewed focus on PHC (CSDH, 2008). Similarly, the World Health Report 2008: Primary Health Care, Now More Than Ever states that a health sector organized according to the tenets of Primary Health Care has the greatest potential for producing better health outcomes, improving health equity and responding to society’s expectations of their healthcare systems. The demand is for better access to people-centered healthcare, better health promotion within communities and more participation in decisions that affect health. Consequently, there is again pressure on policy makers and political leaders to steer their health systems towards the values of health equity, social justice and solidarity (WHO, 2008a).
One central tenet of the renewed push for PHC, as presented by Gofin and Gofin (2005), is that community medicine and primary healthcare are really part of a unified practice. These authors further point out the similarities between PHC and community-oriented primary care, or COPC. A distinctive aspect of COPC is its comprehensive approach to care, taking into account the socioeconomic and cultural determinants of health, identifying health needs and providing healthcare to the total community. Gofin and Gofin conclude that renewed interest in primary care is particularly appropriate because primary care is the component of healthcare services that addresses many of the health problems arising in a community – and, when enhanced by a community orientation, primary care is ‘public health at the local level’ (Gofin & Gofin, 2005). Interestingly, from a health research perspective, in this current issue of Education for Health, Balcazar and colleagues (2009) also draw parallels to COPC in their use of a community-based participatory research approach in understanding and addressing cardiovascular disease in Mexican Americans.
In a report on Primary Health Care made available by the Institute of Development Studies (IDS) Health and Development Information Team, PHC is described as the provision of basic healthcare built on technically sound and socially adequate approaches that are universally accessible and affordable to all individuals (IDS, 2008). The PHC perspective responds to the problem of inadequate resources, shortage of health workers, and it gets beyond many countries’ past focus on providing limited disease interventions rather than strengthening overall healthcare systems. Through past approaches, millions of people in low and middle income countries have not had access to basic and good quality healthcare services. The PHC report also comments on the growing evidence of the cost-effectiveness of various components of Primary Health Care, such as the role of community participation, in improving neonatal and maternal mortality in Nepal.
At the healthcare provider level, the Canadian Primary Health Care Transition Fund supported ‘Building a Better Tomorrow’ (BBT) initiative in four Atlantic provinces (PHCTF, 2004). Its goal was to develop an interprofessional education program to prepare providers with the necessary tools to work successfully in teams and to thereby deliver care in new ways. The initiative was based on the recognition of the role of interdisciplinary collaboration in advancing PHC reform and that the move towards interdisciplinary healthcare would require that providers develop new skills and demonstrate new behaviors. Core BBT modules were: understanding primary healthcare; building community relationships; team building; conflict resolution; facilitating adult learning; the electronic patient record; and program planning and evaluation. The nearly 9,000 participants of the BBT have included nurses, physicians, social workers, pharmacists and other allied health professionals.
At the medical education level, the Pan American Health Organization (PAHO) recognizes that PHC can strengthen society’s ability to reduce health inequities. A working group under the leadership of the Project for Human Resources for the Development of Health and consisting of representatives from Argentina, Brazil, Canada, Cuba, Nicaragua, the United States and Uruguay is developing an on-line PHC course in Spanish, English and Portuguese. Initially, the curriculum will focus on medical educators with the idea of ‘training the trainers’ – preparing medical educators from Central and South American as well as Caribbean medical schools who will, in turn, be able to teach the PHC perspective to their students. The curriculum will be available on PAHO’s Virtual Campus in Public Health with Moodle platform, easily accessible to the PHC enrollees. It will consist of a four-month course presented in three modules: 1) overview of PHC; 2) PHC competencies and putting PHC into practice; and 3) integration of PHC at the health systems level. Eventually, the PHC modules will be adapted for presentation to and training of other health professionals.
We strongly agree with the many that see PHC as a perspective whose time has come – again, 30 years later. Their renewed efforts are important and need to be supported. Initiatives and programs like those of the BBT and PAHO should be replicated in other regions of the world.
Michael Glasser, Ph.D.
Donald Pathman, M.D., M.P.H.
Co-editors, Education for Health
Balcazar, H., Rosenthal, L., De Heer, H., Aguirre, M., Flores, L., Vasquez, E., et al. (2009). Use of Community-based participatory research to dissemínate baseline results from a cardiovascular disease randomized community trial for Mexican Americans living in a U.S.-Mexico border community. Education for Health, 22(3):279.
Commission on Social Determinants of Health. (2008). Changing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. World Health Organization.
Gofin, J., & Gofin, R. (2005). Community-oriented primary care and primary health care. American Journal of Public Health, 95(5):757.
Institute of Development Studies Health and Development Information Team. (2008). Primary Health Care. Sussex, United Kingdom. May 27, 2008.
Peters, K.E., Cristancho, S.M., & Garces M. (2009). Closing the Gap in a Generation - Health Equity through Action on the Social Determinants of Health. Education for Health, 22(2):381.
Primary Health Care Transition Fund. (2004). Building a Better Tomorrow – Engaging Current Providers in a Renewed Primary Health Care System for Atlantic Canada. Ministry of Public Infrastructure Renewal. ISBN 0-7794-6499-0.
World Health Organization (2008a). Primary Health Care, Now More Than Ever. ISBN-13: 9789241563734.
World Health Organization (2008b). Primary Health Care, Including Health Systems Strengthening: Report by the Secretariat. EB124/8. December 4, 2008.