Primary health care

Primary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination".^[1] In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy.^[2][3]

This ideal model of health care was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the World Health Organization's goal of Health for all.^[4] 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.

Contents 1 Goals and principles 2 Approaches 2.1 GOBI-FFF 2.2 PHC and population ageing 2.3 PHC and mental health 3 See also 4 References 5 Further reading 6 External links

Goals and principles

The ultimate goal of primary health care is better health for all. The WHO has identified five key elements to achieving that goal:^[5]

• reducing exclusion and social disparities in health (universal coverage reforms);
• organizing health services around people's needs and expectations (service delivery reforms);
• integrating health into all sectors (public policy reforms);
• pursuing collaborative models of policy dialogue (leadership reforms); and
• increasing stakeholder participation.

Behind these elements lies a series of basic principles identified in the Alma Ata Declaration that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and in coordination with other sectors:^[1]

• Equitable distribution of health care - according this principle, primary care and other services to meet the main health problems in a community must be provided equally to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class.
• Community participation - in order to make the fullest use of local, national and other available resources.
• Health workforce development - comprehensive health care relies on adequate numbers and distribution of trained physicians, nurses, allied health professions, community health workers and others working as a health team and supported at the local and referral levels.
• Use of appropriate technology - medical technology should be provided that is accessible, affordable, feasible and culturally acceptable to the community (e.g. the use of refrigerators for vaccine cold storage).
• Multi-sectional approach - recognition that health cannot be improved by intervention within just the formal health sector; other sectors are equally important in promoting the health and self-reliance of communities. These sectors include, at least: agriculture (e.g. food security); education; communication (e.g. concerning prevailing health problems and the methods of preventing and controlling them); housing; public works (e.g. ensuring an adequate supply of safe water and basic sanitation); rural development; industry; community organizations (including Panchayats or local governments, voluntary organizations, etc.).

Approaches

Different primary health care approaches have evolved in different contexts to account for differences in availability of resources and local priority health problems.

GOBI-FFF

One selective PHC approach is referred to collectively under the acronym “GOBI-FFF”. These are strategies that are being adopted to improve maternal and child health as part of primary care, especially in low income countries burdened with high infant and child mortality. Respectively they include^[6][7]

• Growth monitoring - to prevent most child malnutrition before it begins
• Oral rehydration therapy - to combat dehydration associated with diarrhea
• Breastfeeding
• Immunization

• Family planning (birth spacing)
• Female education
• Food supplementation - e.g. iron and folic acid fortification/supplementation to prevent deficiencies in pregnant women

PHC and population ageing

Given global demographic trends, with the numbers of people aged 60 and over expected to double by 2025, PHC approaches have taken into account the need for countries to address the consequences of population ageing. In particular, in the future the majority of older people will be living in developing countries that are often the least prepared to confront the challenges of rapidly ageing societies, including high risk of having at least one chronic non-communicable disease, such as diabetes and osteoporosis.^[8] According to WHO, dealing with this increasing burden requires health promotion and disease prevention intervention at community level as well as disease management strategies within health care systems.

PHC and mental health

Some jurisdictions apply PHC principles in planning and managing their health care services for the detection, diagnosis and treatment of common mental health conditions at local clinics, and organizing the referral of more complicated mental health problems to more appropriate levels of mental health care.^[9]

See also

Emergency healthcare Global health Health policy Health promotion Healthy city / Alliance for Healthy Cities

Millennium Development Goals Primary Health Care and Resource Centre (Nepal) Primary Health Organisations (New Zealand) Primary Health Care (magazine) Public health

References

1. ^ ^{a b} World Health Organization. Declaration of Alma-Ata. Adopted at the International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978.
2. ^ Starfield, Barbara. "Politics, primary healthcare and health." J Epidemiol Community Health 2011;65:653-655 doi:10.1136/jech.2009.102780
3. ^ Public Health Agency of Canada. About Primary Health Care. Accessed 12 July 2011.
4. ^ Secretariat, WHO. "International Conference on Primary Health Care, Alma-Ata: twenty-fifth anniversary". Report by the Secretariat. WHO. http://apps.who.int/gb/archive/pdf_files/WHA56/ea5627.pdf. Retrieved 28 March 2011. 
5. ^ WHO. "Health topics". Primary health care. WHO. http://www.who.int/topics/primary_health_care/en/. Retrieved 28 March 2011. 
6. ^ Rehydration Project. UNICEF's GOBI-FFF Programs. Accessed 16 June 2011.
7. ^ World Health Organization. World Health Report 2005, Chapter 5: Choosing Interventions to Reduce Specific Risks. Geneva, WHO Press.
8. ^ World Health Organization. Older people and Primary Health Care (PHC). Accessed 16 June 2011.
9. ^ Department of Health, Provincial Government of the Western Cape. Mental Health Primary Health Care (PHC) Services. Accessed 16 June 2011.

Further reading

• WHO (1978). "Alma Ata 1978: Primary Health Care". HFA Sr. (1). 
• WHO (2008). The World Health Report 2008: Primary Health Care, Now More Than Ever. http://www.who.int/whr/2008/en/index.html. 
• McGilvray, James C. (1981). The Quest for Health and Wholeness. Tübingen: German Institute for Medical Missions. ISBN 0728900149. 
• Socrates Litsios (2002). "The Long and Difficult Road to Alma-Ata: A Personal Reflection". International Journal of Health Services 32 (4): 709–732. doi:10.2190/RP8C-L5UB-4RAF-NRH2. PMID 12456122. 
• Socrates Litsios (November 1994). "The Christian Medical Commission and the Development of WHO's Primary Health Care Approach". American Journal of Public Health 94 (11): 1884–1893. doi:10.2105/AJPH.94.11.1884. PMC 1448555. PMID 15514223. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1448555. 
• Julia A. Walsh and Kenneths. Warren. "Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries*". SW. S‘i. & Md. 14C.: 145–163. 
• Gatrell, A.C. (2002) Geographies of Health: an Introduction, Oxford: Blackwell.

External links

• Declaration of Alma-Ata.
• WHO European Observatory on Health Systems and Policies.