Primary Health Care and Nursing Care Interaction
What is Primary Health Care
The interdependence and complimentary nature of health with social
and economic development is a basic premise of primary health care. A PHC
approach emphasizes full development of human potential, community
mobilization, and collaborative decision-making between health professionals
and community members.
Role of WHO and UNICEF
The World Health Organization (WHO) and the United Nations Children's Fund (UN-ICEF) sponsored the International Conference on Primary Health Care held in Alma-Ata, USSR, in 1978. The Declaration of Alma-Ata, endorsed by member governments of the United Nations at the 32nd World Health Assembly in 1979, provided foundational explication and a definition for Primary Health Care.
The basic components of PHC were derived from case studies
(Djukanovic &Mach, 1975; Newell, 1975) that examined diverse international
health care programs, functioning with limited human, technological, and
financial resources, to identify the common structures and strategies across
cases.
Utilization of PHC in Health Care System
Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology. It is made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.
It forms an integral part of both the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community.
It is the
first level of contact of individuals, family, and community with the national
health system, bringing health care as close as possible to where people live
and work, and it constitutes the first element of a continuing health care
process (World Health Organization , 1978).
Basic Principles of Primary Health Care
Five basic principles for implementation of PHC are:
(a) equitable distribution ensuring accessibility of health services to all of the population,
(b) maximum community involvement in the planning and operation of health care services
(c) a focus on health services that prevent disease and promote health rather than cure disease
(d) the use of appropriate technology and local resources that are socially acceptable and sustainable
(e) a multisectoral
approach that integrates health programs with social and economic development
(WHO, 1985 ).
Application of PHC Its Policies and Requirements
Implementation of Primary Health Care is contextually grounded. The development of PHC policies and services are based on the predominant health concerns of communities, and adapted to the cultural, political, and economic conditions of each country or community.
Decentralization enables local community involvement in planning and implementation. Through collaboration, community members and health professionals shape programs and services to the particular socio-cultural circumstances of the community. A system of PHC services requires political commitment and appropriate economic policies locally, nationally, and internationally.
Community development, multisectoral collaboration, and multilevel coordination facilitate implementation of services in keeping with the PHC standards of what is acceptable, affordable, appropriate, effective, and sustainable.
Primary Health Care Interaction with Community Health Care
Primary health care teams interact to coordinate community health activities. The composition of a Primary Health Care team is determined by program needs, availability of health professionals, and local practices.
Lay
community health workers (CHWs) and traditional practitioners are often
provided with basic health education. CHWs serve on health teams with nurses,
midwives, social workers, physicians, or other appropriate multisectoral
personnel.
Activities and Priorities of Primary Health Care
While disease prevention and health promotion activities are given priority by a PHC team, curative and rehabilitative services are provided within a referral network. A predominant function of the health team is provision of education for communities and clients.
Health education includes relevant information about common health concerns, and strategies that enable community mobilization for full participation in community based health programs.
PHC team members facilitate community involvement in an assessment
process that identifies local resources and capabilities for community health
and development. The Primary Health Care process promotes health through
self-learning, self-determination, self-care, and self-reliance.
The terms “Primary Health Care” and “Primary Care” have frequently
been used interchangeably. However, they each have distinctive characteristics.
Primary care, as a level of care focused on individuals, is one component of a
comprehensive primary health care framework that addresses population-based
issues at community and country levels.
Central Focus of Primary Health Care
The essence of primary health care is community participation in defining and addressing problems; practical understanding of the integral relationships among social, economic, and health conditions of a community; commitment to essential health services; and collaboration between community residents, health professionals, and a multisectoral network of other professionals.
Therefore, PHC is an interactive approach to health care where community residents are expected to be knowledgeable in health matters, and to actively engage in their health care management. Moreover, PHC addresses self-care practices for physical and mental aspects of community health, as well as community social and environmental conditions.
The basic goal of Primary Health Care is the attainment of optimum health, expressed in the internationally recognized slogan “Health for All.” Primary health care programs and literature are frequently integrated with other conceptual frameworks.
Adult and popular education concepts, primarily based on Friere's work, and concepts of community assets and capacities have guided PHC implementation with strategies that engage communities in identifying their issues and resources.
Community development concepts have been merged with PHC
approaches from the time of Alma-Ata. In more recent years, social capital and
social cohesion have emerged as concepts incorporated to facilitate PHC
discourse and the growth and development of PHC programs.
Primary Health Care and Nursing
Over the years, various international and national nursing organizations have promoted PHC as a means for meeting the health needs of the public, with special attention to vulnerable and underserved populations.
To this end, Dr. Halfdan Mahler (WHO, 1986), the Director General of the World Health Organization until 1988, recognized the potential for nurses to be a powerhouse for change if they mobilized around advancement of PHC ideas and convictions.
Nursing leadership in PHC is illustrated in the National Institute of Nursing Research (NINR) Agenda for Community-Based Health Care (NINR, 1995).
The document presents an NIH priority expert panel's adoption of primary health care as a key concept for community-based health care, providing a basis to identify strategies for developing nursing knowledge for practice in urban and rural settings.
Within the region of the Americas, nurses have engaged in PHC through the Florence Nightingale tradition of combining political activism and scholarly work, development of community programs, and educating community health workers as change agents for community health ( McElmurry , Marks , &Cianelli , 2002 ).
Nurses' contribution to the development and continuation of PHC is also evident in PHC literature. An integrative literature review of curricular applications of PHC found ongoing commitment to PHC, with 184 nurse authors from a global sample presenting PHC concepts consistent with the Alma-Ata definition (Macintosh & McCormack, 2000).
A multisectoral literature review, with predominant sampling from nursing publications, identified five categories within the PHC literature: concepts, social discourse, human resources, implementation, and participatory evaluation ( McElmurry & Keeney, 1999).
This review highlighted the participation of
nursing in international PHC arenas and provided direction for nursing
leadership in present and future development of PHC policy, services, and
research. Overall, PHC concepts offer a framework for constructing future
directions for nursing within a rapidly changing health care environment.
Critical Overview of Primary Health Care
Since the ratification of the Alma-Ata Declaration, health policies and systems have shifted, beginning with major international initiatives and funding for PHC implementation, then moving to include health policy discourse that has questioned the effectiveness of PHC.
With the 2004 celebration of the twenty fifth anniversary of the declaration, international leaders have named lack of attention, misinterpretation, and oversimplification of PHC principles as basic critiques for not achieving PHC goals and assert that it is essential for the global community to reclaim the comprehensive approach for PHC as delineated at the Alma-Ata Conference (Tejada de Rivero, 2003).
The World
Health Organization has continued to refer to PHC as a cornerstone for
international health initiatives, with the Pan American Health Organization (PAHO,
the WHO Americas Regional Office) passing a resolution in 2004 reaffirming
commitment to Primary Health Care as a strategy for continuing to work towards
the goal of equity and “Health for All” (PAHO, 2004).
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