Primary Health Care: Now More Than Ever
Summary of World Health Organisation Report: October 2008
Primary health care was put forward 30 years ago as a set of values, principles & approaches to improve health in deprived populations, improve fairness in access to health care & efficiency in the way resources were used. It embraced a holistic view of health beyond a narrow medical model & recognized that many root causes of ill health & disease lie beyond the control of the health sector & thus must be tackled through a broad whole-of-society approach. Doing so would meet several objectives: better health, less disease, greater equity, & vast improvements in the performance of health systems.
Though remarkable strides have been made to improve health, combat disease & lengthen life spans, one of the greatest concerns is about the cost of health care. With an estimated 100 million people fall into poverty annually, millions are unable to access any health care.
The source of the problem is that health systems & health development agendas have evolved into a patchwork of components. This is evident in the excessive specialization in rich countries & donor-driven, single disease-focused programmes in poor ones. A vast proportion of resources are spent on curative services, neglecting prevention & health promotion that could cut 70% of global disease burden. In short, health systems are unfair, disjointed, inefficient & less effective than they could be. Moreover, without substantial reorienting, today's struggling health systems are likely to be overwhelmed by the growing challenges of aging populations, pandemics of chronic diseases, new emerging diseases such as SARS, & the impacts of climate change.
"Rather than improving their response capacity & anticipating new challenges, health systems seem to be drifting from one short-term priority to another, increasingly fragmented & without a clear sense of direction," says World Health Report 2008 entitled Primary Health Care – Now More Than Ever.
In the World Health Report, WHO proposes that countries make health system & health development decisions guided by four broad, interlinked policy directions & core primary health care principles.
Universal coverage: For fair and efficient systems, all people must have access to health care according to need and regardless of ability to pay. If they do not have access, health inequities produce decades of differences in life expectancies not only between countries but within countries. These inequities raise risks, especially of disease outbreaks, for all.
People-centred services: Health systems can be reoriented to better respond to people's needs through delivery points embedded in communities.
Healthy Public Policies: Biology alone does not explain many gaps in longevity, such as the 27-year difference in Glasgow's rich & poor neighbourhoods. In fact, much of what impacts health broadly lies outside the influence of the health sector. Ministries of trade, environment, education & others all have their impact on health, & yet little attention is generally paid to decisions in these ministries that have health impacts.
Leadership: Existing health systems will not naturally gravitate towards more fair, efficient & effective models. So, rather than command & control, leadership has to negotiate & steer. All components of society have to be engaged, including civil society, the private sector, communities & the business sector. Health leaders need to ensure that vulnerable groups have a platform to express their needs & that these pleas are heeded.