factors may influence the processes involved in PHC, and awareness of these can help to shed light on the ways in which PHC operates today.
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The history of PHC goes back a long way. In 1920, some early reports in the UK started to distinguish between three levels of health services, including primary health centres, secondary health centres and teaching hospitals (Jones, 2004). Cueto (2004) describes how primary healthcare was an emerging concept during the Cold War decades of the 1960s and 1970s. Throughout this period a ‘vertical health approach’ was utilised by US agencies to combat malaria, although there was criticism of this approach from the WHO at the time. Elzinga (2005) explores three components of vertical programmes, starting with an intervention strategy as a way to deal with health problems, followed by monitoring and evaluating the influence of a strategy on a population. Finally intervention delivery was used depending on the disease involved and the health system of the country, e.g. vaccinations against polio.
In the 1960s, health systems in developing countries were criticised as they were deficient in the concept of “prevention” and were dependent on the hospital sector, regardless of the presence of PHC services (Bryant, 1969). It is clear that PHC is considered to be a means of health promotion and disease prevention (Ross & Mackenzie, 1996), and so a reconsideration of and increased support for PHC were required. This was particularly important, as at the time it was estimated that more than 50 per cent of the world’s people had no access to healthcare through different organisations (Bryant, 1969). Eventually, these concerns found expression on the international stage. In 1978, the WHO International Conference on Primary Health Care, in Alma-Ata drew attention to the need for urgent action by all governments, all health policymakers and the world community to protect and promote the health of all the people in the world (WHO, 1978).
The definition of primary healthcare used by the WHO was “essential health care that is based on scientifically sound and socially acceptable methods and technology, which make universal health care universally accessible to individuals and families in a community. It is 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” (WHO, 1978, p.3). After the declaration of Alma-Ata, PHC was shown to have objectives with a clear focus to deliver both curative and preventative services for health in order to improve the entire health status of the community (Roemer, 1972).
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The scope of primary healthcare, according to Jones (2004), includes: health education and the prevention of health problems; the promotion of nutrition and food supplies; immunization against infectious diseases; the provision of essential drugs; family planning, child and maternal healthcare; appropriate treatments for common diseases.
The initial contact that a patient from the community has with healthcare is now embedded directly through PHC services, which incorporate the full remit of first ‘point-of-call’ services. Hence, PHC as the first point of contact is seen to be vital in providing the public with an adequate level of health. If this first point of contact cannot be consulted successfully this has ramifications for referrals to secondary health care. This is of course an integral factor in the function of any complete system of healthcare globally. It is also highlighted that the population at large needs to be able to access PHC on demand, irrespective of their social status or location (Kleczkowski et al., 1984).
It is, however, expected that the definition and scope of services may vary from one country to another based on the level of industrialization, the philosophy of government, the evolution of health care services and the wealth of the community and the country (Jones, 2004). In addition, it has been demonstrated that PHC is necessary in four distinct areas (Bradley & McKelvey, 2005). Firstly, that PHC services provide knowledge at a local level. Secondly, they engage in the promotion of health alongside curative services. Thirdly, as PHC is usually the first point of contact for patients, it plays a vital role in health advocacy and overall community collaboration on a local level. Fourthly, PHC has also created new approaches that help to support the health of the public, which supports the need to understand a patient’s health history and work at a multidisciplinary level.
The distinctive factors that help to deliver comprehensive PHC are referred to by Magawa (2012), who states that they are administered through the implementation of legislation that facilitates efficient and cost-effective healthcare interventions, as well as community and individual participation. Hence, the development of PHC programmes or strategies requires direct and enduring government commitment. Such commitment was evident in Tanzania, in 1978, when the government initiated a detailed healthcare strategy for PHC involving major increases in both their facilities and the staffing levels of qualified professionals (Magawa, 2012). Further, the government laid the emphasis on PHC facility development in rural areas of the country to provide enhanced preventive health services. Subsequently, these policies, when implemented in the community, reduced child mortality, although high levels of community participation were seen as a key factor in this success (Magawa, 2012).
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