As the name implies, PHC is the first level of health care (first point of contact with the health system) that is easily assessable to the community. This means that effective PHC must be locally based, in proximity to the places where people live and work. Geographic barriers may be overcome by locally situated services; to be universally assessable; PHC services must also be free from financial barriers.
Access to PHC can be elaborate in term of: availability, accessibility, affordability, accommodation and acceptability (Penchansky and Thomas; 1981).
1. Availability – the total number of service from which user can make their choice. It refers to the extent to which a system provides facilities (structural form) and services (process) that meets the needs of people. It also deals with access to specific gender of medical personnel, access to medical stores, laboratory or other equipment. Campbell, Roland et.al., 2000 stated that organizational access can be seen as sub-component of availability. This means even if people have adequate physical access to the facility, there might be other factors creating barriers like length of time in getting appointments, waiting in time before getting treatment or sometimes language barrier with the facility professionals.
2. Accessibility – related to travel impedance (time or distance) between spatial location of user and services. It is most commonly related with the geographic location of patient to the location of facilities. Measures like spatial distance, travel time, mode of transportation used to reach the facility, type of road network and etc. are considered assessing physical accessibility of people. 3 components of physical accessibility are thus: people, activities or services and mode of transport to link them. However, this accessibility varies according to the characteristic of each of these components and it is influenced by the relationship between socioeconomic characters of people, users and spatial dimensions. Another also important component deals with the moment of time the service is available (opening hour of PHC facility) or at which people are able to participate (working hour of people).
3. Affordability – related to cost/financial component. There might be adequate number of health facilities or medical personnel in an area, but these facilities might not be affordable to the people. In this dimension, affordability can be view directly as in the cost of doctor’s fee and indirectly costs like travelling cost, which have effect on overall access to healthcare. Other factors included here are: possession and coverage of health insurance, public supports such as subsidized rate provided for certain group of people.
4. Accommodation/Adequacy (Obrist, Iteba et. al., 2007 later change the term ‘accommodation’ to ‘adequacy’) – it is seen in two ways: quality of service provided and personal treatment by the service providers. Opinion about the medical treatment whether people trust the medical ability provided by the facility or not, if they are satisfied with the quality of service or personal behaviour of all facility personnel.
5. Acceptability – related to cultural and religious factors of people. Other factors like age, gender, education level, race or ethnicity also determines the level of acceptability of service provision. This also depends upon the personal perception of people that might vary within a same religion or gender.
PHC plays a central role in health care systems worldwide. It offers families cost-effective services close to hole, and thus eliminates costly trips to specialists and hospitals. In developing countries, community health centers usually offer a broad range of services including prenatal care, immunizations, treatment of childhood illness, treatment of malaria and other common infectious diseases, and other basic medical care.
However, the coverage and effectiveness of primary care services are limited by insufficient resources and staff, erratic drug supplies, and faulty equipment. Governments increasingly recognize that adequate delivery of primary care services is fundamental to the effective functioning of health systems, to keeping families healthy, and to achieving national health goals. Therefore, improvements in access to PHC pave the way for advancement in the quality of people’s life.
PHC provides immediate and often continuing care for the community. It is often their first experience with the formal health care system. As the first level of health care services, PHC services need to be well integrated with the secondary and tertiary health care sectors, in order to provide continuity of care for people throughout all levels of the health care system. In developing countries, public health posts and health centers often provide this care through services from the nurses and mid-level health workers. Ideally, doctors are available for support, training and referrals.
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| 3 levels of health care; with PHC as the first level of contact with the community |
The philosophy behind PHC is based upon:
- Holistic understanding and recognition of the multiple determinants of health
- Equity in health care
- Community participation and control over health services
- Focus on health promotion and disease prevention
- Accessible, affordable, acceptable technology
- Health services based upon research methods
Therefore, the purposes of PHC include:
- The services are usually located in the communities, making them the first point of contact with the health system
- The services can handle a wide range of basic health conditions
- Patients are followed over time by the same primary care providers
- The services are coordinated with higher levels of the health system that can provide more specialized care when need
- The services can reach out to marginalized and underserved groups that might not otherwise seek or receive health care
Although PHC aim to provide health care to all people, there are still remain some constraints that prevent them to do so. However, efforts have been taken to overcome such problems. One such attempt is focusing on prevention methods to difficult-to-reach communities by providing immunizations or vitamin A; or by community-wide health promotion of child nutrition. Now PHC also provide home-based care for chronic conditions like tuberculosis and HIV/AIDS.
Through referral, PHC gives people access to higher levels of care, particularly at the district level.
So, have you ever wonder why PHC is important in one’s country?
Here are a few reasons for that:
1. Reduces the disease burden. By effectively addressing most of the common health needs of children, PHC can bring the greatest benefits to the health of families and communities.
2. Produces economic savings. By improving family health, primary care services reduce the economic consequences of ill-health (illness lower worker productivity and drain household assets).
3. Assures greater equity. Compared with higher levels of care, primary care services are more geographically, financially, and culturally accessible to local communities, thus providing more personalized care to the poorest people who need it the most.
Research has also shown that community-based health interventions reduce the use of emergency and other services in hospitals, improve the control of routine illnesses, and improve patients’ perception of their own health. The continuity of care offered by primary care services is associated with improved patient satisfaction, reduced use of laboratory tests, increased patient compliance with treatment, and better recognition of patients’ behavioural problems.
Now that we know the benefits of PHC in providing health care to the people, but have we ever wonder if PHC is implemented well in one’s country. We have to take note that in much of the developing countries, particularly in the poorest countries, can only provide limited services of the minimum package of care due to a few factors.
Therefore, what are the efforts and strategies to offer success in providing primary care services?
1. Developing a district health system. If decentralized health care is to be successful, management teams at the district level will need to play a greater role in health planning and tackle inefficiencies (such as low worker skills and productivity, and faulty equipment).
2. More financial resources. In poor countries, the additional funding will need to come from re-prioritized government budgets and donors.
3. Better training and support of health workers. The skills and competencies of primary care workers need to be improved, and problems of understaffing, low motivation, and lack of incentives and support need to be addressed.
4. Multi-disciplinary health workers. Balance between health promotion, preventive care and illness treatment can be best achieved through the use of a team drawn from a variety of disciplines; which includes: medical and nursing health professionals, community workers, population health professionals, health promotion workers and educators.
5. Harnessing the private sector. Private-sector providers could provide services for a fee to some populations. Public-private partnerships (example through government contracting) can be used in bringing services to poor communities.
6. Setting health priorities. The skills of local health managers need to be developed for decentralized health planning
REFERENCES:
- Primary Health Care: Key to Delivering Cost-Effective Interventions
- Evaluation of Access to Primary Healthcare; Jeny Shrestha; February 2010
- Primary Health Care and General Practice; National Information Service; August 2003
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