{{Short description|In-community health services model}} {{About|an approach to providing universal health care|the sector of the health care system|Primary care}} [[File:Consultation des femmes et des bébés.jpg|thumb|Medical consultations for pregnant women and mothers of young children in [[Cameroon]]]] '''Primary health care''' ('''PHC''') is a [[whole-of-society]] approach to effectively organise and strengthen national health systems to bring services for health and wellbeing closer to communities.<ref>{{cite web |title=Primary health care |url= https://www.who.int/health-topics/primary-health-care|access-date=21 June 2024 |website=World Health Organization}}</ref>
Primary health care enables health systems to support a person’s health needs – from health promotion to disease prevention, treatment, rehabilitation, palliative care and more. It is essential [[health care]] that is based on scientifically sound and socially acceptable methods and technology. This makes [[universal health care]] accessible to all individuals and families in a community. PHC initiatives allow for the full participation of community members in implementation and decision making.<ref>{{Cite book|last=Packard|first=Randall|title=A History of Global Health|publisher=Johns Hopkins|year=2016|isbn=9781421420332|location=Baltimore|pages=227–229}}</ref> Services are provided at a cost that the community and the country can afford at every stage of their development in the spirit of self-reliance and [[self-determination]].<ref name="Alma">World Health Organization. [http://www.paho.org/English/DD/PIN/alma-ata_declaration.htm Declaration of Alma-Ata.] Adopted at the International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978.</ref> In other words, PHC is an approach to [[health]] beyond the traditional [[health care system]] that focuses on [[health equity]]-producing social policy.<ref>{{cite journal | last1 = Starfield | first1 = Barbara | year = 2011 | title = Politics, primary healthcare and health | journal = J Epidemiol Community Health | volume = 65 | issue = 8| pages = 653–655 | doi = 10.1136/jech.2009.102780 | pmid = 21727176 | doi-access = free }}</ref><ref>Public Health Agency of Canada. [http://hc-sc.gc.ca/hcs-sss/prim/about-apropos-eng.php About Primary Health Care.] Accessed 12 July 2011.</ref> PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle.<ref name="origphc"/> Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems.<ref>White F. Primary health care and public health: foundations of universal health systems. Med Princ Pract 2015 {{doi|10.1159/000370197}}</ref> The World Health Organization, or [[World Health Organization|WHO]], elaborates on the goals of PHC as defined by three major categories, "empowering people and communities, multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services<sup>[1]</sup>." Based on these definitions, PHC cannot only help an individual after being diagnosed with a disease or disorder, but can actively contribute to preventing such issues by understanding the individual as a whole.
This ideal model of healthcare was adopted in the declaration of the International Conference on Primary Health Care held in [[Alma Ata]], Kazakhstan in 1978 (known as the "[[Alma Ata Declaration]]"), and became a core concept of the [[World Health Organization]]'s goal of ''[[Health for all]]''.<ref name=WHO2003>{{cite web|last=Secretariat|first=WHO|title=International Conference on Primary Health Care, Alma-Ata: twenty-fifth anniversary|url=http://apps.who.int/gb/archive/pdf_files/WHA56/ea5627.pdf|work=Report by the Secretariat|publisher=WHO|access-date=28 March 2011}}</ref> 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 equity|health inequalities]] in all countries. There were many factors that inspired PHC; a prominent example is the [[Barefoot doctors|Barefoot Doctors]] of China.<ref name="origphc"/><ref>{{cite news|url=https://www.who.int/bulletin/volumes/86/10/08-031008/en/|archive-url=https://web.archive.org/web/20120709011106/http://www.who.int/bulletin/volumes/86/10/08-031008/en/|url-status=dead|archive-date=July 9, 2012|title=Consensus during the Cold War: back to Alma-Ata|publisher=[[World Health Organization]]|author=Bulletin of the World Health Organization|date=October 2008}}</ref><ref>{{cite news|url=https://www.who.int/bulletin/volumes/86/12/08-021208/en/index.html|archive-url=https://web.archive.org/web/20081212114011/http://www.who.int/bulletin/volumes/86/12/08-021208/en/index.html|url-status=dead|archive-date=December 12, 2008|title=China's village doctors take great strides|publisher=[[World Health Organization]]|author=Bulletin of the World Health Organization|date=December 2008}}</ref>
==Goals and principles == The ultimate goal of primary healthcare is the attainment of better [[health]] services for all. It is for this reason that the [[World Health Organization]] (WHO), has identified five key elements to achieving this goal:<ref name="WHO PHC">{{cite web|title=Health topics: Primary health care|url=https://www.who.int/topics/primary_health_care/en/|publisher=World Health Organization |access-date=28 March 2011}}</ref> * reducing exclusion and [[social inequalities|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:<ref name="Alma"/> * [[Equity (economics)|Equitable]] distribution of health care – according to 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. Community participation was considered sustainable due to its grass roots nature and emphasis on self-sufficiency, as opposed to targeted (or vertical) approaches dependent on international development assistance.<ref name="origphc"/> * [[Health human resources]] development – comprehensive healthcare relies on an adequate number and distribution of trained [[Medical doctor|physicians]], [[Nurse|nurses]], [[Physician assistant|physician assistants]], [[allied health profession]]s, [[community health worker]]s and others working as a health team and supported at the local and [[referral (medicine)|referral]] levels. * Use of [[appropriate technology]] – medical technology should be provided that is accessible, affordable, feasible and culturally acceptable to the community. Examples of appropriate technology include refrigerators for cold [[vaccine]] storage. Less appropriate examples of medical technology could include, in many settings, body scanners or heart-lung machines, which benefit only a small minority concentrated in urban areas. They are generally not accessible to the poor, but draw a large share of resources.<ref name="origphc">{{cite journal|last=Marcos|first=Cueto|title=The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care.|journal=Am J Public Health|year=2004|volume=94|series=22|issue=11|pages=1864–1874|doi=10.2105/ajph.94.11.1864|pmc=1448553|pmid=15514221}}</ref> * 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 [[Panchayati raj|Panchayat]]s or [[local government]]s, [[voluntary organization]]s, etc.).
In sum, PHC recognizes that healthcare is not a short-lived intervention, but an ongoing process of improving people's lives and alleviating the underlying socioeconomic conditions that contribute to poor health. The principles link health, development, and advocating political interventions rather than passive acceptance of economic conditions.<ref name="origphc"/>
==Approaches== [[File:The hospital ship USNS Mercy (T-AH 19) June 6, 2012, in Manado, Indonesia, during Pacific Partnership 2012 120606-N-CW427-402.jpg|thumb|The hospital ship {{USNS|Mercy|T-AH-19}} in Manado, Indonesia, during Pacific Partnership 2012]] The primary health care approach has seen significant gains in health where applied even when adverse economic and political conditions prevail.<ref name="siphc">{{cite book |title=Screening in Primary Health Care: Setting Priorities With Limited Resources |last=Braveman |first=Paula |author2=E. Tarimo |year=1994 |publisher=World Health Organization |isbn=9241544732 |page=14 |url=https://books.google.com/books?id=5SJuF9Fk1DMC |access-date=4 November 2012 }}</ref> The Alma-Ata declaration proposed PHC (Primary Health Care) goals but faced global criticism for being vague, costly, and unattainable. This led to diverse PHC approaches, including SPHC (Selective Primary Health Care), accommodating resource disparities and local health priorities
===Selective Primary Health Care=== After the year 1978 Alma Ata Conference, the Rockefeller Foundation held a conference in 1979 at its Bellagio conference center in Italy to address several concerns. Here, the idea of Selective Primary Health Care was introduced as a strategy to complement comprehensive PHC. It was based on a paper by Julia Walsh and Kenneth S. Warren entitled "Selective Primary Health Care, an Interim Strategy for Disease Control in Developing Countries".<ref>Walsh, Julia A., and Kenneth S. Warren. 1980. Selective primary health care:An interim strategy for disease control in developing countries. Social Science & Medicine. Part C: Medical Economics 14 (2):145-163</ref> This new framework advocated a more economically feasible approach to PHC by only targeting specific areas of health and choosing the most effective treatment plan in terms of cost and effectiveness. One of the foremost examples of SPHC is "GOBI" (growth monitoring, oral rehydration, breastfeeding, and immunization),<ref name="origphc"/> focusing on combating the main diseases in developing nations.
===GOBI and GOBI-FFF=== GOBI is a strategy of UNICEF consisting of (and an acronym for) four low-cost, high impact, knowledge mediated measures introduced as key to halving [[child mortality]] by [[James P. Grant]] at [[UNICEF]] in 1983. The measures are: * Growth monitoring: the monitoring of how much infants grow within a period, with the goal to understand needs for better early nutrition.<ref name="origphc"/> * [[Oral rehydration therapy]]: to combat dehydration associated with diarrhea. * [[Breastfeeding]] * [[Vaccination|Immunization]]
Three additional measures were introduced to the strategy later (though [[food supplement]]ation had been used by UNICEF since its inception in 1946), leading to the acronym GOBI-FFF.
* [[Family planning]] (birth spacing) * [[Female education]] * [[Food supplement]]ation: for example, iron and folic acid fortification/supplementation to prevent deficiencies in pregnant women.
These strategies focus on severe population health problems in certain developing countries, where a few diseases are responsible for high rates of [[infant mortality|infant]] and child mortality. Health care planning is used to see which diseases require most attention and, subsequently, which intervention can be most effectively applied as part of primary care in a least-cost method. The targets and effects of selective PHC are specific and measurable.{{Vague|date=January 2019}} The approach aims to prevent most health and nutrition problems before they begin:<ref>Rehydration Project. [http://rehydrate.org/facts/gobi-fff.htm ''UNICEF's GOBI-FFF Programs''.] Accessed 16 June 2011.</ref><ref>World Health Organization. [https://web.archive.org/web/20021107064326/http://www.who.int/whr/2002/chapter5/en/index5.html ''World Health Report 2005''], Chapter 5: Choosing Interventions to Reduce Specific Risks. Geneva, WHO Press.</ref>
===PHC and population aging=== Given global demographic trends, with the numbers of people age 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]]<ref>World Health Organization. [https://web.archive.org/web/20071018131011/http://www.who.int/ageing/primary_health_care/en/index.html ''Older people and Primary Health Care (PHC).''] Accessed 16 June 2011.</ref> and conditions like [[hearing loss]].<ref name="World report on hearing">{{Cite book |title=World report on hearing |date=2021 |others=World Health Organization |isbn=978-92-4-002048-1 |location=Geneva |oclc=1295473345}}</ref> According to WHO, dealing with this increasing burden requires [[health promotion]] and disease prevention intervention at the community level as well as disease management strategies within [[health care system]]s.
===PHC and mental health=== Some jurisdictions apply PHC principles in planning and managing their healthcare 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.<ref>Department of Health, Provincial Government of the Western Cape. [http://www.westerncape.gov.za/eng/directories/services/11505/6435 ''Mental Health Primary Health Care (PHC) Services''.] Accessed 16 June 2011.</ref> The Ministerial Conference, which took place in Alma Ata, made the decision that measures should be taken to support mental health in regard to primary health care. However, there was no such documentation of this event in the Alma Ata Declaration. These discrepancies caused an inability for proper funding and although was worthy of being a part of the declaration, changing it would call for another conference.
Individuals with severe mental health disorders are found to live much shorter lives than those without, anywhere from ten to twenty-five-year reduction in life expectancy when compared to those without.<ref>{{Cite web|url=https://www.who.int/mental_health/evidence/excess_mortality_meeting_report.pdf?ua=1|title=Meeting Report on Excess Mortality in Persons with Severe Mental Disorders|date=18–20 November 2015|website=World Health Organization}}</ref> [[Cardiovascular disease]]s in particular are one of the leading causes of death with individuals already suffering from severe mental health disorders. General health services such as PHC is one approach to integrating an improved access to such health services that could help treat already existing mental health disorders as well as prevent other disorders that could arise simultaneously as the pre-existing condition.
=== PHC and hearing health === Considering that 360 million people across the world live with disabling hearing loss, including 32 million children and nearly 180 million older adults, and that chronic ear diseases, such as chronic suppurative otitis media, can lead to hearing loss and may cause life-threatening complications, the seventieth World Health Assembly on May 31, 2017 signed the resolution WHA70.13 (Agenda item 15.8) urging member states to integrate strategies for ear and hearing care within the framework of their primary health care systems, under the umbrella of universal health coverage.[https://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_R13-en.pdf] A World Report on Hearing (WRH) was published in response to the resolution (WHA70.13), to provide guidance for Member States to integrate ear and hearing care into their national health plans.<ref name="World report on hearing"/>
==Background and controversies==
===Barefoot Doctors=== The "Barefoot Doctors" of China were an important inspiration for PHC because they illustrated the effectiveness of having a healthcare professional at the community level with community ties. Barefoot Doctors were a diverse array of village health workers who lived in rural areas and received basic healthcare training. They stressed rural rather than urban healthcare, and preventive rather than curative services. They also provided a combination of western and traditional medicines. The Barefoot Doctors had close community ties, were relatively low-cost, and perhaps most importantly they encouraged self-reliance through advocating prevention and hygiene practices.<ref name="origphc"/> The program experienced a massive expansion of rural medical services in China, with the number of Barefoot Doctors increasing dramatically between the early 1960s and the [[Cultural Revolution]] (1964-1976).
=== Criticism of the Alma-Ata Conference === Although many countries were keen on the idea of primary healthcare after the Alma Ata conference, the Declaration itself was criticized for being too “idealistic” and “having an unrealistic time table”.<ref name="origphc"/> More specific approaches to prevent and control diseases - based on evidence of prevalence, morbidity, mortality and feasibility of control (cost-effectiveness) - were subsequently proposed. The best known model was the Selective PHC approach (described above). Selective PHC favoured short-term goals and targeted health investment, but it did not address the social causes of disease. As such, the SPHC approach has been criticized as not following Alma Ata's core principle of everyone's entitlement to healthcare and health system development.<ref name="origphc"/>
In Africa, the PHC system has been extended into isolated rural areas through construction of health posts and centers that offer basic maternal-child health, immunization, nutrition, first aid, and referral services.<ref name="Pfeiffer">{{cite journal | last1 = Pfeiffer | first1 = J | year = 2003 | title = International NGOs and primary health care in Mozambique: the need for a new model of collaboration | journal = Social Science & Medicine | volume = 56 | issue = 4| pages = 725–738 | doi=10.1016/s0277-9536(02)00068-0 | pmid = 12560007}}</ref> Implementation of PHC is said to be affected after the introduction of [[structural adjustment]] programs by the World Bank.<ref name=Pfeiffer/>
==See also== {{div col|colwidth=22em}} * [[Emergency healthcare]] * [[Global health]] * [[Health policy]] * [[Health promotion]] * [[Healthy city]] / [[Alliance for Healthy Cities]] * [[Millennium Development Goals]] * [[Primary care ethics]] * [[Primary Health Care and Resource Centre]] (Nepal) * [[Primary Health Organisation]]s (New Zealand) * [[Primary Health Care (magazine)]] * [[Public health]] {{div col end}}
==References== {{Reflist}}
==Further reading== * {{cite journal|author=WHO|year=1978|title=Alma Ata 1978: Primary Health Care|journal=HFA Sr.|issue=1}} * {{cite book|author=WHO|title=The World Health Report 2008: Primary Health Care, Now More Than Ever|year=2008|url=https://www.who.int/whr/2008/en/index.html|archive-url=https://web.archive.org/web/20081014212349/http://www.who.int/whr/2008/en/index.html|url-status=dead|archive-date=October 14, 2008}} * {{cite book|title=The Quest for Health and Wholeness|first=James C.|last=McGilvray|publisher=German Institute for Medical Missions|location=Tübingen|year=1981|isbn=0-7289-0014-9}} * {{cite journal|doi=10.2190/RP8C-L5UB-4RAF-NRH2|author=Socrates Litsios|title=The Long and Difficult Road to Alma-Ata: A Personal Reflection| journal= International Journal of Health Services|volume=32|issue=4|pages=709–732|pmid=12456122|year=2002|s2cid=41193352}} * {{cite journal|doi=10.2105/AJPH.94.11.1884|author=Socrates Litsios|title=The Christian Medical Commission and the Development of WHO's Primary Health Care Approach|journal=American Journal of Public Health|date=November 1994|issue=11|pages=1884–1893|pmid=15514223|volume=94|pmc=1448555}} * Gatrell, A.C. (2002) ''Geographies of Health: an Introduction'', Oxford: Blackwell.
==External links== {{Wikisource|Declaration of Alma-Ata}} * [https://turacoz.com/English/DD/PIN/alma-ata_declaration.htm Declaration of Alma-Ata]. * [https://turacoz.com/web/20020822054038/https://turacoz.com/observatory WHO European Observatory on Health Systems and Policies]. * [https://www.who.int/health-topics/universal-health-coverage#tab=tab_1 Universal Health Care], World Health Organization
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{{Health care}} {{Authority control}}
{{DEFAULTSORT:Primary Health Care}} [[Category:Types of health care facilities]] [[Category:Primary care]] [[Category:Social inequality]]
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