How familiar are we with Primary Health Care?

This wonderful idea was born in 1978. Perhaps many of us in Maldives, just like everywhere else, have forgotten it – or perhaps have accumulated some cobwebs in the recesses of our minds where this was stored. And why not, after almost 35 years no one can blame you if you have. But let me tell you, it’s a subject worth reviewing, for it is the backbone of our Maldives health system. In 1980 Maldives prepared its first national health plan with Primary Health Care as its basis. And we have worked with this idea in mind over the past several decades, and have achieved stuff worth crowing about. We have beaten Malaria and leprosy into its den, flattened diarrheal diseases, limited tuberculosis and filariasis, and squeezed down infant mortality to almost a tenth of what it was forty years ago. All of this achievement through the use of Primary Health Care, but perhaps without being consciously aware of the power of this exciting health strategy. Using this approach, our health workers have done a fabulous job over the past three decades and more. 

But now we in Maldives are faced with a major challenge in the face of the health sector decentralization where the island health councils will be taking the big responsibility for heath governance in the islands and atolls. But without an understanding of PHC, the results can be disastrous. The clamor to build hospitals and bringing in a flood of doctors to the midst will not be the solution. So, let’s first seek to understand PHC in its essence. Seek first to understand and then attempt to be understood. A detailed account would be too lengthy to put in this blog, but I will venture to highlight the very basics.

PHC has clear principles it embodies that give PHC its unique character or flavor. Firstly, PHC is an approach and not a method. It works along a process that embodies key defining principles that makes PHC what it is, and those that may not be violated for us to say what we practice is PHC. Contrasting this with other forms of care – such as primary care, secondary care, tertiary care, catastrophic care, etc -- these salient principles relate to equity and human rights --- which is about being fair to everyone in making health services available to everyone; community involvement --- which is about the need for everyone in the community to be involved in making the services that are provided, effective. Primary Health Care also says something about the kinds of services provided – that they must be made available to everyone at a cost people can afford, and also that these must be physically accessible and culturally acceptable in respect to the existing social and religious values in a given society. Other forms of care do not have these elaborate principles integrated. Mostly those are about taking care of individual patients and not the health concerns of a community which PHC essentially deals with.

Given these features of PHC, the model proposed by the World Health Organization together with UNICEF in 1978 stated at least 8 key areas of health service delivery which I will not elaborate here but those of you interested may look up on the internet (WHO website or just by asking Google). An overarching consideration that PHC calls for is its prime focus of Prevention. Public health consideration is key in PHC, for prevention is always better than cure. If we can take care of ourselves in not getting sick, we will save a lot of money that we would otherwise spend for the doctor’s bills. Additionally, by being public health vigilant, we will save our national exchequer heaps of money too. Just imagine, if few of us get sick, we will have more money to spend for the more serious of health interventions when we do need them. Now, that is the plus for understanding and practicing PHC.