August 6, 2012

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.   


Naani said...

Very interesting and informative to have a bit of an insight into the PHC system that was first formed in this country.
Especially in the areas of controlling endemic diseases, providing nutrition and health education the public,and even in the area of maternal and child health, I believe Maldives has come a long way today (this being said, there are still loopholes in the system which we could work to improve further)

Abdul Sattar Yoosuf said...

Thanks for your comment Naani. No respite from making improving our systems. There are always things to make better. PHC however remains valid as an approach. Its truth is timeless as long as we accept that prevention is better than cure. Present concerns of non-communicable diseases can also be addressed with PHC. But of course we have to move out of the health sector to make that happen. Future health leaders must be ready to take that leap away from the comfort of their sector.

Dr Junaid said...

A very informative article on public health.I believe that public health is very much neglected and a host of diseases can be prevented if we just take precautionary measures and be vigilant.Couple of months back we conducted a workshop to Health Workers on the preventive aspects of Ophthalmology and how to give basic first aid care in Ophthalmological emergencies.The Health Workers were mostly young and very enthusiastic but I was very disheartened and felt so bad when I found out that most of them do not even have the Snellens Chart to check vision and many of them do not even know what it is.As you know many cases of low vision can be detected by the health workers themselves and they can play a pivotal role in the school health programs to to detect low vision.The sad scenario is that some hospitals do not even take them seriously and they have practically nothing to do there.There is a lot of communication gap between them and the resident doctors and some are even openly hostile towards them.In this scenario the authorities have to do a lot and an important first step may be to build confidence of the health workers and instill a team spirit among the health professionals.

Abdul Sattar Yoosuf said...

Delighted to have such a positive response from you Dr Junaid. Prevention is always better than cure. Imagine how greater effort in that department can transform the cost implications of our Aasandhu scheme for example, to bring it down drastically if people practice prevention more vigorously. The case on preventive ophthalmology you cite is sad, and yes, relates to our weak status of inter-sectoral collaboration. You can make a difference however by your simple effort of making that connection with technical staff at the ministry of education's school health department where I know there is a very energetic program manager. Similarly, such tinkles to the health sector policy officials can also raise such dormant yet addressable issues to the fore. Good luck.