Building healthier nations through Primary Health Care

Abstract

At the end of June 2009, the International Council of Nurses (ICN) will hold its Congress in Africa for the first time. This issue of INR will be displayed on the ICN and Wiley/Blackwell stands at the ICN Congress in Durban, South Africa. A wide range of articles in this issue help to illustrate the Congress theme Leading change: building healthier nations. As this editorial was being written, the World Health Organization (WHO) was celebrating the 30th anniversary of the Alma Ata International Conference on Primary Health Care (PHC), with the WHO 2008 Annual Report devoted to this theme (WHO 2008a). Dr Halfdan Mahler, WHO Director-General at the time of Alma Ata and a great champion of nursing's contribution to health care, had no doubt that nurses could and would lead the change to tackle inefficiencies in health systems and inequities in health, through PHC. Celebrating the first ICN Congress to be held in sub-Saharan Africa is a good moment to remember Dr Mahler's wisdom. In an interview (WHO 2008b) to mark the 30th anniversary, he was asked why PHC had lost its way in the years since 1978. He responded that with the introduction of Structural Adjustment Programs and all sorts of privatisations at the end of the 1970s, there was no support from the World Bank and the International Monetary Fund. Instead, selective, vertical programmes for the treatment of TB and malaria, popular in the 1960s, were re-introduced, and this weakened the holistic PHC approach. As I write towards the end of 2008, and as global banking systems collapse around us, it is perhaps ironic that WHO should once again be urging change for ailing health systems through a return to holistic PHC. Hopefully, the current WHO leadership also will remember Dr Mahler's belief in nursing's contribution. A concurrent WHO publication (WHO 2008c) reminds us that worldwide, Africa accounts for 9 out of 10 child deaths due to malaria, 9 out of 10 deaths due to HIV/AIDS, and for half the world's child deaths due to diarrhoeal disease and pneumonia. Where is the practice research that identifies the cost-effectiveness of PHC in reducing these avoidable deaths? For all the excellent articles that INR publishes from research on nursing, too few take a perspective that challenges the vertically oriented ethos of much contemporary health care. Too many accept the status quo without question. Too few studies embed their research questions in the current state of a local population's health, or urge their governments to develop holistic policies to meet these needs. The Wellness Centres initiated by ICN in sub-Saharan Africa are a notable but rare exception. Meanwhile, nursing's educational systems teach the principles of PHC in college but following graduation nurses need jobs, and these are frequently found in the high technology sectors of health care systems. Yet, many nurses never lose the vision of primary health care as the basis for their practice (ICN 2008; Robinson 1998). As nurses meet in Durban for a pivotal moment in nursing's history, it is important to remember that it is not only their individual contributions, but also the type of systems in which nurses work that influence health outcomes. Let us re-commit to the principles of PHC and seize this opportunity to make a real difference to the people's health.