Primary healthcare implementation in practice: Evidence from primary healthcare managers in Ghana.

Nana Nimo Appiah-Agyekum

doi:10.4102/phcfm.v12i1.2183

Abstract

BackgroundPrimary healthcare (PHC) is a core part of healthcare in developing countries. However, the implementation of PHC since its inception in developing countries has been lethargic, inconsistent and marred by controversies.AimThis study investigates some of the controversies surrounding PHC implementation. It also examines how PHC is being implemented in Ghana as well as how the approaches adopted by PHC implementers influence PHC outcomes in developing countries.SettingThis study is set in Ghana and involves national, regional and district managers of PHC.MethodsA qualitative case study was used to gather information from 19 frontline PHC managers through semi-structured interviews. Interviews were recorded and transcribed. They were then qualitatively analysed using the thematic framework analyses approach.ResultsFindings uncover a lack of clear meaning of what PHC is and how it should be approached amongst key implementers. It also shows discrepancies between official policy documents and directives, and actual PHC practices. Findings also show a gradual shift from Alma Ata’s comprehensive PHC towards a more selective and intervention-specific PHC. Whilst donor and external stakeholders’ influence are the key determinants of PHC policy implementation, their support for vertical and other medicine-based interventions have gradually medicalised PHC.ConclusionThere is a need to pay more attention to understanding and addressing the gaps in PHC implementation and its inconsistencies. Furthermore, the role and control of donors and external development partners in PHC policy formulation and implementation, and their concomitant effects on community participation and empowerment, must be critically examined.

Highlights

Findings uncover a lack of clear meaning of what Primary healthcare (PHC) is and how it should be approached amongst key implementers
This study shows that the nature and scope of PHC implementation in Ghana is premised by the lack of clarity on its meaning, components and limits
PHC in Ghana and other subSaharan countries has generally metamorphosed from its comprehensive, local community-driven, bottom-up and people-centred approach to a medically oriented, donordriven, selective and predominantly top-down activity

Summary

Introduction

Introduction and problem analysisPrimary healthcare (PHC) is ‘essential care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation, and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and selfdetermination’.1 Owing to the comprehensive and wide-reaching implications of this definition, PHC to date remains a nebulous concept with several issues arising from the context, components and feasibility of the approach.[2,3]Principally, the definition above was constructed around the public health failings in developing countries[4,5] and the expression of the desired pathway for achieving health outcomes similar to that of developed countries. Akin et al.[6] describe the PHC movement as merely an international effort to expand and redirect health service programmes in developing countries. This may be because the conditions that necessitated the summit as well as the content of the definition limit its relevance and applicability to developing countries. Primary healthcare has received its greatest support and application in developing countries, where it operates as a standalone national health programme.[7,8]. Primary healthcare (PHC) is a core part of healthcare in developing countries. The implementation of PHC since its inception in developing countries has been lethargic, inconsistent and marred by controversies

Objectives

Results

Discussion

Conclusion