Shifting Focus of Primary Health Care in the Context of Health Systems Reform in Resource Poor Settings

Ga Nnaji

doi:10.4172/2167-1079.1000102

Abstract

Purpose:To review the concepts of Primary Health Care (PHC) and provide evidence for a shift in its focus and implementation in the resource poor setting. Sources of data:Desk and internet based review of relevant articles and official documents. Data extraction:Search themes were ‘concepts and models of PHC’, contextual issues in PHC and health care reforms aimed at achieving the universally accepted core social values of health care delivery. Results:Four main concepts and approaches to PHC include selective PHC, primary care; Alma-Ata comprehensive PHC and health and human rights approach. The concept of PHC in resource poor settings is oversimplified and restrictive. This is in contrast with the situation in well-resourced contexts where primary care concept is practiced.The World Health Organisation recommends a shift in focus of PHC through four sets of reforms in the health system, universal coverage reforms, service delivery reforms, public policy reforms and leadership reforms. This shift should bridge the gap between citizens’ expectations and performance of the health care system. Conclusion:Inability of health services to deliver levels of national coverage that meet stated demands and changing needs has been a source of worry. The health systems need to respond better and faster to the challenges of a changing world.

Highlights

The Alma-Ata conference, held about thirty years ago resulted in a paradigm shift in the thinking about health and this eventually led to the mobilization of the “Primary Health Care (PHC) movement” of professionals, institutions, governments, civil society organizations, researchers and grassroots organizations [1]
In a recent PHC review by the Pan American Health Organisation, this perspective became clearer as the “right to the highest attainable level of health”, “maximizing equity and solidarity” while being guided by “responsiveness to people’s needs” [7]
The purpose of this paper is to review the concepts of PHC and to provide evidence for a shift in its focus and implementation in resource poor settings

Summary

Introduction

The Alma-Ata conference, held about thirty years ago resulted in a paradigm shift in the thinking about health and this eventually led to the mobilization of the “PHC movement” of professionals, institutions, governments, civil society organizations, researchers and grassroots organizations [1]. The Alma-Ata declaration focused on a set of values to be pursued such as social justice and the right to better health for all, participation and solidarity [2,3]. Health systems development has been devoid of equity and social justice and has failed to get the best health outcomes for citizens’ money. Three trends have characterized the health system; focusing disproportionately on a narrow offer of specialized curative care; using a command-andcontrol approach to disease control with focus on short term results and fragmenting service delivery; a laissez-faire approach to governance, which has allowed unregulated commercialization of health to flourish [1]. The health systems should respond to the challenges of a changing world and growing expectations for better performance if the goal of health for all would ever be achieved

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