Primary Health Care
What is primary health care?
Primary health care (PHC) is the first level of contact individuals, families and communities have with the health care system.
In Australia, PHC
- incorporates personal care with health promotion, the prevention of illness and community development
- includes the interconnecting principles of equity, access, empowerment, community self-determination and inter-sectoral collaboration
- it encompasses an understanding of the social, economic, cultural and political determinants of health.
Keleher H. (2001). Why Primary Health Care Offers a more Comprehensive Approach to Tackling Health Inequalities than Primary Care. Australian Journal of Primary Health. 7(2), 57-61.
A commonly used definition of Australian PHC is:
Primary health care is socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems with a suitably trained workforce comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives priority to those most in need and addresses health inequalities; maximises community and individual self-reliance, participation and control; and involves collaboration and partnership with other sectors to promote public health. Comprehensive primary health care includes health promotion, illness prevention, treatment and care of the sick, community development, and advocacy and rehabilitation.
Definition developed by the Australian Primary Health Care Research Institute (APHCRI) and cited in Primary Health Care Reform in Australia: Report to Support Australia's First National Primary Health Care Strategy [PDF:1.2Mb] (September 2009).
This definition is drawn from The World Health Organization (WHO) Alma-Ata declaration of 1978, which defined PHC as:
Essential health 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 self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.
World Health Organization. (1978). Declaration of Alma Ata, International conference on PHC, Alma-Ata, USSR, 6–12 September. (accessed September 2011).
Why is PHC important?
A strong, accessible PHC system reduces pressure on hospitals by supporting people to manage their health issues in the community. It is the cornerstone underpinning population health outcomes and key to ensuring we have a high-quality sustainable health system into the future.
Yet, despite its critical importance, PHC is not always clearly understood by those working outside the system. Certainly it is a complex mosaic, characterised as much by its funding diversity (a mix of private and publicly-funded services) and workforce distribution as its multi-faceted delivery.
The video clip, What is primary health care? Why is it important? offers some insights.
An Australian PHC Strategy
As part of a process of health reform the Australian Government has developed a National Primary Health Care Strategic Framework to better tackle the health challenges of the 21st century. The Framework takes a broad view of comprehensive primary health care, extending beyond the 'general practice' focus of traditional Australian Government responsibility. It accounts for the importance of community-based PHC to respond to the needs of local communities by focusing on the integration of PHC with specialist care and other health sectors including acute care, aged care and Indigenous health services.
The National Primary Health Care Strategic Framework is a nationally agreed approach for the Commonwealth, states and territories to work in partnership to better integrate health care across care settings and to improve health outcomes for all Australians. The Department of Health (2013).
Australia's comprehensive approach to PHC
Australia strives for a PHC framework based on a comprehensive definition of PHC that is distinguishable from selective PHC that focuses on treatment, rehabilitation and primary medical care. A comprehensive approach to PHC takes into account the social determinants of health, health inequalities, health promotion, illness prevention, treatment and care of the sick, community development, advocacy, rehabilitation, inter-sectoral action and population health approaches.
Table 1: Differences between comprehensive and selective PHC
Reference: Rogers W, Veale B. (2000). Primary Health Care: a scoping report. Adelaide: National Information Service, Dept of General Practice, Flinders University. p18
PHC position statements
Various Australian PHC organisations have outlined their vision for Australia's primary health care system. These include:
- World Health Organization (WHO)
- Australian Medical Association (AMA)
- The Australian Nursing Federation, the Australian Practice Nurses Association, the Australian Nurse Practitioner Association, the Royal College of Nursing, Australia and the Australian College of Mental Health Nurses
- Public Health Association of Australia
Useful PHCRIS Resources
Russell L. (2013). 1990-2012: A chronology of federal government strategies, policies, programs and funding. Canberra: Australian Primary Health Care Research Institute.
Starfield B. (2012). Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gac Sanit, 26 Suppl 1, 20–26.
This is a review of the evidence of the value of primary care in health systems.
Bhatia M, Rifkin S. (2010). A renewed focus on primary health care: revitalize or reframe? Globalization and Health, 6, 13. doi:10.1186/1744-8603-6-13
This article provides a commentary reviewing developments in the last 30 years and identifies challenges for the future.
Kringos D, Boerma W, Hutchinson A, van der Zee J, Groenewegen P. (2010). The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Services Research, 10, 65.
This examines the breadth of primary care by identifying its core dimensions and the evidence for their interrelations and outcomes at health system level.
Felix-Bortolotti M.(2009). Unravelling primary health care conceptual predicaments through the lenses of complexity and political economy: a position paper for progressive transformation. J Eval Clin Pract, 15(5), 861–7.
The author reviewed the primary health care literature to disentangle the concepts of primary health care and primary care as well as their conceptual and empirical ramifications. Complexity is used to look at the ways in which the concept of primary health care is socially constructed. [Abstract precis by PHCRIS]
World Health Organization. (2008). The World Health Report 2008: Primary Health Care (Now more than Ever)
This report calls for four sets of reforms:
- universal coverage to ensure that health systems contribute to health equity and social justice
- service delivery reforms to reorganize health services around people's needs
- public policy reforms that integrate public health actions with primary care,
- leadership reforms with movement towards inclusive, participatory, negotiation-based leadership.
Haggerty J, Burge F, Lévesque J, Gass D, Pineault R, Beaulieu M, Santor D. (2007). Operational definitions of attributes of primary health care: Consensus among Canadian experts. Annals of Family Medicine, 5(4), 36.
A consultation with Canadian primary health care experts to define the attributes that should be evaluated in models of primary health care.
McDonald J, Cumming J, Harris M, Powell Davies G, Burns P. (2006). Systematic review of comprehensive primary health care models.
Canberra: Australian Primary Health Care Research Institute.
This review examines primary health care models in Australia. United Kingdom and New Zealand, focusing on organisational structures, funding and the changing face of the primary health care workforce.
Saltman R B, Rico A, Boerma W. (2006). Primary health care in the driver's seat? World Health Organization on behalf of the European Observatory on Health Systems and Policies.
Cross-national policy analysis of recent developments and organizational change in European primary care.
New Zealand Ministry of Health.(2001). The Primary Health Care Strategy.
Links to the Strategy and a range of related documents, websites and reference material.
Rogers W, Veale B. (2000). Primary Health Care and General Practice: A Scoping Report. Adelaide: NIS.
Published by the Primary Health Care Research & Information Service (Rogers & Veale, 2000).
- describes and defines both primary health care and general practice, highlighting the areas of overlap and the major philosophical and strategic differences
- identifies issues to be addressed in strengthening primary health care in Australia
- includes examples of both research and programs in the categories of medical model, selective primary health care and comprehensive primary health care.
A summary version of this information is available in a two-page colour PHCRIS Fact Sheet
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Primary Health Care Research & Information Service (2016). PHCRIS Getting Started Guides: Introduction to... Primary Health Care. From http://www.phcris.org.au/guides/about_phc.php (Accessed 28 Oct 2016)