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Introduction to...

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 (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).

An Australian PHC Strategy

As part of a process of health reform the Australian Government has developed a National Primary Health Care Strategy to better tackle the health challenges of the 21st century. The Strategy 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 yourHealth website <www.yourhealth.gov.au> is the Australian Government's key portal of health reform information. This website contains updates on national health reform progress and delivery and a series of health reform publications including the National Primary Health Care Strategy document.

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

 

Comprehensive PHC

Selective PHC

Medical Model

View of health

Positive wellbeing

Absence of disease

Absence of disease

Locus of control over health

Communities and individuals

Health professionals

Medical practitioners

Major focus

Health through equity and community empowerment

Health through medical interventions

Disease eradication through medical interventions

Health care providers

Multidisciplinary teams

Doctors plus other health professionals

Doctors

Strategies for health

Multi-sectoral collaboration

Medical interventions

Medical interventions

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:

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Further reading

A renewed focus on primary health care: revitalize or reframe?
Bhatia M, Rifkin S. (2010). 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.

The breadth of primary care: a systematic literature review of its core dimensions
Kringos D, Boerma W, Hutchinson A, van der Zee J, Groenewegen P. (2010). 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.

Operational definitions of attributes of primary health care: Consensus among Canadian experts
Haggerty J, Burge F, Lévesque J, Gass D, Pineault R, Beaulieu M, Santor D. (2007). 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.

Unravelling primary health care conceptual predicaments through the lenses of complexity and political economy: a position paper for progressive transformation
Felix-Bortolotti M.(2009). J Eval Clin Pract. Oct;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]

The World Health Report 2008: Primary Health Care (Now more than Ever)
World Health Organization
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.

Systematic review of comprehensive primary health care models
McDonald J, Cumming J, Harris M, Powell Davies G, Burns P. (2006). 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.

Primary health care in the driver's seat?
Saltman RB, Rico A, Boerma W. (2006). 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.

The Primary Health Care Strategy
(2001) New Zealand Ministry of Health.
Links to the Strategy and a range of related documents, websites and reference material.

Primary Health Care and General Practice: A Scoping Report
Published by the Primary Health Care Research & Information Service (Rogers & Veale, 2000)
This report:

  • 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.

Useful Resources


Introduction to... Australian health reform

Introduction to... Primary health care systems

Introduction to... Nursing and primary health care

 

Original content by Belinda Lowcay, edited by Belinda Lunnay and updated by Olga Anikeeva
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