Primary Health Care

definitions

Primary Health Care (PHC) incorporates personal care with health promotion, the prevention of illness and community development. The philosophy of PHC includes the interconnecting principles of equity, access, empowerment, community self-determination and intersectoral collaboration. It encompasses an understanding of the social, economic, cultural and political determinants of health.
Reference: 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.

“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 was developed for an ADGP Primary Health Care Position Statement in 2005, and also included in the Australian Medical Association Primary Health Care position paper, 2006.

An Australian PHC Strategy

As part of a comprehensive program of health reform the Australian Government is developing a National Primary Health Care Strategy to better tackle the health challenges of the 21st century.

The yourHealth website supports the reform process and encourages Australian people to provide ideas for future improvements to the health system.

This website contains final reports of the:

National Health and Hospital Reform Commission, A Healthier Future for all Australians (June 2009)
Preventative Health Taskforce, Australia: The Healthiest Country by 2020 (September 2009)
National Primary Health Care Taskforce, Building a 21st Century Primary Health Care System(September 2009)

These reports provide the governments of Australia with a well thought out foundation for health reform that will benefit Australians, not just now but well into the future.

Following the release of the reports a comprehensive consultation program is underway. A reform plan will be released in early 2010.

Position statements

1. Primary Health Care
Australian General Practice Network (AGPN): released a Primary Health Care Position Statement (2009) outlining the Division Network's vision for the Australian primary health care system. In conjunction with the Australian Primary Health Care Research Institute (APHCRI), AGPN produced an accompanying monograph: Primary Health Care Position Statement: a scoping of the evidence an update for 2009.

World Health Organisation (WHO): PHC gained currency following the 1978 International Conference on Primary Health Care held by the WHO and UNICEF at Alma-Ata. The WHO's Declaration of Alma-Ata (1978) is a ten point statement identifying health as a fundamental human right, with primary health care described as the key for attaining health for all by the year 2000.

Australian Medical Association (AMA): produced its Primary Health Care Position Statement - 2006 addressing issues such as primary care teams, access, advocacy, safety and quality, workforce, funding, after hours, preventive medicine, Aboriginal and Torres Strait Islander health, training, research and doctor health.

The Australian Nursing Federation, the Australian Practice Nurses Association, the Australian Nurse Practitioner Association, Royal College of Nursing, Australia and the Australian College of Mental Health Nurses released a Consensus Statement in 2008 on Advanced registered nurse and nurse practitioner role in primary health care.

2. Primary Care
The Australian Government Department of Health and Ageing's response to the review of the role of Divisions of general practice in 2004, Divisions of General Practice: Future Directions includes information about the Government's priorities for advancing primary care in Australia. The response highlights that the "focus of Divisions should be to assist general practice to provide services to the community in a primary care system" (p.22).

Reference: Commonwealth of Australia. (2004). Divisions of General Practice: Future Directions. Canberra: Department of Communication, Information Technology and the Arts, Commonwealth of Australia.

Differences between comprehensive and selected 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. National Information Service, Dept of General Practice, Flinders University. p.18.

Worth reading

Part 1--unravelling primary health care conceptual predicaments through the lenses of complexity and political economy: a position paper for progressive transformation
Felix-Bortolotti M. J Eval Clin Pract. 2009 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 PHC RIS]

The World Health Report 2008: Primary Health Care (Now more than Ever)
World Health Organisation
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. A one and three page summary for the findings are also available.

'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.