The following are the five key elements to achieving the goals of primary health care:
- integrating health into all sectors (public policy reforms);
- pursuing collaborative models of policy dialogue (leadership reforms); and
- increasing stakeholder participation.
- reducing exclusion and social disparities in health (universal coverage reforms);
- organizing health services around people’s needs and expectations (service delivery reforms);
Challenges faced by primary health care after the Alma Ata declaration
- Disregard for curative intervention: Primary health care programmes dismiss curative interventions and ignore the desire people have for some help with their immediate health problems.
- Tendency to exclude practising clinicians: As the notions of primary health care were developed, the strong emphasis was on disease prevention and health promotion. Consequently, over the years, the development of the community health cum public health cum population health approach focused on healthy lifestyle and ‘wellness’ in the extreme, to the point of excluding the practitioners, the clinicians—doctors, nurses and others who are perceived to be dealing with ill health. That dichotomy and the tension itself has created difficulties.
- Bureaucratic context: Many primary health care programmes are ineffective because they reflect the perspective and needs of the health bureaucracies involved rather than those of the local villages receiving the services. Often primary health care is interpreted differently in different bureaucratic settings and adapted to bureaucratic needs, but not necessarily adapted to the village cultures and conditions.
- Presence of selective-vertical designed initiatives: Selective vertical programmes enable the International Aid Agencies to measure results and protect their investments from complicated long-term multisectoral and interdepartmental implementation. Also, non-government organizations (NGOs) and religious groups have found that holistic community-based health programmes are generally undermined by narrowly selective interventions and that the sustainability of people-owned initiatives can be put in jeopardy. So clearly this approach of selective vertical programmes often focused on particular diseases has been another problem with the implementation of primary health care.
Solution to challenges faced by primary health care
- Community Participation
Strategies:
-
- Awareness, building and consciousness raising on health and health-related issues.
- Planning, implementation, monitoring and evaluation done through small group meetings (10-20 households cluster)
- Selection of community health workers by the community.
- Formation of health committees.
- Establishment of a community health organization at the parish or municipal level.
- Mass health campaigns and mobilization to combat health problems.
- Self-reliance
Strategies
-
- Community generates support (cash, labour) for health programs.
- Use of local resources (human, financial, material)
- Training of community in leadership and management skills.
- Incorporation of income generating projects, cooperatives and small scale industries.
- Recognition of interrelationship of health and development
Strategies:
-
- Convergence of health, food, nutrition, water, sanitation and population services.
- Integration of PHC into national, regional, provincial, municipal and barangay development plans.
- Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services.
- Establishment of an effective health referral system.
- Social Mobilization
Strategies
-
- Establishment of an effective health referral system.
- Multi-sectoral and interdisciplinary linkage.
- Information, education, communication support using multi-media.
- Collaboration between government and non-governmental organizations.
- Decentralization
Strategies
-
- Reallocation of budgetary resources.
- Reorientation of health professional and PHC.
- Advocacy for political and support from the national leadership down to the barangay level
6.Accessibility, Availability, Affordability and Acceptability of Health Services
Strategies:
-
- Health services delivered where the people are
- Use of indigenous/resident volunteer health worker as a health care provider with a ratio of one community health worker per 10-20 households
- Use of traditional (herbal medicine) with essential drugs.
7.Provision of quality, basic and essential health services
Strategies:
-
- Training design and curriculum based on community needs and priorities.
- Attitudes, knowledge and skills developed are on promotive, preventive, curative and rehabilitative health care.
- Regular monitoring and periodic evaluation of community health workers performance by the community and health staff.
