By Dr Than Lwin Tun
Health is one of the most important factors for the development of individuals, communities, and nations. An effective healthcare system is essential for improving people’s quality of life, preventing diseases, and reducing mortality. Primary Health Care (PHC) is the foundation of an effective healthcare system. It is the first level of contact between individuals, families, and communities and the national healthcare system. PHC provides essential health services that are accessible, affordable, acceptable, and equitable to all people. Therefore, strengthening PHC is essential for achieving better health outcomes and sustainable healthcare development. The Declaration of Alma-Ata (1978) was endorsed at the Alma-Ata conference, jointly convened by WHO and UNICEF that focused world attention on primary healthcare as the key to achieving an acceptable level of health throughout the world.
All people, everywhere, have the right to achieve the highest attainable level of health. This is the fundamental premise of pri mary healthcare (PHC). Primary healthcare is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and well-being closer to communities. It has three components: integrated health services to meet people’s health needs throughout their lives, addressing the broader determinants of health through multisectoral policy and action, and empowering individuals, families and communities to take charge of their own health. Primary health care enables health systems to support a person’s health needs from health promotion to disease prevention, treatment, rehabilitation, palliative care and more. This strategy also ensures that healthcare is delivered in a way that is centred on people’s needs and respects their preferences.
The Global Conference on Primary Health Care in Astana, Kazakhstan, in October 2018 endorsed a new declaration emphasizing the critical role of primary healthcare around the world. The declaration aims to refocus efforts on primary healthcare to ensure that everyone everywhere is able to enjoy the highest possible attainable standard of health. The new declaration has renewed political commitment to primary healthcare from governments, non-governmental organizations, professional organizations, academia and global health and development organizations. The new declaration was also a chance to commemorate the 1978 Alma-Ata Declaration on Primary Health Care, and reflect on how far we have come and the work that still lies ahead.
Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care. To deliver on this promise, countries need to have strong, efficient and equitable health systems that are rooted in the communities they serve. Primary health care (PHC) is the most effective and cost-efficient way to get there. Every country has a different path to achieving UHC and to decide what to cover based on the needs of their populations and the resources at hand. Investing in PHC ensures that all those needs are identified, prioritized and addressed in an integrated way; that there is a robust and By Dr Than Lwin Tun equipped health and care workforce; and that all sectors of society contribute to confronting the environmental and socioeconomic factors that affect health and well-being, including preparing for, responding to and recovering from emergencies.
Importance of Strengthening PHC
First, strengthening PHC improves access to essential health services. Many people, especially those living in rural and remote areas, face difficulties accessing hospitals and specialized health facilities. PHC brings health services closer to the community through health centres, rural health facilities, and community-based services. Second, PHC plays an important role in disease prevention and health promotion. It emphasizes preventing diseases before they become serious rather than focusing only on treatment. Health education, immunization, nutrition promotion, environmental sanitation, personal hygiene, and family planning are important components of PHC. These activities help reduce the incidence of communicable and non-communicable diseases and encourage people to adopt healthy lifestyles.
Third, strengthening PHC contributes to reducing maternal and child mortality. Antenatal care, postnatal care, immunization, growth monitoring, breastfeeding promotion, and family planning services are essential components of primary healthcare. Through these services, health workers can identify health problems early, provide appropriate treatment, and refer high-risk mothers and children to higher-level facilities when necessary. As a result, preventable maternal and child deaths can be reduced.
Fourth, PHC helps achieve Universal Health Coverage (UHC). Universal Health Coverage means that all people can access the health services they need without experiencing financial hardship. By providing essential services at the primary level, PHC helps reduce inequalities in healthcare access and protects poor and vulnerable populations. Strengthening PHC also helps reduce unnecessary out-of-pocket expenditure and supports equitable distribution of health resources.
Fifth, a strong PHC system reduces the burden on hospitals. Many common illnesses can be managed effectively at the primary care level. Early diagnosis, appropriate treatment, and timely referral can prevent complications and unnecessary hospital admissions.
This allows secondary and tertiary health facilities to concentrate on patients who require specialized treatment. Consequently, the overall healthcare system becomes more efficient and cost-effective. Sixth, strengthening PHC promotes community participation and empowerment. Community members are important partners in identifying health problems, planning health activities, and implementing solutions. Health workers can cooperate with community leaders, volunteers, and local organizations to improve health awareness and encourage healthy behaviours. Community participation also builds trust between healthcare providers and the people they serve. Seventh, strengthening PHC improves the quality of health services through the development of human resources. Adequately trained and competent health workers, including doctors, nurses, midwives, and community health workers, are essential for providing quality care. Continuous training, supportive supervision, teamwork, and adequate supplies help health workers perform their duties effectively. The availability of essential medicines, equipment, and appropriate technology is also necessary for delivering safe and reliable services.
Furthermore, PHC contributes to the management of non-communicable diseases and long-term health conditions. Diseases such as diabetes, hypertension, cardiovascular diseases, and asthma require continuous monitoring, health education, and regular treatment. Strong primary healthcare services help patients manage these conditions, prevent complications, and maintain a better quality of life. In addition, PHC strengthens the ability of the health system to respond to public health emergencies. Community-based health workers can help identify unusual disease patterns, report outbreaks, provide health information, and support vaccination campaigns. Strong primary health care services are therefore important for preparing for and responding to epidemics, natural disasters, and other emergencies. Strengthening PHC supports sustainable healthcare development.
It encourages the effective use of limited resources and promotes collaboration between the health sector and other sectors, such as education, agriculture, nutrition, water, and sanitation. These combined efforts address the social and environmental factors that influence health. PHC also contributes to achieving the health-related Sustainable Development Goals, particularly the goal of ensuring healthy lives and promoting well-being for all.
Strategies for Strengthening PHC
Several strategies can be implemented to strengthen primary healthcare, such as allocating adequate financial resources to primary health services and ensuring the equitable distribution of health facilities and health workers. Health workers should re ceive appropriate training and continuing professional development. Essential medicines, vaccines, medical equipment, and reliable referral systems should be available. Community participation and health education should be encouraged, while health information systems should be strengthened to support effective planning, monitoring, and evaluation. Collaboration among government agencies, non-governmental organizations, communities, and other sectors is also necessary to improve the effectiveness and sustainability of PHC.
In summary, strengthening Primary Health Care is essential for sustainable health care development because it improves access to health services, promotes disease prevention, reduces maternal and child mortality, and supports Universal Health Coverage. It also reduces the burden on hospitals, improves health equity, encourages community participation, and makes effective use of available resources. However, achieving these benefits requires adequate funding, skilled health workers, essential medicines, and active community involvement. Therefore, strengthening Primary Health Care should be given high priority in health policies and development plans.
References
https://www.who.int/ publications/i/item/WHOHIS-SDS-2018.61
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