What is Primary Health Care?

The term is used commonly within all health professions globally.
Australian doctors continually make the claim to be the natural leaders of any primary health care initiative within Australia, often disruptively.
But Primary Health Care is bigger than any single profession no matter how inflated its point of view.
Just how did the term arise, and what are the origins and implications of Primary Health Care (PHC)?
i2P takes you back to the “roots” of this term and what it may mean to the pharmacy profession if pharmacists are ready to step up and accept responsibility.

Alma-Ata, renamed Almaty, is the largest city in Kazahkstan, and is historically significant, for it was the venue for an international health conference from 6-12 September, 1978.

The conference expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people.
It was the first international declaration underlining the importance of primary health care.
The primary health care approach has since then been accepted by member countries of the World Health Organization (WHO) as the key to achieving the goal of Health For All but only in third world countries at first.
This applied to all other countries five years later.

Primary health care (PHC) refers to “essential health care that is based on scientifically sound and socially acceptable methods and technology, which make universal health care universally accessible to individuals and families in a community.

It is through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.
In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. 

PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle. 
Thus, primary health care and public health measures, taken together, may be considered as the cornerstones of universal health systems.

Australian Pharmacists have always been involved in Primary Health Care Systems (such as the Pharmaceutical Benefits Scheme (PBS)), and previous to PBS inception, pharmacists were the actual face of Primary Health Care, when for most people their first contact with the Australian health system when they become ill was a visit to a local community pharmacist who diagnosed and prescribed to the limit of their ability.

At that point they were referred to their own GP for further investigation.
Some GP’s have valued the referrals from pharmacists – others have disparaged the idea that pharmacists have patients or can even treat someone under any circumstances.
This latter attitude has been an unprofessional one and one that came with many medical reprisals.
One of the benefits of the PBS system is that it has slowly sorted out some of these negative attitudes, and now that it is near the end of its life cycle, it has lost value and thus is a less potent weapon for GP’s to manipulate, as they blatantly did in the past.
In 1953 the National Health Act was introduced, and that led to patients being able to visit a doctor at no cost and obtain prescriptions at no cost.

Unwittingly, pharmacists had signed themselves into a system that progressively reduced the volume of Primary Health Care transactions directly with patients because when a person became sick they went directly to a doctor (GP) and then on to the pharmacist, removing diagnosis and prescribing from pharmacist control.

The GP may then refer them to a specialist or a public hospital, order diagnostic testing, write them a prescription or pursue other treatment options.
But patient and clinical care are just two components of a much broader and complex network that involves multiple providers working in numerous settings, supported by a variety of legislative, regulatory and funding arrangements.
This is the Australian health system.

According to the World Health Organization (WHO), a health system is ‘all the activities whose primary purpose is to promote, restore and/or maintain health’. Further, a good health system ‘delivers quality services to all people, when and where they need them’.

While the configuration of services varies from country to country, common elements include robust funding mechanisms, a trained workforce, reliable information on which to base decisions and policies, and well-maintained facilities and logistics to deliver quality medicines and technologies.

Australia’s health-care system is a multi-faceted web of public and private providers, settings, participants and supporting mechanisms.
Health providers include medical practitioners, nurses, pharmacists, allied and other health professionals, hospitals, clinics and government and non-government agencies.
These providers deliver a plethora of services across many levels, from public health and preventive services in the community, to primary health care, emergency health services, hospital-based treatment, and rehabilitation and palliative care.
What is lacking is a coordinated plan to integrate the health professions so that they can alternatively support or compete against each other.
Everybody, more or less, remains contained in a number of “health silos” at great expense.

Public sector health services are provided by all levels of government: local, state, territory and the Australian Government.
Private sector health service providers include private hospitals, medical practices and pharmacies.

Although public hospitals are funded by the state, territory and Australian governments, they are managed by state and territory governments.
Private hospitals are owned and operated by the private sector.
The Australian Government and state and territory governments fund and deliver a range of other health services, including population health programs, community health services, health and medical research, Aboriginal and Torres Strait Islander health services, mental health services, and health infrastructure.

Navigating your way through the Australian health system has become difficult and expensive.
With increased technologies it is becoming possible to provide services cheaper and with less restraint e.g. biometric tests for common markers delivered by pharmacists.
Health knowledge is also increasing at an exponential rate and it is impossible and impractical to agree to the proposal that one health profession should dominate leadership roles within Primary Health Care.
Pharmacists can be at the forefront of this new revolution in Primary Health Care, but it requires the leadership bodies of Australian pharmacy to think “out of the square” and begin to more aggressively claim new roles for pharmacists and ensure these roles are distributed equitably.
There is some evidence that the process has begun, but it is not moving with sufficient momentum to stimulate investment, conserve pharmacy remuneration and pharmacist jobs.
Also, every pharmacist should have the right and ability to practice their professional specialty without political hindrance – either from within the profession or without.

Opportunity is occurring daily that delivers technology for pharmacists to perform their existing work in an enhanced fashion (3D printing), or a clinical service in an enhanced format (say, Home Medicines Review).
These new opportunities can be developed collaboratively with other health professionals, or in competition with them.
Nurses already have a head start in pharmacy clinics. Where is the basic education program to update pharmacists?

This type of “fresh air” has long been needed for health professions that have built themselves into a professional corner, becoming vulnerable to disruptive technologies.

It’s now “get on with it – or die of asphyxiation”.


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