SHARE

What Is Primary Health Care?

WHO defines Health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." According to this definition, healthiness does not merely mean "a state of not being sick." If healthiness means more than not being sick, what other factors affect human health?
Health disorders are often a cumulation of multiple different factors, and are not solely associated with a physical ailment. Being "healthy" has much to do with a persons standard of living and way of life, and is affected by food, water, shelter and family alongside physical medical care. Simply diagnosing somebody with an illness does not pinpoint the underlying factors which may have caused, or continue to prolong, a persons symptoms. "Health" is a state which can only be achieved by tackling multiple facets of a persons life, and even more broadly the country in which he or she is living. Without examing each of these aspects--including agriculture, education, communication, infastructure, and cultural and political barriers--pure "health" is difficult to achieve. Bettering these factors contributes to both mental and physical wellbeing, promoting a healthier and more peaceful society.

Definition:

Primary Health Care (PHC) is a set of principles, based on the Alma Ata Declaration made in the Soviet capital of Kazakhstan in 1978, which classify health as a basic human right. Using these principles, PHC has been molded into an approach to improve the health of people in less developed countries with the help of both local and professional volunteers. The principles of PHC regard individual self-determination as a key concept in achieving universal health, and call for local participation in the process of improving the health of each community.
According to the Alma Ata Decralation, PHC is "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 the country can afford to maintain at every stage of their development in the spirit of self-determination...It is the first level of contact of indivicuals, the family and community with the national health system, bringing health care as close as possible to where people live and work, and continues the first element of a continuing health care process".　
(http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf )

Principles of PHC:

The following are the 5 essential principles of PHC: (1) Address peoples' needs, (2) Utilize local resources, (3) Ensure local and outside participation, (4) Involve all related sectors such as agriculture, education, communication and infrastructure, (5) Promote new technology ((5) is often included in (2)).

Issues that are tackled by the PHC approach:

(1)Health education, (2) Nutrition and diet, (3) Hygeine and sanitation (including clean drinking water), (4) The health of mothers and children (including family planning), (5) Immunization for infectious diseases, (6) Control of endemic diseases, (7) Primary treatment for diseases and injuries, and (8) Supplying essential drugs.
After the Alma Ata Declaration, several other issues including reproductive health, mental and physical disabilities, dental hygeine, substance abuse, HIV/AIDS, and accident prevention have been added to this list.

Philosophy behind PHC:

The concept of PHC is a culmination of research conducted in several different fields of study. It was developed with the input of a wide variety of experiences and thoughts regarding the current world health situation, and has become what it is today only through the collaboration of may different fields as to how to mitigate this situation. There are at least five core ideas and practices that shaped the concept of PHC. These include theories in development studies, experiences in developing countries, establishment and dissemination of ideas regarding human rights, influence from movements which support the independence and community based rehabilitation (CBR) of the mentally and physically disabled, and the development of participatory theories in education.
According to the late Dr. Muro, PHC can be described as stemming from second generation theories of development studies such as "Alternative Development" and "Basic Human Needs (BHNs)," which were influential in the late 1960s and 1970s. The concept of PHC was also developed by studying the problems in 9 developing countires--including Cuba, China, Tanzania, and India--in the 1960s and early 1970s. One of the first places to use the PHC approach was the Saku Hospital in Japan, which adopted this approach after World War II. PHC also owes its foundation to the universal dissemination of respect for human rights. The strong emphasis on the need for human rights and bioethics was first expressed in the International Declaration of Human Rights in 1948, and again in the Covenant on Economic, Social and Cultural Rights and the Covenant on Civil and Political Rights, which were both UN treaties adopted in 1966. In addition, the eye-opening books 中西正司・上野千鶴子著｢当事者主権｣（岩波新書）and 中西由紀子・久野研二著｢障害者の社会開発｣（明石書店）describe how support groups for the mentally and physically disabled were empowered by the concept of PHC, and conversely how PHC was influenced by these movements. Lastly, educational philosopher Paulo Freire, founder of Participatory Rural Appraisal (PRA) Robert Chambers, and author David Warner shaped PHC's method of education, which encourages local participation in improving health issues.

PHC in the 21st Century

David Warner describes the philosophy of PHC most simply and eloquently in the phrase "nothing about us without us," which is also the title of his book. Alternatively, it can be summed up in the word "prosumer (producer-consumer)," which A. Toffler used in his book "The Third Wave" published in 1980. I believe that the 21st century is certainly a time to think of those who have been discriminated against--the elderly, the disabled, refugees, people living with HIV/AIDS, people living in developing countries, foreigners, and the homeless. I hope that PHC leads to the empowerment and independence of those who are in difficult circumstances, so they are able to live healthily and peacefully into the future.

-