The origins of primary health care and selective primary health care

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.     

The role of health promotion in primary health care

A major transformation has been occurring in primary healthcare during the past 20 years. These changes are reviewed brieflyfor the benefit of those who do not work in the front-line ofcare and for those who have not had the opportunity to experiencethe changes. Two major components of the transformation arestressed:

1. the shift towards person (patient) centred methods;
2. a broadframework of reference which encourages horizontal integrationof skills in the nonspecialised way.

The opportunities for health promotion in primary health careare legion and evidence from worldwide experimental sourcesis reviewed to show how different levels of achievement canbe demonstrated and monitored. Responsibility, empowerment and participation were firmly declaredprinciples in the WHO Alma Ata Declaration on primary healthcare. The practical realisation of such principles in the fieldis occurring at an increasing rate, but their continuation willdepend on the further growth and development of appropriatecommunity-centred skills and practices. Evidence for the power of a "social sieve" to moderate professionalor official health recommendations is also discussed in thelight of current research. If recent research data is upheld,the relationship between primary health care personnel and thesocial network around them is likely to be shown to make a criticaldifference to health outcomes.     

The role of health promotion in primary health care.

A major transformation has been occurring in primary health care during the past 20 years. The changes are reviewed briefly for the benefit of those who do not work in the front-line of care and for those who have not had the opportunity to experience the changes. Two major components of the transformation are stressed: (i) the shift towards person (patient) centred methods; (ii) a broad framework of reference which encourages horizontal integration of skills in the nonspecialized way. The opportunities for health promotion in primary health care are legion and evidence from worldwide experimental sources is reviewed to show how different levels of achievement can be demonstrated and monitored. Responsibility, empowerment and participation were firmly declared principles in the WHO Alma Ata Declaration on primary health care. The practical realisation of such principles in the field is occurring at an increasing rate, but their continuation will depend on the further growth and development of appropriate community-centred skills and practices. Evidence for the power of a "social sieve" to moderate professional or official health recommendations is also discussed in the light of current research. If recent research data is upheld, the relationship between primary health care personnel and the social network around them is likely to be shown to make a critical difference to health outcomes.     

The public health nurse--the linchpin of primary health care

Finland is an example of a country in which primary health care has been put successfully into practice. This could not have been done without the help of public health nurses. At a time when socioeconomic and health status was low, a simple and effective public health nursing service was created to bring primary care to people in their homes and neighbourhoods.     

The perceptions of occupational health in primary care

AIM: A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care. METHODS: Qualitative data were collected using focus groups with three groups of primary care sector professionals. Quantitative data were collected nationally from 295 GPs using a postal questionnaire. RESULTS: GPs and PNs had minimal OH training, and 60% of GPs reported constraints in addressing OH matters with patients. The lack of referral routes (63 and 67%, respectively) was also seen as a barrier. OH was regarded as a speciality, and primary care professionals preferred to refer patients with OH problems to specialist centres because they perceived barriers to their dealing with the issues. A total of 74% of GPs surveyed thought that speedier access to secondary care would help them to address OH problems. CONCLUSIONS: This study has identified some of the problems associated with delivering OH through primary care. It also demonstrated a need for greater emphasis on OH education in medical and nurse training, and a need for better advice for GPs, PNs and PMs regarding support services for OH.     

Ethnic health workers in primary health care

Abstract: Ethnic health workers were employed to increase the access of communities of non-English-speaking background to health services, but their role has remained unclear in a national health system that has been criticised for being slow to respond to the needs of these communities. Interviews and a questionnaire were used to survey a convenience sample of 40 South Australian ethnic health, welfare and community workers and 17 supervisors about the important roles of ethnic health workers, how they should perform their roles and their ability to fulfil them. Interviews with 11 staff from the New South Wales Ethnic Health Worker Program then provided a broader perspective to the South Australian findings. High-priority roles were to provide help to solve immediate health problems. Roles included providing access as well as services. There were pressures on ethnic health workers to become service providers: clients from non-English-speaking backgrounds expected assistance with a wide range of problems, and mainstream staff lacked competence in meeting these needs. Ethnic health workers' involvement in needs assessment and health agency change was limited by these pressures, by ethnic health workers' separation from the work of mainstream staff and because systematic planning of services to non-English-speaking communities was lacking. The appropriate role for an ethnic health worker is as an access provider, with a greater emphasis on needs assessment and agency change. Agencies need to develop culturally appropriate service plans and training so that ethnic health workers and mainstream staff are better able to work together.     

Information in primary health care

The results of two recently completed studies, one in the Trent Region and the other in the Anglia and Oxford Region, of the information-related behaviour of general medical practitioners (GPs) and of information activities within the general practices illustrating the information seeking behaviour of GPs, their generation of information, and communication within, to and from the practice. GPs stated that there is a need for more information to enable practices to function within the changing NHS environment. The increasing emphasis on evidence-based medicine also creates the need for appropriate information sources. The Trent study resulted in guidelines for best information practice, especially the need for each practice to have an information strategy. The Anglia and Oxford Study examined the role which the library and information services could play in supporting primary health care.     

Phytotherapy in primary health care

OBJECTIVE

To characterize the integration of phytotherapy in primary health care in Brazil.

METHODS

Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed.

RESULTS

Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions.

CONCLUSIONS

Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population.     

The straw men of primary health care

The following paper discusses the progress made in providing primary health care (PHC) to the developing world in the 10 years following the joint WHO/UNICEF International Conference on Primary Health Care held at Alma Ata, U.S.S.R., in 1978. UNICEF is now 12 years from the goal to provide Health for All by the Year 2000. In this context, the authors describe UNICEF's 'country programming approach' to PHC as part of the child survival and development revolution (CSDR), articulated by the agency in 1982. A polarization between the two concepts of 'selective' and 'comprehensive' PHC is examined in the light of quotations from the original conference document which set forth strategies and priorities. The authors, a consultant and a staff member of UNICEF, respond to criticism of the agency in this regard by drawing directly on UNICEF's own work in the field and its record of success, even at a time when developing countries are battling severe economic constraints and health budgets are being slashed--a contingency not foreseen at Alma Ata. WHO evaluations of both the Expanded Program on Immunization (EPI) and oral rehydration therapy (ORT) show that accelerated programs develop best when underpinned by a good health infrastructure. The challenge is to develop priority programs in such a way as to build on or strengthen this infrastructure. Flexibility is the key in adapting national priorities to local programs. The point is made that international agencies should be careful to limit themselves to advocacy and support.(ABSTRACT TRUNCATED AT 250 WORDS)     

The evolution of selective primary health care

This paper traces the evolution of the selective primary health care (SPHC) concept, from its presentation at a meeting in Bellagio, Italy, and its subsequent publication in the New England Journal of Medicine in 1979. It reviews the early debate between those in favor of selectivity and those in favor of comprehensive primary health care (CPHC). While this debate was going on, a breakthrough in terms of implementation came with UNICEF's launching of its Children's Revolution in 1982/83, promoting four specific 'social and scientific advances' for improving the health and nutrition of the world's children. They were growth monitoring, oral rehydration therapy, breastfeeding and immunization. Meanwhile the interest of a number of people for achieving 'Health For All' by targeting for action an essential short list of diseases was the impetus for another conference in 1985, Good Health at Low Cost. Through analysis of the achievements of four societies (Cost Rica, China, Kerala and Sri Lanka) efforts were made to define further a prioritized health development strategy, and a number of measures were identified as helping countries achieve good health. While some have argued that SPCH and CPHC are irreconcilable and diametrically opposed, this paper suggests that both SPCH and CPHC are both acceptable. Technology has its place. The field of view of SPHC has enlarged drastically, from individual diseases to the role of other sectors such as education and agriculture. The concept of SPHC has broadened to accept Rifkin's and Walt's assertion that "developmental processes need further exploration and research strengthening capabilities within countries".(ABSTRACT TRUNCATED AT 250 WORDS)     

Nursing work in primary health care -- family health care

This article is part of an integrated research project called The Organization of Primary Health Care (a perspective for nursing practice). Its objective is to investigate the perception of nursing personnel concerning their practice in family-centered primary health care. This article presents a case study focuses on nursing personnel workers from the Family Health Program (PSF), in the city of Batatais. Data collection was done through semi-structured interviews with those professionals. Thematic analysis of the data was realized in which initial categorization was done with the help of the Ethnograph software. The topics identified in the workers' narratives were: comprehensiveness, health care, bonding and active case-frading. These themes suggested that the work in family-centered care is difficult, therefore it leads to a more comprehensive health care practice in which decision-making is shared with clientele.