PRIMARY HEALTH CARE SHOULD BE THE FOCUS OF ANY NATIONAL HEALTH SYSTEM. HERE IS WHY.

Author: Alexandre da Silva Santos

NMO: IFMSA Brazil

Section: Article themed “The paper of the primary health care in achieving a universal health cover”

E-mail: [email protected]

It is well known that the primary health care has a unique role in any health system worldwide, due to its possibility of resolving up to 80% of the health demand with little to no complex technology in its practice. With that said, primary health care is crucial to achieving true universality and equity in health access, as various studies show that it links the base of any health system to more complex medical care and procedures as approximately 80% of patients return from those complex steps of the health system to the base for follow up consults or other problems that the patients may encounter. (1)

But taking it back a while, how did primary care come into existence? During the final decades of the Cold War (the late 1960s and early 1970s) the US was embroiled in a crisis of its own world hegemony—it was in this political context that the concept of primary health care emerged. Another important influence for primary health care came from the experience of missionaries. The Christian Medical Commission, a specialized organization of the World Council of Churches and the Lutheran World Federation, was created in the late 1960s by medical missionaries working in developing countries. The new organization emphasized the training of village workers at the grassroots level, equipped with essential drugs and simple methods.(2)

Furthermore, in 1978 in Alma-Ata, one of the most important declarations about primary health care was made. In its seventh paragraph it shows how a true universal health system is, taking into consideration the characteristics of the country and its population, and acknowledging the sociocultural aspects of each territory when listing resource priority. Also, the primary health care has to be integrated to the rest of the health care chain, not limiting the patient to basic services. (3)

Providing primary care is cost-effective as it is cheaper overall to build multiple units focused on primary care than to spend the money on building state of the art hospitals with the latest technology of medical care. (4) But does that mean that only poor countries should have a primary care focused health system? Not quite. Taking the NHS in consideration, it is capable to reach 80% of the United Kingdom women for cervical smear tests, and in every comparison made with other health care systems, it is noticeable that the lower cost of care is due to primary care. (5,6)

Beyond that, today’s concept of health by the World Health Organization states that it is not only the absence of sickness, it is the complete state of physical, social and mental well-being, putting aside the idea that we only address biological matters. Every problem is worthy of attention, and everything that a person thinks might be an issue has to be addressed. The primary care is the perfect place to go beyond only “biological care”, due to the proximity between the health professional and the patient. Not only that, it also makes it easier to formulate a differential diagnosis of any condition when you have years of detailed medical history catalogued and all of it made by the same person or team. (3) 

At last, the health system must be focused towards its population, due to the particularity of each territory that a health network is inserted to, and the primary care is the only way to do that. As mentioned above, the ability to personalize care to each individual population and create guidelines and algorithms to each unit of health network is the key to lowering wait times, getting more patients tested for key conditions, and therefore, reducing mortality and improving the quality of life of patients, which is what medicine is all about.

References:

1. Starfield, B. Atenção primária: equilíbrio entre necessidades de saúde, serviços e tecnologia. Brasília, DF: Unesco. 2002.
2. Cueto, M. The origins of primary health care and selective primary health care. American journal of public health, 94(11), 1864-1874. 2004
3. World Health Organization. Declaration of Alma-Ata, 1978. 2002.
4. Merhy, E.E. A perda da dimensão cuidadora na produção da saúde: uma discussão do modelo assistencial e da intervenção no seu modo de trabalhar a assistência. Sistema Único de Saúde em Belo Horizonte: reescrevendo o público. São Paulo: Xamã, 103-20. 1998.
5. Wilson, T., Roland, M., Ham, C. The contribution of general practice and the general practitioner to NHS patients. Journal of the Royal Society of Medicine, 99(1), 24-28.

Gusso, G., Lopes, J.M.C. Tratado de Medicina de Família e Comunidade: Princípios, Formação e Prática. Artes Medicas. 2018