Primary health care the way to go

ZIMBABWE needs to take bold steps to accelerate the re-engineering of its healthcare sector to promote primary health care systems that improve the health status of its population and reduce health inequalities, a renowned family medicine expert has said.

Professor James Thompson, a researcher and family physician at the University of Washington (UW), recently told a public lecture at the Institute of Continuing Health Education (ICHE) of the University of Zimbabwe College of Health Sciences that community oriented primary health care is the way to go now to help deal with the health needs of the people.

“Zimbabwe has done a lot to improve primary health care and the country now needs to do more research, particularly now when there is a rise in non-communicable diseases such as hypertension, diabetes and cancer,” he said.

“The traditional legacy of curative and hospital-centric approach to health care is simply unsustainable. We can’t build hospitals and clinics everywhere and so we need to promote the primary health care approach which is cheaper, effective and readily accessible.”

Prof Thompson delivered a lecture titled “Why Primary Care Research is Essential for Population Health” to an enthusiastic audience made up of medical students and health professionals.

Health experts say the primary health care system is based on, among others, disease prevention, promotion of healthy lifestyles and the establishment of a system whereby health care workers work closely with communities, mapping areas, understanding the culture, beliefs and habits of the community, socio-economic status as well as prevalent health conditions.

“There are very few professionals who are specialising on primary health care and we need to build our research capacity and grow enthusiasm in this particular approach that helps meet the health needs of the community,” said the UW professor.

“It’s so cost effective. We need to manage horizontally and not vertically when it comes to the care of the patients. Approaches applied in dealing with the HIV and AIDS pandemic can be applied to all other chronic diseases. This needs to be replicated.”

Primary health care has now been acknowledged internationally as an important approach when it comes to dealing with the health needs of the community.

Zimbabwe has since incorporated this in its health strategy which was adopted in recent years.

Prof Chiratidzo Ndhlovu, UZ nephrologist (kidney expert) and deputy dean of ICHE said Zimbabwe needs to take practical steps to promote the primary health care approach.

“Prof Thompson is reminding us to go back to basics. Most of the people we need to take care of are not in hospitals. We don’t have enough doctors and nurses and so we need to adopt this approach and go beyond the curative and hospital-centric approach to health care.”

She expressed concern that many health care workers and health care users in Zimbabwe have been socialised in this approach (curative and hospital-centric).

“The primary health care approach is important to understand the health needs of the community and what treatment works for them,” Prof Ndhlovu said.

“Research has to be done in communities and not in hospitals. Zimbabwe needs to grow its own research infrastructure, promote the role of nurses working in communities and put the community at the centre of all efforts to deal with problems related to NCDs.

“Managing these conditions has to be done at home. There will never be enough hospitals. Medical doctors, nurses and communities need to work closely to deal with such conditions.”

Health experts say the key feature of primary health care reform is a shift to teams of providers who are accountable for providing comprehensive services to their clients.

It is said there is a growing consensus that family physicians, nurses, and other professionals working as partners will result in better health, improved access to services, more efficient use of resources and better satisfaction for both patients and providers.

Such teams are well positioned to focus on health promotion and improving the management of chronic disease.

This team approach, along with telephone advice lines, facilitates access to primary health care services after-hours, reducing the need for costly emergency room visits, pro-primary health care experts argue.

Prof Thompson said prioritising the re-engineering of the health care sector into one driven by community needs will help accelerate equity in service delivery towards universal access to health care.

This, he said, is in line with the Zimbabwe National Health Strategy.

Most health experts say primary health care will help keep people healthy for as long as possible through health promotion and disease prevention.

The World Health Organisation advocates incorporating safe and effective approaches into primary health-care systems.

In 2002, the organisation issued its first comprehensive guidelines to help countries, such as Zimbabwe, develop policies to regulate traditional medicine.

The primary health care approach aims to deliver a more personalised primary health care system that provides services closer to home and makes communities healthier.

Primary health care is widely seen as having a part to play in helping reduce acute demand pressure on hospitals by better managing chronic conditions and proactively supporting high need populations.

Said a participant at the lecture: “People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs.

“Needs are rarely met. Few would disagree that health systems need to respond better and faster to the challenges of a changing world. Primary health care can be an important tool to do that.”

Prof Thompson summed it aptly in his patient care philosophy: “I like to work with patients who take an active role in their healthcare and with families as I believe that being able to look after the whole family is vital to healthcare. I like to bring a common sense approach to the increasingly confusing healthcare world that we face.” — Zimpapers Syndication