The delivery of primary health care; are we getting it wrong?

Last week the Prime Minister mentioned that clinics should remain opened up to 4 p.m. This renewed call came about because of the absence of a health care provider in the village of South Rivers, a rural farming village of low socio-economic status.

The Prime Minister’s words were not only directed to that health district, but to the entire country, sending a message that health care services should be available when needed, even in remote areas. He highlighted the importance of the presence of a health care provider at all times in communities, especially those that may be more disadvantaged.

His call is an indication or a hint that there is an urgent need for primary health care in St Vincent and the Grenadines to be looked at. Primary health care is the foundation on which the overall health system of any country is built. In fact, primary health care is very important and critical in the delivery of health care, so that if it is non-functional, all other areas of health sector will suffer.

Primary health care focuses on promotion of health and prevention of diseases. There is little diagnostics and treatment at that level. It is at this level that cost effective interventions are carried out in order to promote better health for the population.

Primary health care focuses on interventions, such as vaccination, health screening, counselling, health education and health promotion.

When Minister Browne took office over a year ago, he pledged his support to reorient primary health care, so that effective, efficient and equitable health care can reach everyone in the country. Minister Browne must be applauded, because we cannot improve the delivery of health care unless primary health care is strengthened.

Before we focus on diagnostics and treatment, we must focus on keeping our people healthy and teach them how to prevent diseases. Primary health care is built on the old saying that “prevention is better than cure”. It is at this level that all the preventative measures must be taken so that people do not get sick and require expensive treatment.

In St Vincent and the Grenadines there is a network of clinics that is ideal for the arrangement of community health services. Almost all major villages have a clinic. However, health care extends beyond just the physical structure. In order for us to have a good primary health care system, there must be a shift from diagnostic and curative services at that level and the focus must be on promotion of health and prevention of diseases. There is the need for more community nursing and for community physicians. Too often the district doctor who has to attend to five or six clinics does not know the villages that he is in charge of, because the only time he visits is the one day that he has clinic in that village.

Primary health care involves understanding your community, interacting with your community and knowing what are the determinants of health in that community. It involves understanding the health problems faced by the communities, so that effective health promotion measures can be taken.

If we are to fix the problems in primary health care, we must invest in human resources for health and have more doctors and nurses who are more involved with the communities. There must be community health aides who will attend to the elderly and the delinquent in the communities. The community health aide must serve as the health police, to ensure that everyone is in check and nothing goes unattended in the community.

Health promotion activities at the level of the communities must be strengthened. There is the need for community intervention and community participation. Focus groups, community groups normally serve as ways of reaching communities and educating them. By educating the communities, we are able to empower them so that they take charge of their own health.

The focus of primary health care should be on understanding and interacting with the community. Great emphasis must be placed on wellness. It must not be on just treating the hypertensive patient with pills, but understanding why he/she is hypertensive and work with his/her family to support him/her.

In conclusion, in order for us to reorganize, reorient, restructure – whatever we want to call it, there is the need for good management and leadership at the primary health care level. There is the need for expanding human resources, for stronger health promotion and education at that level and an urgent need for a shift from diagnostics and treatment to health promotion and wellness.

Dr Rosmond Adams is a medical doctor and a public health specialist. He may be emailed at: adamsrosmond@gmail.com