We were grateful for the recent opportunity extended to civil society organisations to comment on the Astana Draft Declaration on Primary Health Care (PHC). PHC refers to the provision of equitable, accessible, and appropriate care for all people in their community. PHC plays a key role in providing community-based, culture-sensitive diagnosis and treatment of a wide range of ailments, including acute conditions demanding immediate attention and long-term illnesses that require consistent care and follow-up.
In our response to the Draft Declaration, submitted on July 21, 2018, we noted the following—
- Due to the perpetuation of inconsistencies in health program implementation and lack of recognition in some parts of the community of certain components of health—including mental health—we would encourage the WHO to begin this declaration by defining health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” With this definition in mind we also encourage the WHO to acknowledge the role that primary health care has in engaging with a range of non-medical issues, from family violence to housing and homelessness. This reflects that many of the risk factors for illness are determined by “economic, social, gender, political, behavioural, and environmental” factors.
- We acknowledge the WHO’s commitment to the “people-first” nature of this declaration, but we believe it is important to encourage a bigger role for communities. The Alma-Ata Declaration gave a prominent role to primary health care that was located in people’s communities. Thus, we encourage the WHO to recommit to primary health care that is community-based and able to respond to local needs and contexts. While the challenges of fragmented services at the community and national levels should be acknowledged, the potential of technology to address these challenges should also be explored.
- The role that technology can play in providing Universal Health Coverage (UHC) has been acknowledged by the WHO and other international organisations. This same enthusiasm should be applied to technology and PHC. Technology can be used to make health care not only more efficient, but also more accessible and equitable—key tenets of primary health care.
- To this effect, we encourage the WHO to consider highlighting the role of health services co-design and co-produce in this declaration, which reflects a move towards greater citizen participation in service design and delivery. For primary health care to best respond to local needs, local people should be involved in the design and delivery of services. This should also include a diverse range of people (age, gender, sexuality, cultural background) with a lived experience, such as people with a lived experience of mental illness. There is growing evidence for the role co-design/production as a way to facilitate participatory health care, and improve the experience and appropriateness of care.
- The importance of PHC to addressing the global burden of non-communicable diseases (NCDs) cannot be understated. It is well recognised that NCDs account for a large proportion of the preventable burden of disease—they are responsible for 70% of of deaths worldwide. Long-term care, screenings of individuals at risk of NCDs, and preventative approaches within local communities play integral roles in both PHC and the monitoring and treatment of NCDs. With access to specialist care remaining elusive in the universal health coverage dialogue, ensuring universal PHC remains the most equitable and practical way to diagnose and treat NCDs.
- Youth voices must be heard in the PHC discussion. The “adolescent” years of life between 15 and 24 tend to be seen as years of health, opportunity, and wellbeing. For many young people, however, the transition from childhood to adolescence brings increased risks of disability and death—which are, in many cases, preventable.2 These risks include an increased chance of smoking and alcohol consumption, overweight and obesity, physical inactivity and poor diet, while mental illness, injuries and sexual health issues also become greater concerns in the adolescent years. More attention must be paid to young people’s health, and the potential that these years have for setting people up for a healthy and happy future.PHC has a key role to play in young people’s health—it enables policymakers and health workers alike to engage with factors and determinants beyond the health system and the clinical needs of individuals. Many of the determinants of young people’s health are found in the social and economic structures of societies, such as education, employment, and the built environment.
- Barriers to young people’s engagement with PHC services—including lack of availability, accessibility, acceptability and equity—must be addressed. Ensuring confidentiality and autonomy is also of particular importance for youth when accessing PHC services for sensitive issues.4 We must be explicit in demanding an equitable PHC system that provides critical care for youth without judgment.
Written by Timothy Kariotis and Elyse Franko-Filipasic.