Principles Of Primary Healthcare

Primate healthcare can be defined as the aspect of healthcare system of every nation that operates mainly within community actins as the first point of call for a patient. The primary care services should be developed in ways by which the healthcare professionals can ensure five important facets of quality healthcare practices. The services should be promotive, preventive, rehabilative, curative as well as supportive (Das et al., 2016). While developing each form of care, professionals need to ensure that their focus prevails on prevention of ailments and promotion of health. This form of care approach needs to be such that it should cater the needs for the different of client groups from professionals. Hence, the foundations principles of the primary healthcare services ensure greater accessibility, effective public participation, health education and health promotion programs as well as appropriate technology and inter-sectoral cooperation. However, a large number of nations have not yet been able to develop a proper primary healthcare structure that had impacted the care service delivery for the people of the nation (Lund et al., 2016). In most of the developing countries, social equity and social justice still prevail to be the most concerning situations in the healthcare services. These evidently results in poor accessibility of the patients towards their appropriate healthcare services as well as inequity. The healthcare systems of two nation that would be compared here would be Australia and India.

The backbone of the economy’s development and growth is provision of the primary healthcare services. The primary healthcare is seen to include the day-to-day care needed for the prevention as well as maintenance and curing any health issues. India had been one of the first nations in identifying the merits of the primary healthcare approaches. This system was recognized in India in 1946 by the Bhor-e- committee. India had already tried to adopt the model for primary healthcare following the main reason that poverty should not be the sole reason for inaccessibility of the healthcare services (Patel et al., 2017). Although, the primary healthcare services in India is still constantly improving , it cannot be denied that huge number of challenges are still faced by people of India which are inaccessibility and inequity of healthcare services. Comparison Of Primary Healthcare Services In India And Australia Discussion Paper

In India, primary healthcare centers are mainly state owned rural healthcare facilities and are essentially single physician dispensaries. They mainly from the part of the government funded public healthcare systems in the nation and act as the most basic units of this system.  One interesting aspect is presently in India, there are 28,868 primary healthcare centers when the total population of India 1.30 billion all over the nation. This data can very well show gives us an estimate that around 35000 people to that of one primary healthcare center. This can very well show the lack of availability of primary healthcare services in every community where patients need to travel huge distances to reach to a center (Shidaye et al., 2016). Non-availability of primary healthcare centers is not only the main reason for the inaccessibility of the Indians towards primary healthcare services. It has even been found that that the healthcare investments done by the nation on developing primary healthcare services is not enough to cater the needs of such huge people. Lack of manpower and lack of allocation of resources result in huge waiting times of patients where many patients even cannot be sure to get an appointment even after waiting for long hours. These are mainly common in rural and sub-urban regions where social justice and health inequities come to play a major role.

Primary Healthcare In India

The Australian government had been able to recognize the significance of primary healthcare services and have tried to ensure that inaccessibility does not become the barriers to attaining quality healthcare services. A number of important statistics will help in enlightening the accessibility rate of the Australians towards the primary healthcare services. They have ensured universally accepted care services regardless of the health of the individuals, their socio-economic conditions and similar others (Patel et al., 2015). Still, there have been reports that there is inequality in the spread of the primary healthcare services in the nation of Australia as well. Unlike India. the number of primary healthcare services are nearly sufficient for meeting the needs of the people and are seen to be increasing more in number under the encouragements of the healthcare department if the nation. However, the accessibility of the people towards the healthcare services are found to be not sufficient. Data by Australian Institute of Health and Welfare had stated that in some of the metropolitan areas, healthier individuals were seen to use higher than average GO services and in some of the regions, less healthy populations were seen to have lower than average of GP services. This can be well attributed to the fact that availability of the services might be higher in number but are not equally distributed that might result in inaccessibility of healthcare services in Australia as well (Srivastava et al., 2015). Herein, lies the differences between India and /Australia about the cause of inaccessibility of services. Where the previous nation had limited number of PHCs, the latter had higher numbers of PHCs but unequally distributed centers.

Three major forms of inequities are found to be responsible for the improper service delivery of the primary healthcare services in the nation. These are the historical inequities, socio-economic inequities as well as inequities in the provision and access to health care services.  Researchers are of the opinion among the various types of factors that influence health, the three components of availability, accessibility as well as affordability of health services are some of the determinants of population health. India is still suffering from the historical inequities which have its roots in the policies as well as practices in the British colonial India and many of them were still followed even after Indian independence. Another is the socio-economic inequities which are still found to manifest the caste, creed and gender differentials in the nation (Salvi et al., 2015). Another form of inequity experienced by the healthcare system of India is the inequity in the utilization, availability as well as affordability of the different healthcare services. These forms of inequities make it very difficult for the patients to India to access the healthcare services in the nation.

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Challenges Faced By Primary Healthcare In India

Healthcare investment in India is not sufficient and this is evident in the following scenarios observed in the nation of India. India has a large network of the primary healthcare centers and each of them are supposed to handle for about a population of 25000 people. However, it has been observed that in reality each center is caring for 35000 people in the nation with highly restricted infrastructure and manpower in each resulting in overcrowding and many people returning back not even getting the scope of treatment. In many of the poor states like that of Madhya Pradesh, Jharkhand and Bihar, each of the PHC is seen to be serving 45000, 76000 and even 49000 (Agarwal et al., 2018). This can inevitably show that PHC when allocated to serve 25000 people but serving to average 50000 with same quantity of resource and manpower, the service provided would never be of quality. In the state of Rajasthan, population is found to be quite dispersed mainly in the hilly regions in the south as well as in the desert in the west. Here, different of the families are found to travel for about 20 to 40 kilometers to reach their nearest PHC. Along with this fact, the rural transports system is quite poor. When persons get sick is remote distant villages, they may have to wait for many days as well as hours for reaching a facility. Even after a patient is seen to reach the primary healthcare centers, many of them are seen to be without doctors. Recent studies have stated that there are about 9000 doctors in about 25000 PHCs in the nation of India, and about 2000 of the PHCs do not have any doctors at all.  Even many of the centers have seen to have one doctor only who works around the clock throughout the 365 days. Most of the vacancies have been found to be in the rural and tribal areas of the nation and other disadvantaged areas of the nation (Reddy, 2015). Half of the primary healthcare centers even do not employ nursing professionals as well. Management of the PHCs as well as the curative and preventive care are highly dependent on nurses and physicians, the absence of such healthcare professionals mean that most of the PHCs are ill managed a swell as ill-equipped for providing quality care.

However, unlike India, Australia had been able to successfully overcome the barriers of financial constraints in healthcare expenditures to make primary healthcare services more accessible and equitable (Powell et al., 2017). Commonwealth governmental Funding for the general practice services are currently seen to be standing about 8% of the total government health expenditure. Researchers are of the opinion that this value represents one of the modest investments which is helping in delivering of excellent outcomes for most of the patients. Commonwealth is the dominant funder of this primary healthcare services, patients are also seen to make around 6.5 per cent of the total global practice costs (Duckett & Willcox, 2015). Funding for the general practices in Australia is based on the blended model of funding although it predominates model if fee-for-service model. It has been found to work effectively for majority of the patients, providing autonomy and choice as well as access to care on the clinical need. Although the level of inaccessibility and inequity experienced by the patients in the nation is not like that of the high level like that of the Indians but still some cases have been reported. Some of the population groups in the nation of Australia had experienced marked inequities in health as compared to that of the general population. These groups are the indigenous Australians, as well as the people living in the remote areas, people with low socioeconomic status as well as people with disabilities. However, the government had undertaken extensive strategies, policies and health promotion projects that included establishment of new centers and allocation of resources that would help in overcoming the situations.

Primary Healthcare In Australia

Nursing professionals comprise of one of the largest manpower of the primary healthcare centers. In the nation of Australia, nurses have many important duties to fulfill that include health education, health promotion, advocating for disadvantaged people and participating in policy development besides introducing curative measures and developing care plans for people over the nation. As a result of this, nurses in Australia had been able to understand the impact of inequity and inaccessibility faced by certain people in the nation and accordingly they are seen to advocate the issues to higher governmental sectors for strategy development (Wakerman et al., 2017). They are given the authority by the health industry to take their decisions regarding the betterment of health of people and even caring for them and meeting their needs. However, in the nation of the India, nurses are only given the position of supportive aids. They are not given the power to develop care plans for patients as well as to advocate for the needs of the people to higher authorities. Moreover, as nurses work in close association with patients, they are the best representatives of the issues of people towards policy development. In Australia, such power is already allocated to burses. But in India, such systems are not present. Therefore, the policies that are developed by the policy makers are found to half-hearted and fail miserably in meeting their targets and motives (Cunningham et al., 2016). Most of the health promotion programs developed by India had failed either due to lack of funds or due to failure of them to meet the goals or because of their slower intensity. Until, India allocates more nurses like that of Australia and gives them more scope to practice their expertise and skills for helping people like that of Australia, such issues would never be resolved.

Another cause of poor inequity and inaccessibility of Indians is due to poor cultural competence as well as person-centered care towards citizens. Australian nurses are trained with greater cultural competency where they need to treat all people from various cultures, background, ethnicity and classes with same affection and dedication and never to discriminate between them (Wills et al., 2016). They are taught about the approach of person-centered care where people irrespective of their class and background are ensured social justice and made centers of decision-making regarding their care and meeting their dignity and autonomy. Hence, patients in Australia find the services to be more accessible ensuring equity. However, in the nation of India, nurses are not culturally competent (Osborn et al., 2015). Cultural biasness of the nurses about the untouchables, poorer castes discriminations, improper behaviors for the “dalits” and others had been reported often make the patients prevent themselves from visiting services making the services inaccessible. Lack of equity is also noticed in the care services allocated from the poor people.

Issues Of Inaccessibility And Inequity In Primary Healthcare In Australia

It has been found that in the nation of India, the urban regions are full of privately owned primary healthcare services where there are advanced healthcare technologies and services that are provided by nurses and doctors. The services are quite costly and can be afforded by upper middle class people and the people belonging to higher socio-economic status. The poorer sections of the society do not get access to such advanced healthcare services and technologies due to high cost care (Schadewaldt et al., 2016). This is completely against the healthcare equity principles. Such is not the case in the Australian healthcare system. The government had tried its best to maintain equity by allowing equal high quality and safe care to all people of the society irrespective of their social backgrounds. Although, researches show that low socioeconomic people are not being able to enjoy accessibility to care services, the prevalence rate is much lesser in comparison to India with government undertaking new initiatives.

Conclusion:

From this discussion, it can be seen that India is lagging far behind the nation of Australia in ensuring accessibility and inequity in healthcare services. It is high time that the nation of India should try to reconstruct their primary healthcare system with better health investments and recruitment of educated and trained nurses and more professionals to overcome inaccessibility and inequity in healthcare services. Australia had already implemented a well structured primary care system that managed accessibility and equity concerns of patients in the nation. However, researchers need to be still carried on to ensure disadvantaged groups to enjoy their care services successfully.

References:

Agarwal, S., Satyavada, A., Kaushik, S., & Kumar, R. (2018). Urbanization, urban poverty and health of the urban poor: status, challenges and the way forward. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3133050

Cunningham, F. C., Ferguson-Hill, S., Matthews, V., & Bailie, R. (2016). Leveraging quality improvement through use of the Systems Assessment Tool in Indigenous primary health care services: a mixed methods study. BMC health services research, 16(1), 583. https://doi.org/10.1186/s12913-016-1810-y

Das, J., Holla, A., Mohpal, A., & Muralidharan, K. (2016). Quality and Accountability in Health Care delivery: audit-study evidence from primary care in India. American Economic Review, 106(12), 3765-99. https://www.aeaweb.org/articles?id=10.1257/aer.20151138

Duckett, S., & Willcox, S. (2015). The Australian health care system (No. Ed. 5). Oxford University Press. https://www.cabdirect.org/cabdirect/abstract/20173279780

Lund, C., Tomlinson, M., & Patel, V. (2016). Integration of mental health into primary care in low-and middle-income countries: the PRIME mental healthcare plans. The British journal of psychiatry, 208(s56), s1-s3. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/integration-of-mental-health-into-primary-care-in-low-and-middleincome-countries-the-prime-mental-healthcare-plans/23AEEE5DFC34FDEBB8AD0F60E88B5A98

Osborn, R., Moulds, D., Schneider, E. C., Doty, M. M., Squires, D., & Sarnak, D. O. (2015). Primary care physicians in ten countries report challenges caring for patients with complex health needs. Health Affairs, 34(12), 2104-2112. https://doi.org/10.1377/hlthaff.2015.1018

Patel, V., Parikh, R., Nandraj, S., Balasubramaniam, P., Narayan, K., Paul, V. K., … & Reddy, K. S. (2015). Assuring health coverage for all in India. The Lancet, 386(10011), 2422-2435. https://doi.org/10.1016/S0140-6736(15)00955-1

Patel, V., Weobong, B., Weiss, H. A., Anand, A., Bhat, B., Katti, B., … & Vijayakumar, L. (2017). The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. The Lancet, 389(10065), 176-185. https://doi.org/10.1016/S0140-6736(16)31589-6

Powell Davies, G., Harris, M., Perkins, D., Roland, M., Williams, A., Larsen, K., & McDonald, J. (2017). Coordination of care within primary health care and with other sectors: a systematic review. https://openresearch-repository.anu.edu.au/handle/1885/119231

Reddy, K. S. (2015). India’s aspirations for universal health coverage. New England Journal of Medicine, 373(1), 1-5. DOI: 10.1056/NEJMp1414214

Salvi, S., Apte, K., Madas, S., Barne, M., Chhowala, S., Sethi, T., … & Gogtay, J. (2015). Symptoms and medical conditions in 204 912 patients visiting primary health-care practitioners in India: a 1-day point prevalence study (the POSEIDON study).  Comparison Of Primary Healthcare Services In India And Australia Discussion Paper