National Health Reform

Primary Health Care Reform in Australia - Report to Support Australia’s First National Primary Health Care Strategy

Definitions of primary health care

Primary health care is commonly viewed as a first level of care or as the entry point to the health care system for consumers. It can also be taken to mean a particular approach to care which is concerned with continuing care, accessibility, community involvement and collaboration between sectors. From a theoretical perspective, primary health care is sometimes regarded as a spectrum ranging from comprehensive primary health care to selective primary health care to the medical model of primary health care.⁴⁰ For the majority of Australian health consumers, however, primary health care is a term that is not widely used or even understood with most people simply distinguishing between the health care they receive in the community and the health care they receive in hospital.

The World Health Organization (WHO) Alma-Ata declaration of 1978 defined primary health care as:

Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.⁴¹

In the Australian context, a commonly used definition from the Australian Primary Health Care Research Institute (APHCRI) is:

Primary health care is socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems with a suitably trained workforce comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives priority to those most in need and addresses health inequalities; maximises community and individual self-reliance, participation and control; and involves collaboration and partnership with other sectors to promote public health. Comprehensive primary health care includes health promotion, illness prevention, treatment and care of the sick, community development, and advocacy and rehabilitation.⁴²

The WHO wrote that:

The service delivery reforms advocated by the PHC [Primary Health Care] movement aim to put people at the centre of health care, so as to make services more effective, efficient and equitable. Health services that do this start from a close and direct relationship between individuals and communities and their caregivers. This, then, provides the basis for person-centredness, continuity, comprehensiveness and integration, which constitute the distinctive features of primary care.

Table 4 summarises what the WHO sees as the differences between primary care and care provided in conventional settings such as in clinics or hospital outpatient departments or through the disease control programs that shape many health services in resource-limited settings.⁴³

Table 4: Aspects of care that distinguish conventional health care from people-centred primary care

Conventional ambulatory medical care in clinics or outpatient departments	Disease control programs	People-centred primary care
Focus on illness and cure	Focus on priority diseases	Focus on health needs
Relationship limited to the moment of consultation	Relationship limited to program implementation	Enduring personal relationship
Episodic curative care	Program-defined disease control interventions	Comprehensive, continuous and person-centred care
Responsibility limited to effective and safe advice to the patient at the moment of consultation	Responsibility for disease-control targets among the target population	Responsibility for the health of all in the community along the life cycle; responsibility for tackling determinants of ill-health
Users are consumers of the care they purchase	Population groups are targets of disease-control interventions	People are partners in managing their own health and that of their community

Source: WHO, The World Health Report, 2008

Barbara Starfield has written extensively on the importance of primary health care noting that:

Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care.⁴⁴

Changes in acute care leading to shorter stays, earlier discharges and more day surgery procedures also requires better integration between hospital services, community-based support and ambulatory care specialist services.

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⁴⁰Rogers W & Veale B, 2000. Primary Health Care: a scoping report, National Information Service, Department of General Practice, Flinders University, Australia, available from: http://www.phcris.org.au/phplib/filedownload.php?file=/elib/lib/downloaded_files/publications/pdfs/phcris_pub_1150.pdf (accessed June 2009).
⁴¹World Health Organization, 1978. Declaration of Alma Ata, International conference on PHC, Alma-Ata, USSR, 6-12 September, available from: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf (accessed June 2009).
⁴²Definition developed by the Australian Primary Health Care Research Institute for ADGP Primary Health Care Position Statement 2005, also included in the Australian Medical Association Primary Health Care position paper, 2006.
⁴³World Health Organization, 2008. The World Health Report 2008: Primary Health Care Now More Than Ever, p. 43, available from: http://www.who.int/whr/2008/whr08_en.pdf (accessed June 2009).
⁴⁴Starfield B, Shi L & Macinko J, 2005. Contribution of Primary Care to Health Systems and Health, The Milbank Quarterly, vol. 83, no. 3, pp. 457–502.

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