Publication: Revitalizing primary health care - another utopian goal?
Date
2010
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
The quest for greater efficiency, fairness and responsiveness to the expectation of
the people that system serve have brought about three generations of health system
reforms in the twentieth century. The first generation saw the founding of national
health care systems and extension to middle income nations of social insurance
systems in the 1940s and 1950s. By the late 1960s the rising costs of hospital based
care, its usage by better off, inaccessibility by the poor and rural population of even
the most basic services heralded second generation reforms promoting primary health
care as a means of achieving the affordable universal coverage. It included the best
public health strategy that is prevention and the highest ethical principle of public
health that is equity. It was expected the best system for reaching households with
essential and affordable care, and the best route towards universal coverage. The
primary health care approach though adopted universally did not materialize its notion
of translating ethos of Health for All by 2000. Overall, primary health care movement
by the end of 20th century became lifeless. Since the Declaration of Alma-Ata,
fundamental changes have occurred affecting health service delivery, such as economic
development and financing approaches, globalization of trade and knowledge, and the
shift to privatization. This is the time to develop a new vision, taking into consideration
the many changes affecting global health and the strategic developments in health of
recent years. With this recognition, the third generation of reforms now underway in
many countries is driven by the idea of responding more to demand, assuring access for
the poor and emphasizing financing rather than just provision within the public sector.
The key concern is: how to translate ethos of revitalizing in the reality. Otherwise the
revitalizing concept will turn into utopian goal so like HFA by 2000 strategy.
Key words
health system, primary health care, reform
Description
Sujan B Marahatta
Department of Community Medicine Kathmandu University Hospital, Kavre, Nepal