Feature by Lydia Asamoah
Accra, Feb 7, GNA - Preventable communicable, or infectious, diseases like cholera, malaria and HIV and AIDS account for millions of deaths in the world each year, especially in low-income countries like Ghana.
Non-communicable, or chronic, diseases like heart attacks, hypertension and diabetes are having an increasing effect across the globe.
In whatever forms it comes, both communicable and non-communicable diseases could well be prevented through many concerted actions and efforts by individuals and collectively by communities and even by the State through exercising, good rest and eating well and putting up interventions that could prevent diseases from striking.
All these could be achieved through the promotion of Primary Health Care (PHC) by stakeholders alike.
The International Conference on Primary Health Care at Alma Ata in 1978 in Kazakhstan (formerly Kazakh Soviet Socialist Republic), defined PHC as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the communities.
It is 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”.
Eight components of PHC have been identified by experts as; Education concerning prevailing health problems and the methods of preventing and controlling them; the Promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; and maternal and child health care.
The rest are family planning; immunisation against the major infectious diseases; appropriate treatment of common diseases and injuries; and the provision of essential drugs.
Before the advent of PHC, various health paradigms were introduced and practiced by countries globally, among which was the traditional medical paradigm which views health in terms of the presence or absence of signs and symptoms of disease in individuals and therefore treatment was directed at removing the immediate causes of the signs and symptoms of the disease in the individual in a fixed health facility such as hospitals with the hope that the individual would be healthy.
Unfortunately Ghana is still stuck to this traditional medical paradigm of providing health care at a stationary place even in this 21st century although other paradigms of reaching out to communities with health care services like the Onuador Mobile medicare health vans and the Community based Health Planning and Services (CHPS) were being practiced in some of the communities.
Dr George Amofah, a private Health Consultant, says this model of health was highly curative oriented, and drug and facility dependent and that any work in the community was thought to be a waste of time and certainly not befitting the medical practitioner.
However, a new social paradigm expanded the medical model by recognising that diseases have a social dimension and therefore placing a lot of emphasis on improving the environment especially the physical, biological and social environment.
Programmes undertaken under the social health paradigm may include water treatment, sanitation improvement, vector control and control of industrial pollution.
“The hope is that when these environmental determinants of health are controlled then people will be healthy,” Dr Amofa who is also a former Deputy Director General of Ghana Health Service has stated.
In the late 1960s and early 1970s, a socialist paradigm was proposed to improve upon the social paradigm.
This paradigm recognises that the determinants of health and ill-health were primarily to be found in the socio-economic and political environment in which people live.
There was therefore a focus on broad socio-economic development to improve upon the health status of the people in the community.
Health was therefore determined by a complex interaction between individual characteristics, lifestyle and the physical, social and economic environment.
Most experts agree that these 'broader determinants of health' are more important than health care or treatment in ensuring a healthy population.
Therefore the call by Dr Amofah, on stakeholders to pursue proven interventions that could prevent diseases as a better option to finding curative remedy for diseases when they strike is rightly in order.
“We must investigate and look for what is leading to an outbreak of a disease like cholera and find a holistic approach of addressing it to prevent it re-occurrence in a particular area or region”, Dr Amofah explained.
Speaking at a health training workshop organised by the Alliance for Reproductive Health Rights (ARHR) and Curious Minds, a media based youth organisation for journalists in Accra recently, Dr Amofah said the totality of health care provisions depended largely on many factors and not only the provision of health facilities and health care professionals.
“What needs to be done is to become champions of the fact that health does not only depend on hospitals and health professionals but it depends on the integrated actions of a number of multiplicity actors.
“It’s more on the focus of prevention of diseases and promotion of health and then as a last result, no matter what happens, you will fall sick and then the hospital will manage that,” Dr Amofah said.
Dr Amofah explained that primary health care became a bigger issue before the late 1970s after it was observed that there was inequality in the health status of the people leading to deterioration in the health of Ghanaians and that necessitated the mobilisation of integrated approaches adopted at the time to improving the health of people.
He said although that intervention really helped at the time, the focus had now shifted more into provision of mainly health facilities, which most politicians pride themselves in, leaving the core actions of preventing diseases and health promotion that would lead to behavioural change in the life styles of the people at the background.
He said the introduction of the National Health Insurance Scheme was also still related to curative health services and not the preventive that would allow people to just walk into a facility to check their health status to help prevent diseases like hypertension and diabetes which continue to increase.
Role of Journalists in PHC
Dr Amofa called on journalists to learn to become “medical journalists” who would strive to understand the issues of health holistically and help in efforts at informing and educating the public on health promotion.
He said since the media had a critical role to play in championing the tenets of primary health care, it would be important to partner practitioners in creating the needed awareness among the citizenry.
The Media could also be involved in the mobilisation of funds to bridge the resource gap and monitor events for accountability and evaluation purposes.
Dr Robert K. Mensah, a Consultant on Reproductive Health at the UNFPA, who also spoke at the training, said, in the provision of primary health care, community engagement was key in achieving higher results.
“People should be part of finding solutions to their health needs.
“Attitudes of people and communities must be influenced by leadership. We need to make communities and individuals be aware of what is wrong with them, what they are doing right or wrong and not only to sensationalise issues,” Dr Mensah told the journalists.
He said journalists needed to build their capacities in Medical journalism, which involves the dissemination of health-related information through mainstream media outlets.
He said when medical issues were widely reported, these reports influence physicians, the public, and the government as well.
“And therefore for journalists to avoid being criticised for being misleading, inaccurate, or speculative, personnel needed to be professional and precise.”
Dr Mensah, however, admitted that the availability of health information through accurate journalistic reportage was steadily increasing every year and had led to a variety of effects in the behaviours of recipients.
He said most inaccuracies and speculations in news coverage could be attributed to a number of barriers between the scientific community and the public that include: lack of knowledge by reporters, lack of time to prepare a proper report, and lack of space in the publication.
He advised journalists to ensure that they do evidence based reporting and get their terminologies right to enable them have a positive effects of the public.
In summary the major concepts that underlie the principles and philosophy of the original PHC Declaration are: Equity of access, Emphasis on prevention of Diseases and Promotion of Health, Integrated Quality Health Service Delivery, Appropriate technology, Holistic health, Social acceptability and community participation, Cost-effectiveness and affordability, Socio-economic development and health, Intersectional collaboration and team-approach as well as Political support.
“Under such a scenario it behoves governments and ministries of health, especially in developing countries, not to forget the principles and philosophies underlying the original PHC concept. Otherwise the mistakes of the past are bound to be repeated,” Dr Amofa noted.