Primary health care is a term used to describe a system where a patient’s health care needs are attended to by the most appropriately trained individual. This method of health care delivery has been called a “team based approach” (Health Canada, 2006). Instead of seeing the doctor for every health concern, other health professionals such as nurse practitioners, pharmacists, dieticians or physiotherapists may be called upon to take care of your concerns.
In this paper I will discuss the issues in primary health care from the literature review/article Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health (2010). I will once again provide a summary of Romanow’s (2002) arguments and recommendations concerning primary health care, and do the same with the Accord on Health Care Renewal (2003) and the First Ministers’ Meeting on the Future of Health in Canada (2004) accord’s.
As the paper progresses I will then analyze and evaluate how the Accord on Health Care Renewal (2003) and the First Ministers’ Meeting on the Future of Health in Canada (2004) accord’s ignored or exceeded Romanow’s (2002) recommendations concerning primary health care. Toward the paper’s end, I will explain what has happened in Ontario in regard to primary care since the Agreements and the Romanow Commission report (2002) release.
Lastly to conclude the paper I will try to go in depth and explain if Romanow’s (2002) recommendations about primary health care have been implemented by Ontario, and if his recommendation has helped improve the situation of primary health care. Through my research I found the piece of literature, Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health (2010) extremely interesting and intriguing.
Unlike any of the other reports and accords in this paper, this report draws on how an increasing focus on health inequities brought renewed attention to two related policy discourses ? primary health care and the social determinants of health (Rasanathan et al, 2010). Both prioritise health equity and also promote a broad view of health, multisectoral action and the participation of empowered communities (Rasanathan et al, 2010).
The report draws upon the importance of how primary health care and social determinants of health share a strong focus on intersectoral action for health (Rasanathan et al, 2010). Primary health care recognises that the health sector is not the only contributor to improving health. The Social Determinants of health discourse clearly reveals how the majority of health inequities are not caused by a lack of access to health services, but by the influence of inequalities in other sectors such as occupation, housing, or income.
Thus, action regarding social determinants of health involves the whole of society, but the health sector has a key role in moving towards health equity and moving toward intersectoral action (Rasanathan et al, 2010). Unlike the Romanow (2002) report or the two accord’s (2002) (2003), this report involves the topic of social determinants of health. Although primary health care is supposed to be available to all 24/7, this report suggests that is not necessarily true.
Rasanathan et al (2010) suggest that primary health care is an approach to organising society, including health systems, with the aim of achieving health equity. However, it is owned by and thus starts with health systems. By contrast, social determinants of health spark the issue that health inequities exist, which sees possible entry points for action to limit health inequities in the whole of society.
In this analysis, the health sector/system is itself a social determinant of health (Rasanathan et al, 2010). The Rasanathan et al (2010) report calls in to question if primary health care truly helps everyone. It reaches out and sparks the issue that primary health care is based not on research, but on good ideas with no grounds to them, and only benefit the middle and upper class without paying regards to those who lack education, housing and financial stability (Rasanathan et al, 2010).
According to the Ramanow report, (2002) Canadian’s appear to support primary health care change (Romanow, 2002). While Canadian’s may not fully understand all the details of what primary health care means, recurrent themes in the consultations and opinion polls conducted by the Commission fully underline the importance they place on health promotion and prevention (Romanow, 2002).
Polls also reveal Canadians hope for strong and accessible primary health care services, and their desire to have a long-lasting and extremely trusting relationship with any type of health care professional needed (Roamnow, 2002) Knowing this, the question the Romanow report (2002) suggests is not whether primary health care is the right approach to take, but rather removing the obstacles which lie in its way and actually making it happen. The obstacles Ramnow (2002) suggests are in the way of primary health care, is transforming the way health systems work today.
This would involve breaking down many of the barriers that too often exist between health care providers. With primary health care as the central point of our health care system we can; replace unnecessary use of hospital, emergency, and costly medical treatments with comprehensive primary health care available to Canadians 24 hours a day, 7 days a week. Another obstacle suggested in the Romanow report (2002), is trying to break down the barriers between health care providers, facilities, and different sectors of the health care system and concentrate on the common goal of improving health and health care for Canadians (Romanow, 2002).
With such positives in regard to primary health care, many wonder why it is not fully implemented. The Romanow report (2002) suggests that there are 6 main obstacles that face primary health care (Romanow, 2002). I will discuss the two obstacles I think are the most difficult to overcome. The first obstacle is the limited control patients have over their own care (Romanow, 2002). Patients have a passive, limited role when it comes to health care. The focus of Primary health care is essentially the opposite, as it provides patients with dominant control in decision making in regards to health (Romanow, 2002).
The second obstacle is marginal prevention and promotion. Why this is such a major obstacle is because the government puts almost no funding or “push” for prevention and promotion activities (Romanow, 2002). Primary care truly emphasises the importance of activities that would better ones health, and thus a lot of funding and focus would be put toward such activities. One of the major problems with primary health care throughout the report that I noticed is that many of the ideas are not grounded on research instead they are established based on “good ideas/good thought” (Romanow, 2002).
According to the Romanow report, (2002) for primary health care to succeed it must, have its proposals based on evidence, have an absolutely clear and precise message, have well identified targets (reporting key health indicators to proper people) and target it’s approaches to individuals and communities, which means being clear on objectives and expectations and the benefits primary health care can provide (Romanow, 2002). The outcome of the Accord on Health Care Renewal (2003) is quite interesting in regards to primary care. First it reveals that the Ministers ultimate goal of primary health care reform is to provide all
Canadians, no matter what the circumstance, with access to a health care provider, 24 hours a day, 7 days a week (Health Canada, 2003). To act upon this goal, First Ministers agree to immediately accelerate primary health care initiatives and to make significant yearly progress so that citizens can receive required care from multi-disciplinary primary health care organizations (Health Canada, 2003). The article discusses how each year they will trace the progress toward achieving the objective of having at least 50 percent of their residents have access to an appropriate health care provider 24/7 (Health Canada, 2003).
Similarly to this accord, the First Ministers’ Meeting on the Future of Health in Canada (2004) accord discusses that significant progress is underway in all jurisdictions to meet the goal of 50% of Canadians having 24/7 access to appropriate health teams by 2011 (Health Canada, 2004). To improve primary health care, the donation of funds must be made to support electronic health records and tele-health, as tele-health truly many individuals, especially people living in rural areas who don’t have regular medical locations near them (Health Canada, 2004).
The two accords mentioned in the previous paragraph have addressed and ignored Romanow’s (2002) recommendations and overall knowledge in regards to primary health care. The two accords have addressed the same, important goal in improving primary health care as Romanow (2002). The ultimate goal of primary health care reform is to provide all Canadians, wherever they live, with access to an appropriate health care provider, 24 hours a day, 7 days a week (Romanow, 2002) (Health Canada, 2003/2004).
What I found while reading the two accords in comparison to the Romanow report (2002), is that the two accords ignore to mention any of the obstacles in the way of primary health care(Health Canada, 2003/2004). Yes, the accords provide hopeful outcomes to improve primary health, but it ignores how achieving these obstacles often come at a crucial, rather large price, which is more touched upon while reading the Romanow report (2002). In order to make primary health care work, we as a community have to see the problems, address the problems and overcome the obstacles that may stand in the way logically and co-operatively.
Since the Romanow report (2002) and the Accord on Health Care Renewal (2003) and the First Ministers’ Meeting on the Future of Health in Canada (2004) there has been movement in the primary health care topic. Around the time of the accords and reports previously discussed, the creation of the Primary Health Care Transition fund was established (Health Canada, 2007). Established in September 2000, the $800-million Primary Health Care Transition Fund (PHCTF) supported the efforts of provinces and territories – and other stakeholders – to develop and implement transitional primary health care renewal initiatives.
It also enabled recipients to address primary health care issues that are common nationally or across two or more jurisdictions in Canada (Health Canada, 2007). The PHCTF had five main objectives which are consistent with the benefits of primary health care: multi-disciplinary approaches; increased access; health promotion and prevention of illness and disease; integrated services; and access to essential services 24/7 (Health Canada, 2006). Initiatives had to meet one or more of these objectives to receive funding. They had also to be transitional in nature to ensure that long-term, sustainable change is achieved over the fund’s lifespan.
Funding for PHCTF initiatives ended the end of March 2006. (Health Canada, 2006). The ultimate goal of primary health care is better health for all. Furthermore, since the Romanow report (2002) Ontario has been pushing for better primary health care for all through five principles. The First principle is: Equitable distribution of health care. According this principle, primary care and other services to meet the main health problems in a community must be provided equally to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class (AARN, 2005).
Secondly is: community participation. In order to make the fullest use of local, national and other available resources. (World Health Organization, 2009). The third principle is: Health workforce development. This is comprehensive health care that relies on the distribution of trained physicians, nurses, allied health professions, community health workers and others working as a health team and supported at the local and referral levels (World Health Organization, 2009). The fourth principle is: the use of appropriate technology.
This means that medical technology should be provided and can be accessible, affordable, and culturally acceptable to the community (World Health Organization, 2009). Lastly is: the multi-sectional approach. The multi-sectional approach is recognition that health cannot be improved by intervention within just the formal health sector; other sectors are equally important in promoting the health and self-reliance of communities. These sectors include, at least: food security; education; communication; housing; public works (e. g.
ensuring an adequate supply of safe water); rural development; community organizations including local governments, voluntary organizations, etc (World Health Organization, 2009). A better understanding of these principles has been addressed and thus Ontario is truly benefiting from Primary health care. Personally, I believe the Romanow’s report (2002) set an extremely good foundation in getting the key issues in regard to primary health care/ primary care out there. Romanow’s recommendations have been implemented in Ontario and continue to get stronger.
Romanow made the obstacles that Ontario faces very clear in regards to perfecting primary care, and as the years have progressed different ways to approaching and obliterating these obstacles have been made relevant. Romanow has made people aware of the issues surrounding primary care and what primary care is as a whole. Hopefully in the near future primary health care can be achieved with limited obstacles and benefit all the way it is intended to. References AARN. Primary Health Care, 2005. Retrieved at http://www. nurses. ab.
ca/Carna- Admin/Uploads/Primary%20Health%20Care. pdf Health Canada, 2003. Retrieved at, http://www. hc-sc. gc. ca/hcs-sss/delivery-prestation/fptcollab/2003accord/index-eng. php Health Canada, 2004. Retrieved at http://www. hc-sc. gc. ca/hcs-sss/delivery-prestation/fptcollab/2004-fmm-rpm/index-eng. php Health Canada, 2005. Retrieved at http://www. hc-sc. gc. ca/hcs-sss/prim/phctf-fassp/faq/index-eng. php Health Canada: Primary Health Care Transition Fund, 2005. Retrieved at http://www. hcsc. gc. ca/hcs-sss/alt_formats/hpb-dgps/pdf/phctf-fassp-interm-provisoire-eng.
pdf Health Organization, 2009. Retrieved at http://www. paho. org/English/DD/PIN/alma- ata_declaration. htm Romanow, J. (2002) Building on Values. Retrieved at http://www. collectionscanada. gc. ca/webarchives/20071122004429/http://www. hc-sc. gc. ca/english/pdf/romanow/pdfs/hcc_final_report. pdf p. 116-118 Romanow, J. (2002) Building on Values. Retrieved at http://www. collectionscanada. gc. ca/webarchives/20071122004429/http://www. hc-sc. gc. ca/english/pdf/romanow/pdfs/hcc_final_report. pdf p. 119-121