7 June 2007

Zimbabwe: Primary Health Care Key to National Development


Harare — THE escalating cases of otherwise preventable illnesses have been linked to the lack of emphasis on health promotion and disease prevention.

Primary health care, according to experts, is the only way to ensure health for all for the nation.

The concept of PHC was born in 1978 at a conference organised by the World Health Organisation and the United Nations Children's Fund in Alma Ata.

It is an approach that is viewed as the key to achieving health for all and economic development through a healthy resource base.

The Wikipedia defines 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 community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self determination."

One of the tenets of PHC is its integrative and holistic approach. The local community is fully involved including various sectors such as agriculture, animal husbandry, industry, housing, public works, finance and communication among others.

Primary health care involves health for all, including the vaccination of animals such as dogs, cattle, chickens etc so that they do not pass diseases to human beings.

It eliminates the lack of continuity in health services engendered by various stakeholders working in isolation because both material and human resources would be working together for a common cause.

Significantly, problems of access to health personnel and facilities are done away with and there would be follow-up of patients for after-hours service so that emergency rooms would not be used for non-urgent cure.

The primary health care approach covers a wide range of health and preventative services such as health education and promotion, diagnosis, counselling, disease prevention, curative measures and screening inter alia.

The Alma Ata conference identified the following as some of the key components of primary health care:

1. Education concerning prevailing health problems and methods of preventing and controlling them,

2. An adequate supply of safe water and basic sanitation,

3. Immunisation against major infectious diseases, prevention and control of locally endemic diseases,

4. Appropriate treatment of common diseases and injuries etc.

Albert Nhamoyebonde, a biochemist and lecturer at the University of Zimbabwe School of Medicine, noted that developed countries such as the United States of America were shifting from traditional approaches to health and are now concentrating more on primary health care because of its obvious advantages that include cost effectiveness.

"If rich countries are doing it for effectiveness and as cost cutting measures, why should Zimbabwe spend more money on curative services which we don't have money for? Curative services are very expensive and both individuals and the Government can hardly afford them," he said.

Government, he said, would save a lot of money from looking after people's health at primary level than to concentrate on curative medicine and services most of which rely on the availability of heavy funding and foreign currency for sustainability.

Experts have noted that the current scenario where nurses and other health personnel are dotted around the country solely for curative services was not viable in terms of the pursuit for health for all.

"Remember that in the past, cities and rural areas had qualified nurses who used to visit nearly every household to see that people lived in hygienic conditions and that their diet was nutritious," added Nhamoyebonde.

He added that most people admitted in the country's hospitals suffer from diseases with a social dimension such as tuberculosis, cholera, dysentery and others, diseases that can be eliminated or kept in check if emphasis is placed on primary health care.

"These are called poor people's diseases and are triggered by poor living conditions and lack of proper nutrition," he said.

He said that cities provided more people admitted in hospital because of poor sanitation, overcrowding and bad diet.

"City councils alone do not have the capacity to provide adequate sanitation," he said.

This is evinced by the heaps of uncollected garbage in most of the country's urban areas, the crowded conditions and the free-flowing sewage.

Health experts have noted that nutrition and health are not synonymous but without good nutrition health cannot be optimised.

Malnutrition leads to mortality and morbidity and this decreases the potency of the human resource base.

Consequently, national development is retarded due to a weak human resource base affected by mortality and morbidity.

Nhamoyebonde gave a typical example of the effectiveness of PHC.

"I visited a village where they had not lost a single child below the age of five for the past five years. Before, they would lose at least two children below the age of five every month but after boreholes were sunk and Blair toilets among other primary health infrastructure were availed, primary health care improved and so has their health," he said.

Human health care should start from the time of conception. Pregnant mothers should be taught about and afforded nutritious diet so that babies are born with the correct weight.

Provision of clean and adequate water in rural areas encourages agricultural activities such as gardening and animal husbandry and this is a plus for the production of nutritional foods such as vegetables and white meat for protein.

Experts have argued that when there is good nutrition and health in rural areas, rural urban migration would be checked because at growth points for instance, people would be healthy and this can increase their level of income through productive activities.

As a result, healthy productive workers contribute more to national development.

This reduces rural urban migration whose negative results are evident through squalor and a high incidence of communicable diseases such as TB, cholera, typhoid and HIV and Aids among others.

It is imperative therefore that stakeholders revisit the concept of primary health care to minimise the incidence of ill-health and to save billions of dollars lost through curative services.

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