Advocacy Letter Weak Primary Healthcare PDF

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May 6, 2020 The Honorable Senator Lamar Alexander, Chairman, Committee on Health, Education, Labor, and Pensions, The U.S. Senate Committee, Washington, DC 20510

The Honorable Senator Patty Murray, Ranking Member, Committee on Health, Education, Labor, and Pensions, The U.S. Senate Committee, Washington, DC 20510

Dear Chairman Alexander and Ranking Member Murray, On behalf of the Last Sentinel Research Center (LSRC), thank you for the opportunity to discuss and give recommendations for strengthening the Primary Health Care system in regards to the health challenges facing the country. Continuous research has shown the importance of Primary health care (henceforth PHC) in the development of effective health systems (Bitton et al. 566). In that event, there have been different forms of transformations in PHC over time to ensure sound health of individuals and the population at large. Nonetheless, the inventions have not seemed too fruitful as there is still a large dearth between the needs of a community and individuals in relation to the care quality and its efficacy. This is attributed to the notion that the PHC in most countries is often delivered under unplanned circumstances with bleary integration of other services required to deliver effective treatment in a healthcare setting. As a result, most countries have ended up responding weakly to PHC due to various reasons that involve leadership and policies, funding, the health workforce, and the quality of care, which has necessitated the need for a better model that can be used to strengthen the PHC. Weak Primary Health Care Among Nations In the countries of various continents, primary healthcare has been noted to be weak in many ways, thereby necessitating different strategies to strengthen it. The main point of focus has revolved around the need to ensure relevance and impartiality through providing quality and affordable services, although some of the strategies have not seemed to work well. For instance, some years back, Thailand's government felt convinced that there was a need for the healthcare system to undergo transition. The fundamental aim was to heighten impartiality, enhance quality, and provide a human dimension to healthcare. The medical practitioners moved out of the hospital environment and shifted to providing care at the communal and family level (Maeseneer et al. 807). In the process, intensive training and support programs were used to address the capacity problems. This was an efficient way of strengthening the PHC system, but with no other measures taken, such as employing more staff, the doctors became few with a lack of appropriate

skills required for health promotion. With no further changes to the staff management mechanism, the effect has still been a weak PHC accompanied by a lack of target goals and operations and insufficient monitoring indicators. In South Africa, the government developed a community-oriented PHC which later collapsed under the apartheid. Since then, family medicine has been privatized, with the NHS struggling to transform hospitals into embracing PHC. Evidence points out that there is a strong orientation of health services to the community, although it is limited by the small number of doctors and frequent complaints from patients regarding treatment quality (Maeseneer et al. 807). Consequently, there have been other strategies employed, such as having family physicians across different healthcare organizations. Nonetheless, they seem to contend with defining roles and the clinical services they need to fulfill. On the other hand, when trained, the family physicians are noted to produce appealing results in terms of healthcare outcomes, although there are concerns regarding the level of care provided in comparison to the salary differences as well as a shortage of doctors. To solve the problem, further strategies have been adopted, such as permitting the private health sector to embrace PHC, but this is still hard as this sector has limited knowledge of the family physician's roles in terms of treatment quality and access to healthcare balanced with costs. In other words, this sector might charge the patients highly, thereby keeping them away from the hospitals, especially if the quality is not observed. Eventually, this leaves the PHC still weak, with no effort seeming to work effectively. The United States (U.S.) has also been observed to have a weak PHC system, yet the most expensive system of healthcare in the globe. While consuming almost a fifth of gross domestic product, the healthcare system in the U.S. still performs poorly than most developed countries. This is attributed to the poor results emanating from focusing much on technology and the market, which led to the adoption of the 'medical home' concept as primary care that was aimed to coordinate care. The concept has been applied differently across various states. For instance, New Mexico uses the concept to deal with the challenges arising from cultural diversity due to geographical changes, which then lead to inadequate provision of healthcare due to financial barriers. The University of New Mexico attempted to solve the issue by launching a web-based program known as 'Primary Care Dispatch' to link up the uninsured patients to 'medical home' (Maeseneer et al. 807). However, that health system still experienced other drawbacks such as treatment by race and income disparities, thereby weakening its ability to deliver services with the efficacy required. In India, the government has implemented various models to perfect the PHC system with an aim to accomplish the goals encapsulated in the Alma-Ata declaration. However, it has been quite challenging to achieve PHC in India due to diversity and disparity despite the success of other models in developing countries. Presently, the PHC status in India is quite grim with low immunization coverage, high mortality rates, and low rates of institutional delivery (Kumar 543). In fact, the availability of PHC in most rural and urban areas is nearly nonexistent. Along with this, there is a problem of insufficient medical practitioners and poor health infrastructure. However, there have been strategies in place to improve PHC, but none of them have borne fruits as huge gaps continue to be identified in different areas of healthcare, such as training. Reasons for Weak PHC System

The evidence of weak PHC systems creates an apparent indication that there could be various factors leading to this phenomenon. LSRC, together with other researchers, agree that the following factors can be the major contributors of a weak PHC system: Leadership and Policy: In a broad range of settings, whether in low-, middle-, or high-income countries, systems that are PHC-oriented have seemed efficient and constantly produced better health outcomes. In such a setting, it is identified that the political leadership prioritizes PHC, for instance, Cuba and Costa Rica (WHO and UNICEF 9). In this vein, enhanced policies that focus on the successful implementation of the PHC system are crucial for any country. Nonetheless, research shows that unfit policies and lack of political commitment have deterred the smooth implementation of PHC policies. In fact, the lack of political commitment has hampered social equity and human rights, made it hard to work effectively across sectors concerned with PHC, led to a separation between planning and service delivery in the healthcare system as well as the inadequacy of human resources. The Issue of Funding and Allocation of Resources: the underinvestment put in place to track resources accompanied by the complexity of tracking the expenses on PHC has led to a deficit of available and reliable data on PHC. This has hindered the ability to account for the financing and implementation of PHC. On the other hand, the available limited data already shows that there is underfinancing in the health sector due to insufficient fiscal space (WHO and UNICEF 10). The promotion and prevention activities are mostly underfunded. Also, subspecialist hospitals receive a larger share of funds than the providers of primary care. The result of this has been a weaker PHC system, which can only be strengthened by the increment of allocation of more funds to the health sector affiliated with PHC as well as prioritizing new resources. Lack of Skilled Workforce: an effective PHC system requires a highly skilled workforce and experts across other sectors affiliated with its delivery. LSRC has established that there is a dearth of trained personnel in PHC, which leads to the weakening of the system. Yet, medical practitioners, such as nurses and midwives, together with comprehensive physicians, are an essential group in PHC systems. It is essential to train all the medical personnel to avoid compromising the quality of healthcare. Lack of Quality Care: PHC system requires safety, efficacy, and patient-centeredness. In other words, it should be equitable and not the way it is perceived in the areas with limited resources where 'poor care is administered to the poor'. There are efficient strategies in place to improve healthcare in general. However, engaging the community in evaluating the healthcare quality is still lacking in most countries despite its importance in increasing patient safety and mitigating risks. It is working in Brazil, where it has been noted to improve access to medication, higher regular care, and enhanced satisfaction among patients (WHO and UNICEF 12). Engaging the community in risk-reduction strategies might be a better way of strengthening the PHC systems, but more knowledge is still required to fathom how it improves patient outcomes. Recommendations for Strengthening PHC System From the available evidence, the LSRC proposes a model that can be adopted to strengthen the PHC system. The model will ensure the equitability and provision of effective healthcare at affordable costs to everyone. Also, with the model in place, it will be easier to reduce unnecessary expenditures, which leads to wastage of resources. The following are the components of the model:

Skill Enhancement: it is important to have skilled workers to ensure that there is provision of quality healthcare. Workers should be trained, and more research conducted to provide evidencebased guidelines to ensure uniform management of workers. Improve Accountability, Audit, and Appraisal: there is a need to improve accountability to both the government and the public who are the receivers of healthcare. Conducting an audit annually might give an idea of how resources are wasted and, after that, perform a regular appraisal to improve resource usage. Increase Innovations in the PHC: in the present era of technological advancements, there would be need to adopt any relevant technology that can improve the efficacy of the PHC system. For instance, technologies aimed at efficient patient identification, as well as surveillance, should be embraced to provide the necessary steps required to strengthen PHC. Increasing Public Expenditure: the challenges experienced in making PHC efficient can be solved through increased funding. This would be one of the best ways of moving ahead because such funding would help in upgrading technology in the healthcare sector, training employees, and so forth. There are many things to discuss regarding ways of strengthening the PHC system to the extent that this paper might not suffice. Currently, LSRC believes that the PHC is weak, and the evidence points to the need for embracing strategies that can improve it. Thank you again for the opportunity to contribute to the committee through discussing the PHC system and the recommendations that can be used to improve it. Upon reading this letter and feel our input is necessary in terms of research, please be at liberty to reach out to LSRC through me. Sincerely, Your name, PhD Executive Director [email protected] 555-832-1023 Reflection In writing this essay, I was concerned with showing that there is evidence of weak primary healthcare systems across the world and the United States in general. Therefore, I decided first of all to discuss the evidence showing weak primary healthcare among different nations with the United States included. This can be seen from the subheading' Weak Primary Healthcare Among Nations'. This was important in showing the senate that the problem of weak primary healthcare might not only be in the U.S., but also across the world. Moving on, I also decided to discuss the reasons for weak Primary Healthcare System as indicated in the subheading denoting the same. Finally, I saw it necessary to propose a model that can be used to strengthen Primary Healthcare. It is denoted by the subheading' Recommendations for Strengthening the PHC system. This essay forms an important contribution to scholars fraternity in many ways. First, it shows that weak primary healthcare is still a problem in every country, whether developed or underdeveloped, despite the measures put in place to solve it. Secondly, the essay shows that there is a gap in achieving the appropriate solutions for making the primary healthcare strong and

therefore provides a way of filing this gap by providing an encompassing model that combines possible ways of solving the issue.

Works Cited Bitton, Asaf et al. "Primary Health Care As A Foundation For Strengthening Health Systems In Low- And Middle-Income Countries". Journal Of General Internal Medicine, vol 32, no. 5, 2016, pp. 566-571. Springer Science And Business Media LLC, doi:10.1007/s11606016-3898-5. Accessed May 5 2020. Kumar, Pratyush. "How To Strengthen Primary Health Care". Journal Of Family Medicine And Primary Care, vol 5, no. 3, 2016, p. 543. Medknow, doi:10.4103/2249-4863.197263. Accessed May 7 2020. Maeseneer, Jan De et al. "Primary Health Care In A Changing World". British Journal Of General Practice, vol 58, no. 556, 2008, pp. 806-809. Royal College Of General Practitioners, doi:10.3399/bjgp08x342697. Accessed May 7 2020. Okpokoro, Evaezi. "Primary Health Care: A Necessity In Developing Countries?". Journal Of Public Health In Africa, vol 4, no. 2, 2013, p. 17. Pagepress Publications, doi:10.4081/jphia.2013.e17. Accessed May 7 2020. WHO and UNICEF. A Vision For Primary Health Care In The 21St Century: Towards Universal Health Coverage And The Sustainable Development Goals. World Health Organization And The United Nations Children'S Fund, 2018, https://www.who.int/docs/defaultsource/primary-health/vision.pdf. Accessed May 6 2020....