PRIMARY HEALTH CARE… THE WAY FORWARD: EVERYONE RESPONSIB ILITY, EVERYONE BUSINESS
Far from being over, the implementation of Primary Health Care (PHC) all over the Kingdom of Saudi Arabia became a reality and a health system within the national strategies. Today there are optimistic and ominous trends on all fronts facing PHC programs. There are a variety of factors that lead to a situation of transition and mixing the priorities for the decision makers towards health of the nation. Of these factors, the effects of climate changes in the global food trade, the fragmented global and uncoordinated approach to infectious emerging and re-emerging diseases control, and inadequate worldwide information to allow global monitoring. Moreover, changes in the pattern of non-communicable diseases (about 45% of total deaths from these causes now occur in developing world), the effects of urbanization, the need of special groups (school-age children, and adolescents, elderly and mental health etc.) and the health system crisis and development are also considered in this respect.
The non-communicable diseases (diabetes mellitus, hypertension, coronary artery diseases, asthma, and cancer), that primarily affect adults are also emerging as a major cause of disabilities and deaths in the developing countries with escalation of cost. As mental ill health lies at the bottom of the medical pecking order, smoking emerged as the world’s largest single preventable cause of illness and death. The increase in percentage of elderly in world (the overall increasing rate of population aged over 65 is 2.7% annually) will be one of the most profound forces affecting health and social services in the next decades. These illnesses and other situations are of the most pressing problems in the near future on the provision of specific care for the community. One of the most difficult questions for health decision makers, planners and politicians is trying to allocate funds. This is an area that is greatly under researched, yet the question is assuming ever-greater importance.
To my knowledge the first priority is to complete unfinished businesses, namely the comprehensiveness of implementation of the concept, objectives, approaches and activities of PHC all over the Kingdom. This does not require a huge expenditure, and if the resources are not made available, we will return to the dispensary era.
The second priority is to tackle old diseases, by taking short and long-term actions to combat newly emerging diseases including chronic illnesses as well as genetic and inherited diseases. At the same time, there is a need for intensive research about these diseases for their prevention, treatment and control. Also implementing a new successful initiatives at health centers such as shared care, mini clinic for chronic illnesses, and promoting positive healthy life style activities such as well man, women clinics, periodic health evaluation and the concept of counseling at the level of primary health care.
The third priority and because of population expansion as well as growth of mega cities– is the health infrastructure (buildings, equipment, the staff, the drugs, the disposables, and the vehicles). This is central to good health care, specially if continuous quality improvement is there. Services must be integrated, cost-effective and provided as close as possible to the people who need them.
The importance of health care systems within the concept of PHC cannot be ignored. It is responsible for preventive and curative activities. These systems should be effective, efficient and should take care of consumer satisfaction (employees, and patients). For that, periodic in-depth evaluation is indicated to the extent of patient’s choice of services and whose quality is, in order to balance reality with dreams. One can ask, does the current situation of PHC represent the first step towards comprehensive health strategy for KSA? We believe that it can be, but only if the concerned parties recognize PHC importance, give real attention to its needs and respond critically and effectively to the criticisms and hence establishing a long term planning and implementation strategies. It must also take appropriate steps to ensure early integration of the PHC strategies into both national health strategies and multi-sectorial activities. This should take in consideration the provision of additional resources to develop and implement PHC, action to address problems and obstacles facing PHC.
During the last 20 years, we achieved much of PHC implementation and there were great successes and gains. The processes were very fast in the recent years. We can move forward by building on our previous experiences, successes and learn from others. All of these need commitment, accountability, advocacy and proper plan of action to deal with responsibilities and bridging of the gaps. Our perception and believe that the vision of PHC in the Kingdom of Saudi Arabia is bright and promising by the Will of Allah.
Dr. Tawfik A.M. Khoja, DPHC, FRCGP
Family Physician Consultant and Executive Director for
Executive Board of the Health Ministers Council for GCC States
Riyadh, Saudi Arabia