A missing link in health care system
Primary medical care is recognised as a key component and foundation of health care delivery systems worldwide. It is also the most appropriate means to achieve equitable and sustainable improvements in health for the populations in developing countries. Though very similar, Primary Care and Primary Health Care often use inter-changeably but have a different concepts.
Primary Care or Primary Medical care describes a narrow concept that focuses on the person as a whole to improve the health of the individual by providing easy access to medical care. Thus, primary care is defined as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practising in the context of family and community." Primary Care is the first door of care and connecting link between all the higher levels of healthcare delivery systems.
Primary Health Care, in contrast, is a broader concept that includes both individual-level care and population-focused activities that also incorporates public health elements such as universal access to health care, an emphasis on health equity, and collaboration within and beyond the medical sector.
Many countries emphasise primary care and have developed strong primary care infrastructures. Examples include Britain's National Health Service (NHS), which established Primary Care Trusts (PCT) that integrate primary and hospital-based care. Canada has a more balanced primary care-specialist physician ratio. Like Brazil, Srilanka and Thailand, developing countries have also implemented national-level strategies to increase access to primary care services. An increasingly popular model for orienting the healthcare system to primary care is the gatekeeper model, which requires patients to select a primary care physician (PCP), known as a Family Doctor and then obtain referrals to specialists.
Logically, primary care speciality and Family Medicine are seen as crucial medical speciality and healthcare necessity because it is assumed to positively impact health outcomes in many countries of the world. Experiences in the international context suggest that primary care-oriented healthcare delivery systems can produce better health outcomes and counteract, to some extent, the negative impact of poor economic conditions on health. Increasing primary care availability in low- and middle-income countries also correlate with improved health like Bangladesh.
Many countries in the world have embraced strong primary care, using a variety of structures and models. Lessons from these countries could serve as case studies for our country's healthcare system, which currently faces an imbalance between speciality and primary care and a significant shortage and inequitable distribution in the primary care workforce. Many research suggests the need to increase the supply of primary care physicians in our country to strengthen primary medical care.
Bangladesh College of Physicians and Surgeons (BCPS) has started its membership, and fellowship examinations on Family Medicine to increase the BMDC recognised family doctors. In addition, many private organisations also started weekend diploma and certificate courses in general medicine to increase the number of competent primary care physicians. The services that fall under primary care will vary depending on the needs of different communities.
The writer is a Consultant in Family Medicine, PRAAVA Health. E-mail: [email protected]