Introductory Chapter: Why Primary Health Care Is Essential?

1. Introduction

1.1 Why primary health care is essential?

To benefit from health services is one of the fundamental human rights. Primary health care (PHC) is people’s first point of contact with the national health system. In a society, primary health care is the most cost-effective and efficient approach to improving people’s physical and mental health as well as their social well-being, regardless of age, gender, race, economic status, socio-cultural difference [1]. The primary duty of the primary health care (PHC) is to prevent health-related problems and also provide outpatient treatment and rehabilitation services. That is, PHC provides health-promoting, preventive, therapeutic and rehabilitative services by prioritizing key health problems in the community. Independently from the economic situation of the countries, the PHC is must be equal, free, accessible, continuous, and hospital-integrated health services for everyone [2, 3]. The aim of PHC is to protect and promote health. What needs to be done for this?

• Preventing and eliminating factors that negatively affect health;

• Diagnosis and treatment procedures required to regain health;

• When permanent negativities occur, it includes the reassuring and support procedures necessary to make them compatible with life [1, 2, 3].

2. What is expected from the PHC?

• Health education,

• Nutrition education,

• Provision of clean water and sanitation,

• Maternal and Child Health—Family Planning Services,

• Immunization,

• Control of endemic diseases,

• Appropriate treatment of common diseases,

• Providing essential medicines.

The main purpose of the health care is to protect and promote the health. For this purpose, it is necessary for all countries to have basic health services (BHS) that can equally provide preventive health services for everyone. BHS are essential health services delivered to a society in ways that are acceptable to the general public and with their full participation. Basic health services provide PHC and offer preventive, promotive and curative care. According to the principles of BHS, for the most approprıate provision of health care services:

• Community should participate in health services;

• Health services should be provided with a team approach;

• Units must be established for initial application;

• A gradual dispatch system should be operated;

• Preventive, therapeutic, rehabilitative and health-promoting services should be considered as a whole;

• Health care services must be continuous [4, 5].

3. The historical process of basic health services and primary health care

In Turkey, these services were carried out by hospitals (vertical organization) before 1961. With the Law (No. 224) adopted in 1961, health services were socialized with the horizontal organization model and health centers were established even in hard-to-reach places [6]. The slogan of Law No. 224 is “Broad-Based Health Service in a Small Area”. According to this law, Health is an innate right, everyone has the right to benefit from health services equally and free of charge; people are obliged to protect their own health; there must be a referral chain between levels in the provision of health services; and health is a world and humanity problem [6, 7]. In the 1970s, the World Health Organization (WHO) revealed that the level of health in the world is far below expectations that there are great differences between developing and developed countries and that there are even inequalities between some countries’ own regions [8, 9]. At that time, both developed and developing societies were dissatisfied with the health services in their countries. In many countries, developments in health services do not coincide with the development of society in terms of both quantity and quality. In order to solve these problems, WHO set the goal of “Health for All by 2000″ in 1977. The basis of the goal was to ensure that by the year 2000, everyone could achieve a level of health that would enable them to lead a socially and economically productive life. A year later, in 1978, in Kazakhstan, Primary Health Care Conference was held with the participation of almost all countries and relevant international organizations [8, 9]. This conference was a meeting where policies were determined to develop health services and improve the level of health in the world and was held in 2000. The principles to be followed to achieve the “Health for All” target were determined and announced in a statement at the end of the meeting (known as the Declaration on Primary Health Care or the Declaration of Alma-Ata). Health services in our age were shaped in this meeting. After 17 years of the law 224, the Declaration of Alma-Ata (September 6–12, 1978) convened by WHO and UNICEF focused on primary health care and targeted an acceptable level of health for everyone in the world by the year 2000 [8, 9]. Alma-Ata Declaration advocated the same principle of the law 224 of Turkey after almost a quarter century (Social equality – Health is an inherent right, Self-responsibility – Every individual should appreciate and be responsible for their own health, Health services dimension – Coordination across sectors is required, International solidarity – Health is a world and humanity problem) [10]. The Alma-Ata Declaration was the first international declaration to emphasize the importance of primary health care. Since then, PHC services have been accepted by the member countries of WHO. We see that the declaration, which was announced 45 years ago in 2000 with the slogan of equal health for everyone, unfortunately did not achieve its goal. In today’s medicine, where specialization disciplines are almost separated at the molecular level, physicians are not interested in primary health care. Despite all these negative situations, basic health services remain important and up-to-date. All over the world, investments in primary health care have been shown to improve health outcomes. BHS investments not only directly improve health outcomes, but also contribute to increased social welfare. This is why primary health care is necessary.