Improving primary healthcare service


By Lokethar

Nowadays, there is hardly a person who is not taking some medicine or the other to keep healthy particularly if he or she is over 50 or so years of age. The variety of medicines taken seem to increase proportionately with age. Some doctors, even on the patient’s first visit prescribe a range of medicines including strong analgesics, antibiotics and dietary supplements. All this leads to a demand for a large range of medicines. As the pharmaceutical industry in Myanmar cannot as yet meet the demands for a large range of medicine, almost all the medicines the public consume are imported. What is needed for the people is to be healthy and fit with minimum need for regular medication.
Primary Health Care Service relates to provision of health care which is community based and aims at providing initial healthcare at a primary health care center, through early detection and treatment of disease and averting, to the extent possible, the need for regular use of medicines. If the patient is in need of hospitalization, the primary healthcare centre would refer the patient to the nearest appropriate Public Hospital. Nowadays primary healthcare is becoming more and more relevant as according to the WHO, Non Communicable Diseases (NCD) like diabetes, hypertension, heart diseases, etc. which were once considered to be the diseases of the “rich” have now emerged among the not so rich and the poor as well. NCDs require early detection and treatment to avoid dire consequences later. Primary healthcare service may be provided by doctors of the public health system or under agreement by private general practitioners (GPs). The healthcare providers may also be qualified persons of the nursing profession. However, proper training and certification would benefit doctors and nurses who are to function as primary health service providers.
According to a study by N N Latt et all in 2016, Myanmar already had established 87 primary and secondary health centres (not including the public hospitals and clinics), 348 maternal and child health centres,1,648 rural health centres and 80 school health teams. These facilities are mainly responsible for preventive services and public health activities. Primary healthcare service, if it is to be extensively accessible, will involve increasing substantially the Government budget for primary healthcare. It will also mean a larger input from family incomes and savings where the cost of health care is shared by the public under a out-of-pocket (OOP)cost sharing system.
For the health authorities it means more emphasis on public health and preventive medicine. This translates into the need for a well organized system of primary health care service including basic health checks like monitoring blood pressure, heart rate, blood sugar, blood oxygen etc., and providing help and advice to people in communities across the urban and rural areas, to ensure for them a healthy lifespan.
At the conclusion of the recently held World Health Organization Conference, the Director-General of the World Health Organization said that the current Covid-19 Pandemic was the consequence of “chronic under investment in public health”. He said the WHO will set up a “Council on Economics of Health for All”. He further said that investment in health is not a cost but an investment for a good future.
Of course it would be quite costly for developing countries, to set up an up to date primary healthcare system within a short period of time. It may be possible to an extent in Myanmar where, as mentioned above, there already exists a basic but not yet extensive primary health care system overseen by the Public Health Authorities, to achieve the target of universal primary health care as envisioned in the “Health for All” programm of the WHO. It will have to be undertaken step by step over a period of time, depending on budget allocation of the Government and the other means such as basic health insurance scheme by the private sector perhaps.
In Myanmar the Public Health Authorities would need to upgrade existing facilities and establish new “Primary Healthcare Centres” manned by Healthcare Professionals and Staff all over the country as needed. The system would also have to provide effective basic health care service to the public, including dissemination of knowledge and information as to how one can lead a healthy life that would extend his/her lifespan without resorting to a host of medicines to cure their illness acquired because of their unhealthy lifestyle.
The Primary Health Care Centres, would also help to enlighten the public about nutrition and taking nutritious food available in their areas and communities and advise on the selection of such food items to put together “balanced meals” which will ensure proper growth of both mind and body. Nutritious food intake will and at the same time help negate the need for food supplements and “vitamin pills”, except for the elderly and persons with vitamins and minerals deficiencies. Regarding type of food the nutritionists would advise people to limit their intake of fast food including “junk food” of very little nutritional value. In the preventive health perspective, the role of physical fitness programmes for maintaining health and vitality and controlling body weight would help in warding off many diseases and contribute to a healthier lifespan.
Improving primary healthcare service is easier said than done considering the resources needed to operate and maintain a sustainable primary health care system. However there is the WHO and the development partners to provide financial and technical assistance. A viable primary healthcare system will in the long term reduce the cost of curative health. Another positive outcome would be a healthier lifespan for the ageing people which will reduce the cost of geriatric care. The best outcome however would be a more healthy and productive population which will contribute to enhancing the economy of the country.
With charity to all and malice to none.


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