Healthcare is something that every single person requires access to. But there are many people throughout South Africa as well as the rest of the world who cannot afford even the most basic of health care. This is a prominent problem throughout our society and one that the comprehensive approach to primary health care (PHC) aims to solve (Alperstein, 2018: 15). Primary health care is important in any community and it consists of many principles – three of the most important ones being affordable, accessible and appropriate care, multi-disciplinary teams and health promotion (Alperstein, 2018: 23). These principles are displayed fantastically by the Phelophepa Trains, two trains functioning as mobile clinics that travel all around South Africa (Journeyman Pictures, 2008).
Primary health care is the belief that, despite everything else, everyone has the right to health and wellbeing (Alperstein, 2018: 22). However, due to the unfairness of society, poverty often breeds poor health. Therefore, to achieve health for all, social equity must be a priority to ensure that everyone benefits economically and has access to their required health care. And, because the goals of PHC are very broad, it needs an all-encompassing, comprehensive approach (Alperstein, 2018: 23).
The comprehensive approach to primary health care was defined during the Alma-Ata Conference in 1978 (Alperstein, 2018: 21) as the holistic treatment of health problems, focusing not only on making sure the patient is not ill but also ensuring that they are well in all aspects of life (Alperstein, 2018: 23). Comprehensive PHC is not just curative, it is also about promoting a healthy lifestyle, preventing the spread of disease and rehabilitation when needed (Alperstein, 2018: 34). In essence, the ultimate goal of primary health care is to improve the quality of life for all of society – especially those who need it the most: the impoverished (Alperstein, 2018: 34).
Primary health care is built on many principles – one of these is providing affordable, acceptable, appropriate care (Alperstein, 2018: 23). The first step in making health care accessible for all is making it affordable for everyone (Alperstein, 2018: 29). Denying people healthcare simply because of their financial status is one of the main reasons people are forced to go without health service (Alperstein, 2018: 29). To ensure that everyone can afford healthcare, there needs to be cooperation between the government, the private and public health sectors as well as the general population (Alperstein, 2018: 29). As for making the health care acceptable, all those involved need to be aware of the cultural and religious beliefs and norms of the communities they will be providing care for (Alperstein, 2018: 29). In doing so, the people of these communities will feel accepted and unoffended and will therefore accept the care being offered (Alperstein, 2018: 29). The care also needs to be appropriate in terms of the needs of the community; the appropriate facilities and technology need to be made more readily available to ensure the best possible treatment (Alperstein, 2018: 29).
An excellent example of primary health care is the Phelophepa Trains – two trains travelling all around the rural areas of South Africa, essentially operating as mobile clinics (Journeyman Pictures, 2008). Because this project is directed at helping those in need, the costs are deliberately low. For example, dental procedures cost R10, all prescriptions (whether it be aspirin or medication for the more serious problems) cost R5 and eyeglasses are only R30 a pair (Transnet Foundation, 2018). The affordable costs immediately make it far more accessible for many people who otherwise could not have paid for their treatments. Furthermore, the Phelophepa Trains allow for the transport of a lot of much-needed equipment meaning the health professionals can provide acceptable, appropriate care (Transnet Foundation, 2018).
Another important aspect of PHC is the co-operation and involvement of multi-disciplinary teams (Alperstein, 2018: 23). Having health professionals with various skill working together allows the team to provide a holistic approach to health problems and ensure a satisfactory solution that takes all needs of both the individual and community into consideration (Alperstein, 2018: 29). These teams include doctors, physiotherapists, traditional health practitioners and many more, depending on the needs of the patient (Alperstein, 2018: 30, 31). Interdisciplinary teams are especially a problem in rural areas where specialised skills are scarce (Alperstein, 2018: 29) – therefore, to ensure equal healthcare, we must make an attempt at equal distribution of skills throughout different communities.
Once again, the Phelophepa Trains display this principle of primary health care quite well. Each train has a permanent staff consisting of nurses, opticians, dentists and even translators (Transnet Foundation, 2018). In addition to their permanent staff, the trains also have medical students, psychologists and healthcare educators on board (Transnet Foundation, 2018). By having this many varying health professionals on board, the Phelophepa Trains are able to provide treatment to a large array of health problems and ensure that the needs of their patients are met.
The third essential principle of comprehensive PHC is health promotion (Alperstein, 2018: 23). This principle ensures that healthcare is not entirely curative but also preventative (Alperstein, 2018: 29). By educating the public about how to prevent disease and remain healthy, the amount of people needing treatment decreases. This means that the money that would have been needed for treatment can be spent on something else, therefore making it a more cost-effective solution for all involved (Alperstein, 2018: 29). This is especially important for countries that are struggling to provide appropriate health care due to limited funds and resources (Alperstein, 2018: 29).
Health promotion and education is something the Phelophepa Trains puts a lot of effort into. Their workers partake in multiple outreach programmes (Journeyman Pictures, 2008) – for example, the dentists visit primary schools to provide education about oral hygiene and there is an AIDS action programme aimed at teaching individuals about how to deal with the condition (Transnet Foundation, 2018). In conjunction with St. John (an organisation geared towards community healthcare training), the Phelophepa Trains identify key people in each community visited to train for home-based care (Transnet Foundation, 2018). Multiple workshops are held, for adults and children, and they cover many issues ranging from substance abuse to teenage pregnancy (Transnet Foundation, 2018). These efforts in health education are a good way to ensure that not only is the Phelophepa Train helping these communities in short-term but in the long-term as well and therefore improving their overall quality of life (Journeyman Pictures, 2008).
Learning about the principles of comprehensive primary health care as well as reading about the Phelophepa train has certainly opened my eyes to the intricacies of healthcare as well as the unjust distribution of resources in the health sector. The western-centric version of healthcare that exists today is only possible because of the previous disregard of different cultures and indigenous health knowledge (IHK) (Alperstein, 2018: 15). This has made equal health care that much more difficult to obtain and it saddens me that not only are people subjected to rising healthcare prices that many cannot afford but also that a wealth of knowledge was lost because of past prejudices (Alperstein, 2018: 15). However, the Phelophepa Trains have also showed me that accessible, affordable primary health care for all is possible if the state and the healthcare sector are willing to work together.
As a developing integrated health professional, this topic has helped me identify many areas I need to improve in. Researching the roots of primary health care has brought to my attention that a lot of what I learn is western-centric (Alperstein, 2018:15) and I now know that the knowledge dimension (Olckers,L., Gibbs, T., Duncan, M., 2007: 3) of the IHP model should also include indigenous health knowledge (Alperstein, 2018: 5). Also, part of being an IHP is being empathic (Olckers,L., Gibbs, T., Duncan, M., 2007: 3) and I always thought that I was but I now realize that true empathy is realizing that not everyone has access to healthcare the way that I do and I have a duty to fix that. This assignment has allowed for a lot of reflection on my part and I see now that I have not taken the varying situations of all of the different people of our country into consideration. In an effort to do so, I realize that I have to start questioning the roots of the knowledge I am being taught as a health sciences student and how it relates to traditional medical knowledge.
Overall, primary health care is a right everyone should be afforded despite any other factors, even their financial statuses. Providing cost-effective healthcare is possible, as proven by the Phelophepa Trains, and should be something all health professionals are working towards. The comprehensive approach to PHC has laid out the solution to unequal, unfair healthcare and if the health sector can work together with the state and the rest of the community, I truly believe that universally accessible healthcare is possible.