BY RUWAN LAKNATH JAYAKODY
Necessary investments on health should be done through the primary healthcare system so as to improve health indicators and the human capital.
This recommendation was made by College of Community Physicians of Sri Lanka 2020/2021 Treasurer P.U. Chulasiri in a cover story on “Improving the human capital through integrated primary healthcare” which was published in the Journal of the College of Community Physicians of Sri Lanka 27 (3) in November 2021.
Primary healthcare, Chulasiri explained, is a whole of society approach to health that aims to ensure the highest possible level of health and wellbeing and their equitable distribution, by focusing on the people’s needs, and it is the first point of contact between individuals and their families, communities, and the national healthcare system, thereby bringing healthcare as close as possible to where people live and work, as noted in the International Conference on Primary Healthcare’s Declaration of Alma-Ata. J.H. Bryant and J.B. Richmond’s “Alma-Ata and primary healthcare: An evolving story” mentioned that primary healthcare focuses on the most pressing health issues in the community, and provides services that are promotional, preventive, curative and rehabilitative in nature.
Equity of access to primary healthcare, is, according to L. Richard, J. Furler and K. Densley in “Equity of access to primary healthcare for vulnerable populations: The Innovative models promoting access to care transformation” international online survey of innovations (a five-year long Canadian and Australian research programme aimed at identifying, implementing and trialling best practice interventions in order to improve access to primary healthcare for vulnerable populations), a major social determinant of health and is considered as a strategy for addressing health inequity as countries are striving to find effective ways of reaching equity of access to primary healthcare in order to support those most in need, and to identify which aspects of services and the abilities of people that need to be strengthened.
Similarly, in the Sri Lankan context, Chulasiri pointed out that access to primary healthcare is affected due to the lack of equality in access and the fact that it is dependent on the economy of the country's communities and families.
Economic wellbeing and social advancement in the modern world economy are, as noted in T. Pettinger’s “Human capital definition and importance”, determined primarily by human capital, which measures the skills, education, capacity, and attributes of labour that influence their productive capacity and earning potential. Human capital can be defined, as elaborated on by T. Hancock in “People, partnerships and human progress: Building community capital”, as the sum of the capacities of all individuals in a community, including their level of intelligence, education, creativity, innovativeness, health and wellbeing, the capacity for empathy and caring, and their level of involvement in the community. Investments through primary healthcare would benefit the human capital of a country which can in turn be depicted by the Human Capital Index.
For Chulasiri, the components of the Human Capital Index connect healthcare and human capital. The Human Capital Index describes the importance of integrating primary healthcare in order to improve the human capital and how both are interconnected. Sri Lanka’s Human Capital Index for 2020, the best in the South Asian region, was 0.6 although certain health indicators, especially those pertaining to child nutrition and the survival rates of adults, were not up to the standard. That said, N. Arunatillake emphasised in “Sri Lanka’s human capital progress: Still less than its full potential” that a score of 0.6 indicates however that Sri Lanka’s performance is 40% less than the potential. The reason for this higher Human Capital Index however is due to, Chulasiri concluded, proper investments on health through primary healthcare.
According to the Alma-Ata Declaration which identified primary healthcare as the key to the attainment of the goal of health for all, primary healthcare includes the following:
- Reflects and evolves from the economic conditions and socio cultural and political characteristics of the country and its communities, and is based on the application of the relevant results of social, biomedical and health services research and the public health experience;
- Addresses the main health problems in the community, providing promotional, preventive, curative and rehabilitative services accordingly;
- Includes at least, education concerning prevailing health problems and the methods of preventing and controlling them, the promotion of food supply and proper nutrition, an adequate supply of safe water and basic sanitation, maternal and child healthcare including family planning, immunisation against the major infectious diseases, the prevention and control of locally endemic diseases, the appropriate treatment of common diseases and injuries, and the provision of essential drugs;
- Involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors, and demands the coordinated efforts of all those sectors;
- Requires and promotes maximum community and individual self reliance and participation in the planning, organisation, operation and control of primary healthcare, making the fullest use of local, national and other available resources, and to this end develops through appropriate education, the ability of communities to participate;
- Should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive healthcare for all, and giving priority to those most in need; and
- Relies, at the local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, and traditional practitioners as needed, and who are suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.