1.2.16 Primary health care

1.2.16 Primary health care

The John Hopkins Primary Care Policy Centre defines primary care as:

“Primary care is the level of a health services system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and coordinates or integrates care, regardless of where the care is delivered and who provides it. It is the means by which the two main goals of a health services system, optimisation and equity of health status, are approached.”

In the context of a patient’s contact with a member of a Primary Care team, usually a General Medical Practitioner, the influence of Work on Health, and of Health on Work, may be very important.

In any case, at first contact, the following aspects need to be considered:

Could the patient have a problem or contend with a health risk that may be work-related?

Recently, the World Health Organisation (WHO) published the outcomes of a Conference Connecting Health and Labour: what role for occupational health in primary health care? (The Hague Conference). From this Conference, the following was highlighted:

Of the global population, 70% have access to some form of primary health care.

While this is in itself a concern, it is a much more encouraging picture than access to occupational health care, where globally only 10–15% of workers have such access, and often this does not include those most in need.

In order to improve occupational healthcare access it seems reasonable to consider whether primary health care may provide the setting for developing basic occupational healthcare provision.

This was the focus of the Hague Conference, co-organised by TNO Work and Health and the Dutch Ministries of Health and Labour.

These challenges formed the background of the discussions, which focused on four topics: universal coverage; people-centred care; participatory leadership; and health in all policies. Throughout, the experts found common ground between primary health care and occupational health care, and a set of principles were formulated to address the health of workers more effectively. The Hague Conference summary outlines the strategy to reach more workers by integrating basic occupational health care within primary health care. Important elements include:

  • Training primary healthcare professionals to recognise early work-related ill-health, to advise about improving working conditions and health-at-work, to support return-to-work, and preserve and restore working capacity
  • Linking primary healthcare centres and occupational healthcare services under local primary care networks and providing joint training, referral systems, and occupational information to foster collaboration and continuity of care
  • Financial arrangements for human and technological capacity, including development of work-related guidelines
  • The setting of a research agenda and promotion of good practices
  • Developing national plans for the health of workers, involving professionals of primary health care and occupational health care, and key stakeholders in the society. Governments should guarantee access to care, allowing for a full, productive working life.

This is no simple matter as it not only differs from country to country; it differs from one city to the next.

Nuclear hazards are very wide and complex and treatment requires knowledge of inter alia radiation exposure periods; types of rays exposed to; dosage received, etc. Did General Practitioners in the Koeberg Nuclear Power Station Area receive specialised training to deal with such exposures and how are they to assist in the event of a nuclear disaster?

Should radiation medical treatment be a mandatory subject to all medical practitioners even if Koeberg is the only nuclear power station in South Africa?

Conclusion to Occupational Health

A health worker and a safe workplace depend on many factors. This section illustrated the roles of Personal Health Care, Occupational Health Care and Primary Care as an integrated whole focusing on the wellbeing of each worker.

Even environmental factors are evaluated and mitigated through carefully planned preparatory and reactionary actions to protect workers against all any foreseeable risk.

Without the active participation of each individual, all these efforts are wasted. For that reason, the focus should always be behavioural centric – persuading people to change their behaviours in order to own their wellbeing at all times!