Comprehensive Primary Health Care in Australia: findings from a narrative review of the literature

Abstract

Objectives: To identify the extent to which the Alma Ata defined Comprehensive Primary Health Care (CPHC) approach is practised and evaluated in Australia and to describe the role that GPs and other medical practitioners play in it along with implications of this for future policy in light of the Health and Hospital Reform Commission (HHRC) and Primary Health Care taskforce reports, 2009 recommendations. Methods: We conducted a narrative review of the literature (published and grey) from 1987 to mid 2007 as part of a global review carried out by teams of researchers in six regions in 2007.Results: In Australia, the CPHC approach occurs chiefly in Aboriginal Controlled Community Health Services, state funded community health and in rural/remote and inner city areas. Participation by GPs in CPHC is limited by funding structures, workforce shortages and heavy workloads. Factors that facilitated the CPHC approach include flexibility in funding and service provision, cultural appropriateness of services, participation and ownership by local consumers and communities and willingness to address the social determinants of health. Conclusions: The recent HHRC and Primary Health Care Taskforce reports recommend an expansion of CPHC services as a means of tackling health inequities. The findings of this review suggest that resources will need to be directed beyond individual treatment to population health issues, cross-sector collaboration and consumer participation in order to realise the CPHC model. Without attention to these areas PHC will not be comprehensive and its ability to contribute to reducing inequities will be severely hampered. The absence of an evaluation culture supported with resources for CPHC programs and services also hinders the ability of practitioners and policy makers to assess the benefits of these programs and how their implementation can be improved. Funding structures, workforce issues and evaluation of programs will all need to be addressed if the health sector is to contribute to the goal of reducing health inequities.

Revisiting the ability of Australian primary healthcare services to respond to health inequity

“…The more positive findings for the community controlled and non-government organisations accord with our findings of strengths for these two models in other aspects of CPHC as well, such as health promotion, action on the social determinants of health, and community participation Baum et al, 2013;Freeman et al, 2014). These findings support literature indicating more comprehensive models of PHC only achieve traction outside the mainstream health system (Hurley et al, 2010). Close the Gap funding temporarily supported the comprehensiveness of some of the services' approach to equity, but when this funding was reduced, comprehensiveness was lost, illustrating that long term, secure funding is needed to support CPHC properly.…”

“…Two key CPHC movements in Australia have been the community health movement, emerging from the 1973 Federal Community Health Program (National Hospital and Health Services Commission, 1973), and the Aboriginal community controlled health movement (Hurley et al, 2010), which has pioneered CPHC since the early 1970s (Foley, 1982).…”

Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?

“…Here, PHC is not confined to an episodic biomedical paradigm of treating ill health but instead represents a broader socioenvironmental perspective of health, with an emphasis on providing multidisciplinary care, supporting community empowerment and a focus on prevention, health promotion and inter-sectoral collaboration. 5,13 Although the definition of PHC and its underlying philosophical principles has been contested in the Australian context, over the past decade there has been a shift, at least in policy intent, towards the need to pursue a comprehensive PHC model approach. 13,14 To date however, comprehensive PHC has not been practised in any extensive way in Australia, with some elements only evident in the Aboriginal Community Controlled Health Services (ACCHS) -the Indigenous-specific health sector (discussed later).…”

“…5,13 Although the definition of PHC and its underlying philosophical principles has been contested in the Australian context, over the past decade there has been a shift, at least in policy intent, towards the need to pursue a comprehensive PHC model approach. 13,14 To date however, comprehensive PHC has not been practised in any extensive way in Australia, with some elements only evident in the Aboriginal Community Controlled Health Services (ACCHS) -the Indigenous-specific health sector (discussed later). 13,15 International studies reveal that just as primary healthcare has improved health of populations in general, better access to primary healthcare has also improved outcomes for Indigenous populations.…”

“…13,14 To date however, comprehensive PHC has not been practised in any extensive way in Australia, with some elements only evident in the Aboriginal Community Controlled Health Services (ACCHS) -the Indigenous-specific health sector (discussed later). 13,15 International studies reveal that just as primary healthcare has improved health of populations in general, better access to primary healthcare has also improved outcomes for Indigenous populations. 7,16 In the case of Australia, there is now recognition that the poor performance in alleviating Indigenous health inequality is, in part, the result of inadequate investment in primary healthcare given the very high burden of morbidity and mortality experienced by Indigenous Australians.…”