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Time for a seismic shift in global healthcare

Investment in primary healthcare is the change the world needs, says International Council of Nurses director Howard Catton

Investment in primary healthcare is the change the world needs, says International Council of Nurses director Howard Catton


Picture: iStock

This year marks the 40th anniversary of the Alma-Ata Declaration, a milestone in global health.

The declaration, adopted in what is now Almaty in Kazakhstan, defined and promoted primary healthcare as the central means of achieving good and fair global healthcare – not just services at the primary care level but a health system model that acts on the underlying social, economic and political causes of poor health.

The World Health Organization (WHO), supported by many global health organisations, has grasped this anniversary as an opportunity to refresh the declaration and inspire new generations of leaders to go further and implement a healthcare system that is truly people-centred.

Critical issues

On 25-26 October more than 1,000 government and healthcare leaders will meet in Astana, Kazakhstan, to renew the declaration and consider how to implement changes in healthcare delivery.

‘Nurses sit at the centre of the revolution that is required if we are to successfully meet the global health challenges we face’

The International Council of Nurses (ICN), working with the campaign Nursing Now, has been advising on and shaping the agenda for this event. We know nurses sit at the centre of the revolution that is required if we are to successfully meet the global health challenges we face.

The world has seen dramatic changes in recent years. There is disillusionment with a political establishment that seems distant and unresponsive to the issues ordinary people face. Add to this fluctuating currencies, unstable economies, prolonged conflicts, ethnic tensions and horrific acts of violence.

Society is changing

Society is changing rapidly, as is the environment in which we live. Global temperatures are rising, antibiotics are failing, inequalities in income levels are increasing and healthcare costs are escalating.

While progress is being made on sustainable development goals, new and recurring infectious diseases are affecting the advances made. Meanwhile, non-communicable diseases, which have overtaken infectious diseases as the leading cause of mortality worldwide, have been described as a global health disaster happening in slow motion.

While many health systems have been designed to meet the needs of those with acute infections, we face profound and pressing challenges in improving prevention, enhancing primary healthcare and ensuring genuinely people-centred approaches to care across the world.

How healthcare is delivered

Now is the time to make a seismic shift – not only in how we think about healthcare but how we deliver it.

Primary healthcare has a critical function in supporting the broader health system to deliver high quality care, with key roles in continuity of care, integration between different components of the health and social care systems, and coordination of many functions.

Primary healthcare extends beyond the biomedical model of care to a social model of health. It is based on the philosophy that for health improvement to occur, the social, political, environmental and economic determinants of illness must all be addressed.

‘As nurses, we have a responsibility to speak up and educate world leaders and policy decision makers about the importance of public health and prevention’

For progress to be made on sustainable development goals, primary healthcare must be on the agendas of all governments and healthcare policymakers.

As nurses, we have a responsibility to speak up and educate world leaders and policy decision-makers about the importance of public health and prevention, and to advocate for policies and systems that are centred on the individual.

A comprehensive approach to primary healthcare that takes into account the social determinants of health requires a multidisciplinary approach. This includes collaborations and partnerships across sectors, and puts much greater emphasis on population health and prevention strategies.

Many countries still have a medically dominated approach to healthcare and are set up with the hospital at the centre, rather than the patient.

How health professionals work

If we are to stop seeing people as just a disease or condition and support them to lead decision-making about their own healthcare, we need health systems and health professionals to work differently.

Shifting resources and services closer to people’s homes, using technology to receive information and manage treatments and care, and staff coordinating care and navigating patients and their families along a care pathway are just some of the fundamental changes needed to create a system driven by people’s needs, rather than its own.

These huge changes require brave and visionary leadership to ensure more money goes into public health, rather than simply continuing with traditional spending patterns that favour hospital-based services.

Voice of younger people

The WHO and ICN are also working to ensure that younger people have a much stronger voice and representation. The changes we need in healthcare are due to factors that will be with us for generations to come, and the solutions are being driven by the ideas, values and innovation of the younger generation.

Primary healthcare is the most effective means of delivering essential services at a cost that governments and communities can afford.

The ICN has been working hard to ensure that the new declaration recognises the importance of investing in the nursing and primary healthcare workforce, with a focus on improved education, recruitment and retention.

We remain steadfast in our efforts to increase investment in the nursing workforce to ensure that not only are there enough nurses but also that their practice is supported through ongoing professional development and learning. We also want to see barriers to expanded roles removed and decent working conditions and fair pay for all nursing staff.

We do this not just because it is the right thing for our profession, but because it will deliver changes to the health and well-being of populations.

Without nurses there would be no primary healthcare. Without primary healthcare we cannot move towards health for all.


Howard Catton is director of nursing, policy and programmes, International Council of Nurses

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