Introduction
Good health in any community remains to be an issue of paramount importance. A community that minds its overall health standards must come up with a good assessment system that will assess the health of its members. Health care provision has remained one of the most critical mandates for governments and nongovernmental organizations. Due to the critical nature of health as a human need and right, the field of healthcare intervention especially in community nursing has seen the entry of two closely related terms that are often confused by many of their users (Fitzpatrick and Wallace, 2005). The two terms are primary care and primary health care. This paper seeks to examine what is meant by each term, the differences that exists between the two terms and lastly, how their difference in concept may affect service delivery in the larger health care industry.
Definition of primary care
To understand what primary care refers to, it is important to first understand the nature of services it renders. Primary care services are those health services that patients receive when they visit a health facility. One important aspect that is beneficial towards a clearer understanding of what is primary care is the identification of who are the providers of primary care services. According to Rosenthal, (2008), primary care services are provided by health practitioners such as dentists, community pharmacists, nurses, family physicians or clinical officers among other health practitioners. With this overview on what is entailed by primary care, one can define primary care as the process in which a patient is offered services of treatment by a medical practitioner such as a dentist, a community pharmacist, a nurse, a family physician or a clinical officer. According to the Institute of Medicine, (2007), in most parts of African countries, the health practitioner is usually the first person to make the diagnosis of the ailment and subsequently offer prescription to the patient.
Definition of primary health care
On the other hand primary health care usually abbreviated as PHC is defined as a health care system that is more practical and incorporates sound scientific approaches in the delivery of healthcare services. One of the distinguishing factors between primary care and primary health care is that PHC should be cost friendly and thus, affordable to all people in the society. To guarantee this affordability, primary health care should be offered at customer friendly prices, if not free of charge. The service delivery of PHC is geared towards empowering self reliance of community members by motivating them to be determined in their endeavors towards improving their health and economic standards (Showstack, Rothman & Hassmiller et al, 2004).
According to the world health organization, the ultimate goal of primary healthcare services is to ensure that the overall standard of the society’s health is improved to acceptable levels. To achieve better health standards for all people in the world, the world health organization identifies several measures that can be used to guarantee the health security of all citizens. The first measure is the reduction in the exclusion of some people in the society due to the social disparities in the health care systems. The organization envisages that this reduction in exclusion will ensure that all people in the world receive universal health (Braveman, 2004). The second element that will aid in ensuring that people all over the world receives better health care services is through organization of the health care services by basing the code of delivering the services around what people want to be delivered and around the expectation of the community that is getting the health care services. In other words, the community’s interests should influence the whole process.
The third element in the service delivery process is incorporating health related issues in all aspects of government and private sector. This will ensure that these sectors adhere to the public policy reforms to ensure that all players in these fields are taken care off (Braveman, 2004). The fourth element is making sure that there is collaboration between all relevant stakeholders to ensure that the public policy upheld by government and the private sector has the interest of the people in the society at heart (Braveman, 2004). The last element proposed by the world health body is increasing participation of all stakeholders in the society in matters regarding their health statuses. Involving the community in the process of policy formulation assists them to own the policies that are eventually formulated. Primary health care, with the guidance from the above elements, becomes a requisite in addressing the health related issues with the main objective of ensuring that the services that are being delivered are up to the laid out standards at all times.
Distinction between primary care and primary health care
Primary health care and primary care are terms that are often used interchangeably. This has resulted in a confusion on which term is to be used when referring to a specific health care issue. Therefore, there is a need to bring out the distinctions that exists between the two terms. The first distinction between the two terms should be noted in their definitions. Primary health care does not mention anything concerning the providers of the health care services like dentists or the clinical officers, but the definition concentrates mainly on methods to be used in the delivery of medical services and the technology that will be incorporated to make the delivery of the health care services available to the society in a more participatory, affordable manner (Greenhalgh, 2007). Primary care on the other hand mentions the providers of the medical services in its definition, but it does not tell how these services will be offered in terms of affordability, availability and to the extent they can be offered (Gorol et al, 2009). This brings a clear distinction between the two terms.
Another distinction that is eminent between the two terms is that primary health care concentrates mainly on education that pertains the prevailing health problems affecting the society at large and thus helps in coming up with measures that can be taken in preventing and controlling these problems from recurring. It is concerned with issues such as promoting proper nutrition and drinking of clean and safe water, involvement in provision of basic sanitation, maternity and proper child care, immunization against infectious diseases among many other community based services.
On the other hand, primary care is concerned with provision of direct health services that are offered by medical practitioners to patients who visit them. For instance a person may seek consultation services from a physician on an ailment he or she could be suffering from or may want a prescription of drugs by a pharmacist and so on. Primary care does not diversify to cover other areas other than delivery of medical services directly to the people who consult professional medical practitioners and thus is not widespread as primary health care is in the delivery of services (Peters, 2002).
The primary healthcare depends on a broad range of players who range from the professional medical practitioners, health workers, and auxiliary workers to a common traditional medicine man if his role is needed in rendering services to the society. Primary health care seeks to utilize people with clear understanding of their community of practice as they are considered to understand their communities. Primary health care also recognizes that there are several community based aspects such as cultural traditions that may jeopardize health provision. This could play a pivotal role in coming up with a good solution of fixing the problems facing the society at large. This shows the diversity of the skills required in primary health care unlike primary care that depends solely on the skills of the professional medical practitioners in which the delivery of the services is more direct as it involves only the medical practitioner and the person who is seeking the service. This makes the interaction between the physician and the patient professional and preplanned (Ross & Mackenzie, 2001). Therefore, one can conclude that the greatest distinction between primary care and the primary health care is the level of participation of the stakeholders whereby in primary care there is less participation as compared to the levels of participation in primary health care in which the whole community is involved in all aspects of health promotion. In primary health care, the community plays part in the implementation process while in primary care this is not possible as primary care does not involve the public. (Sines et al, 2009; Goroll & Mulley, 2009).
The confusion of the two terms has led their usage in community nursing to overlap. First, primary care providers are part of the primary health care providers as they carry on with their work. When primary care providers offer advice to their patients, they also double as agents of primary health care as the given advice is meant to improve the overall health quality of the patient and in turn the overall health standards of the society. Secondly, the use of the two terms is increasingly interchanged because primary health care is dependent on the services that are offered by the primary care. This dependence of the primary health care has resulted in primary care being given the precedence in the usage of this term in referring to the services offered. However, it should be noted that if primary health care is disguised as being the primary care it will lose a lot of its meaning and its mandate to address the issue of health inequalities will not be addressed since primary care is involved in offering of services through direct interaction between the medical practitioner and the patient (Spradley, 2001).
Community nursing roles
Thirdly, medical practitioners many at times end up getting funds that were meant to be for primary health care. This happens so often because many people purport primary health care is under primary care and therefore all the funds meant to help the primary health care unit in meeting its mandate has to be channeled through the primary care (Bodenheimer & Grumbach, 2006). This confusion comes about because primary care supports the endeavors’ of primary health care. The misinterpretation of the support from the primary care should be clarified to avoid the overlapping that is continuously happening between the two distinct sections of health care.
Community nursing can be defined as the combination of primary health care with professional practicing of nursing in which the community nurse is held liable for conducting a comprehensive practice of the two and eventually the ultimate results are the prevention of a contiguous disease, curing of a disease and overall rehabilitation of patients (Lundy, 2009). Community nurses provide primary healthcare services to the public and they are not restricted to care for a certain group. Their duty is to ensure the good health of the community is upheld. While the community nurses are delivering their services, they demonstrate the desire to promote health initiatives through reestablishing the practice of this profession in healthcare by nurses providing primary care and primary health care services (Jones, 2004). They are involved in development of specific strategies that they will use in managing certain diseases in the community and aid in coming up with broad community development initiatives and public health promotion needs that ensure that health inequalities are addressed (Jones, 2004).
The advent of primary health care has influenced the way community nurses undertake their roles. The nurses have had to respond to this new approach of doing their job. Primary health care demands that the nurses spend more time on their patients and follow up on the recovery of these patients (Starfield, 2008). This approach has greatly motivated the nurses unlike that traditional approach in primary care in which the nurses only interacted with the patients during the consultation process (Stanhope & Lancaster, 2004).
Community nursing has advocated for the involvement of the whole community in the development of community activities that are aimed at promoting maintenance of good health in the society unlike in primary care that advocates for health care services being rendered when a person seeks medical attention from a practitioner. Therefore, community nursing emphasizes the importance of promoting health rather than combating illnesses as primary care advocates (Bodenheimer & Grumbach, 2006).
Conclusion
Despite the fundamental differences that exist between the two terms, it should be noted that they could be unified to achieve the main goal of addressing health issues that have led to health inequalities in the global society. The collaboration of the two terms will mean that health issues are taken care of by a more effective department and it will be articulated towards eradicating all the health inequalities that exist in the health care industry by addressing the subject from a broader perspective.
References
Bodenheimer, T. & Grumbach, K.(2006). Improving primary care: strategies and tools for a better practice. New York: McGraw-Hill Professional.
Braveman, P. (2004).Screening in primary health care: setting priorities with limited resources. World Health Organization. Pp. 212-229.
Fitzpatrick, J., J. & Wallace, M. (2005). Encyclopedia of Nursing Research. New York: Springer Publishing Company.
Goroll, A., H. & Mulley, A., G. (2009). Primary care medicine: office evaluation and management of the adult Patient. London: Lippincott Williams & Wilkins.
Greenhalgh ,T., A. (2007). Primary health care: theory and practice. New York: John Wiley and Sons.
Institute of Medicine USA. (2007). Primary care in medicine: a definition National Academies. 77(3). Pp 48-62.
Jones, R. (2004). Oxford textbook of primary medical care. New York: Oxford University Press.
Lundy, K., S. ( 2009). Community health nursing: caring for the public’s health. New York: Jones & Bartlett Learning.
Peters, D. (2002). Integrating complementary therapies in primary care: a practical guide for health professionals. New York: Routledge.
Rosenthal, T., C. (2008). The Medical Home: Growing Evidence to Support a New Approach to Primary Care. The Journal of the American Board of Family Medicine. 21 (5): 427-440 (2008).
Ross, F., & Mackenzie, A. (2001). Nursing in primary health care: policy into practice. New York: Routledge.
Showstack, J., A., Rothman, A., A. & Hassmiller, S. (2004).The future of primary care. Upper Saddle River: Jossey-Bass.
Sines, D., Saunders, M., & Forbes-Burford, J. (2009). Community Health Care Nursing. New York: John Wiley and Sons.
Spradley, B., W. (2001). Readings in community health nursing. Upper Saddle River: Cengage.
Stanhope, M. & Lancaster, J. (2004). Community and public health nursing. New York: Elsevier Health Sciences.
Starfield ,B. (2008). Primary care: balancing health needs, services, and technology. London: Oxford University Press.