Primary health care: a necessary, current and profitable investment

Translated title (es): Atención primaria: una inversión necesaria, vigente y rentable

 

Traditionally, the primary health care has focused on education and health campaigns, as part of a strategy to address the diseases of interest in public health 1. As many of these problems still remain in the public health agenda, it is urgent to review the concept of primary health care. In the past, the control of vaccine-preventable diseases was its main success 2, 3. For the future, it is necessary to consider primary health care as a strategy of high impact, and to stop looking at it as a series of low-cost activities, limited to the services provided by promoters and volunteers, with low complexity technologies to serve the poor.

The health system requires a leading primary health care, worthy to be seen as an investment with social returns, understood as the overcoming of benefits (weighted) against the costs incurred 4- 6. Thus, the primary health care strategy could be the strategy that succeeds integrating private and social interests, by achieving that the earnings of prevention contribute to the economic sustainability and the improving of health conditions for the population in general. These should be common interests to both the institutions that provide services and the health system.

The scope of primary care leadership is not obtained without any effort. It requires investing in qualified professionals and developing interventions and innovative technologies of proven effectiveness. The costs are high and redistribution of resources will be required, which will return with results of great impact in the medium and long term to support the goals and indicators proposed in the programs. In particular, addressing infectious diseases, such as tuberculosis, in which it has become evident the need for innovation; it could greatly benefit from primary care. For example, the use of geo-referencing systems could improve the valid and timely identification of respiratory symptomatic patients and positive cases in the general population 7, 8. The implementation of home delivery systems of treatment or monitoring via video cameras have proved cost-effective in improving adherence to treatment 9, 10. By improving the timeliness of diagnosis and ensuring successful treatment, the costs of complications, the costs of drug resistance, and even the social losses due to premature death are inevitably avoided.

Similarly, the use of technological applications such as the access to rapid diagnostic tests and the benefits of advertising on prevention have given successful results in controlling transmission and the adherence to treatment for HIV / AIDS 11- 13.

In Colombia, a contradictory situation arises. While health is promoted as a universal right, the institutions that provide health services declare to be in economic difficulties. To keep the emphasis on essentially healing actions will result in higher costs, possibly even unsustainable costs. It is required to exit the naiveté of thinking about "saving" today's care resources, and to have an innovative approach for prevention.

The call is to invest in research for the development of technologies and interventions that bring the health system to the population; to train professionals capable of leading a primary, innovative and sustainable care; to make use of research results in the design of programs in health, so that they integrate interventions of proven cost-effectiveness; and to formulate health policies with continuity based on primary health care, as a strategy allied to institutions and the system, in a general sense. Only that way, will the universal right to health care -enacted for so long- become real.

Referencias

1 

Ruiz-Rodriguez M, Acosta-Ramirez N, Rodriguez VLA, Uribe LM, León-Franco M. Experiencia de implementación de un modelo de Atención Primaria. Rev Salud Publica. 2011;13:885–896

2 

Macinko J, Starfield B, Erinosho T. The impact of primary healthcare on population health in low- and middle-income countries. J Ambul Care Manage. 2009;32:150–171

3 

Mosquera MPA, Granados HG, Vega RR. La estrategia de Atención Primaria en Salud (APS) para Bogotá-Colombia y su relación con la disminución de inequidades de resultados en salud. Rev Gerenc Polit Salud. 2008;7:88–109

4 

Montes F, Sarmiento OL, Zarama R, Pratt M, Wang G, Jacoby E, et al. Do health benefits outweigh the costs of mass recreational programs? An economic analysis of four Ciclovia programs. J Urban Health. 2012;89:153–170

5 

Girón-Vargas SL, Mateus-Solarte JC, Cabrera-Arana GA. Costos familiares de mantener y abandonar la lactancia exclusiva en el primer mes posparto. Rev Salud Publica (Bogota) 2009;3:395–405.

6 

Girón S, Mateus J, Castellar C. Análisis de costo-efectividad de dos intervenciones para el control de la malaria en el área urbana de Buenaventura, Colombia. Biomédica. 2006;26:379–386

7 

Kolifarhood G, Khorasani-Zavareh D, Salarilak S, Shoghli A, Khosravi N. Spatial and non-spatial determinants of successful tuberculosis treatment outcomes: An implication of Geographical Information Systems in health policy-making in a developing country. J Epidemiol Glob Health. 2015;5:221–230

8 

Lin HH, Shin SS, Contreras C, Asencios L, Paciorek CJ, Cohen T. Use of spatial information to predict multidrug resistance in tuberculosis patients, Peru. Emerg Infect Dis. 2012;18:811–813

9 

Nieto E, Lopez L, del Corral H, Marín D, Lopera LD, Benjumea D, et al. Cost-effectiveness of an alternative tuberculosis treatment: home-based guardian monitoring of patients = Rev Panam Salud. Publica. 2012;32:178–184

10 

Garfein RS, Collins K, Munoz F, Moser K, Cerecer-Callu P, Raab F, et al. Feasibility of tuberculosis treatment monitoring by video directly observed therapy: a binational pilot study. Int J Tuberc Lung Dis. 2015;19:1057–1064

11 

Van Handel M, Mulatu MS. Effectiveness of the U.SS. national HIV testing day campaigns in promoting HIV testing: evidence from CDC-funded HIV testing sites, 2010. Public Health Rep. 2014;129:446–454

12 

Figueroa ME, Kincaid DL, Hurley EA. The effect of a joint communication campaign on multiple sex partners in Mozambique: the role of psychosocial/ideational factors. AIDS Care. 2014;26 1:S50–S55

13 

Campbell JI, Haberer JE. Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited SettingsRecent Advances. Curr HIV/AIDS Rep. 2015;Epub ahead of print.