INTRODUCTION
In 1978, the Alma-Ata Declaration proposed a forward-thinking vision that has been the
foundation of primary health care (PHC) for more than forty years. The declaration was
founded on principles of social justice and equity, acknowledged the importance of addressing
the wider determinants of health through preventive measures, emphasized intersectoral action;
and placed patient and community engagement and empowerment as key to achieving health
for all.
These principles were reiterated at the 2018 Global Conference on Primary Health Care in
Astana, Kazakhstan. The Astana Declaration defines PHC as an orientation toward health
systems that are integrated, community-based, and the product of user engagement and
empowerment, thus facilitating the needs of all throughout their life course.
It is therefore an "essential health care" that is based on scientifically sound and socially
acceptable methods and technology. This makes universal health care accessible to all
individuals and families in a community, but at a cost and that country can afford to maintain
at every stage of their development, In the spirit of self-reliance and self-determination.
The Alma-Ata Declaration’s version of PHC put the emphasis on community capability to plan
and respond to every situation that crops up. When communities take ownership of their health
challenges, they take actions to overcome them. Ownership drives action that will not be
dependent on external stimulus; it is the foundation of sustainability the global health agenda
emphasizes the importance of communicating and building partnerships with the communities
affected by these issues. This community-based focus could generate solutions where
community members participate in health intervention, and this is often exemplified by the
recruiting and training of community health workers to perform safe practices and promote
health within their social circles.
There are aspects of communities that can be clearly observed and delineated. On the most
basic level, communities are made up of people who are geographically close to one another.
They live in the same location and are thus affected by the same issues impacting a certain
area. Through daily proximity and interaction, community members build relationships with
one another, naturally amplifying their mutual trust, recognition of shared concerns, and ability
to work together to solve shared problems. Community members can build on each other’s
ability to create effective, realistic solutions that are aligned with the structures of their
governance, culture, and values.
The term community, therefore, is used generously in delineating its significance to health
program interventions. It is comprised of all individuals and families whose roles are well
defined to sustain primary health care.
Arnstein’s ladder makes the point that there are gradations in participation in the depth and
range of redistribution of power. Ownership goes beyond consultation, engagement, and
empowerment. This dates back to Article VII of the Alma-Ata Declaration, which states:
“Primary health care . . . requires and promotes maximum community and individual selfreliance and participation in the planning, organization, operation, and control of PHC, making
the fullest use of local, national and other available resources; and to this end develops through
appropriate education the ability of communities to participate.”
1.ROLES OF LEADERS IN PRIMARY HEALTH CARE.
In every society in Kenya, leaders form 10% of the individuals. Strong management and
leadership competencies have been identified as critical in enhancing the health system. In this
article we are going to expound on the roles of two categories of leaders:
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Community leaders
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National government leaders.
(i). National government leadership.
The responsibility of the government to protect and advance the interest of society includes the
delivery of high-quality health care.
Leaders that are appointed and salaried by the national
government that are close to the members of the society such as governors, senators, members
of parliament and members of county assembly play a crucial role in primary health care. This
is because they have power and control over financial resources that are needed in provision of
health care. Due to their closeness they are also able to evaluate the health needs of their people.
Their roles are as follows:
A. Development of the healthcare workforce; Government officials are responsible of
ensuring that the area they are governing have qualified health care officials such as
medical officers, clinical officers, nurses among others. They should ensure their staff
are paid in time to avoid strikes that hinder provision of health care services.
B. Construction of health care institutions; they allocate funds to the construction of
different levels of hospitals and dispensaries. Furthermore, they also ensure that these
facilities are well equipped to provide health care services to the people.
C. Policy making; leaders provide rules and regulations that enable the smooth running of
the health care system. These policies regulate the practice of health care workers and
also the health seeking behavior of the members of the society. Health in all policies
(HiAP) is an intersectoral approach that facilitates decision making among policy
makers to maximize positive health impacts of other public policies. Kenya as a
member of WHO, has committed to adapting HiAP, which has been included in Kenya
Health policy for the period 2014-2030.
D. Support information surveillance and research; public health surveillance is a tool to
estimate health status and behavior of the populations served by the ministry of health.
Because surveillance can directly measure what is going on in the population, it is
useful both for measuring the need for interventions and for directly measuring effects
of interventions. Developing countries are recognizing that data from effective
surveillance and research systems are useful for targeting resources and evaluating
programs. In 2020, the investment into the epidemiology research centers was seen to
bear fruits after the Covid-19 surge. These research institutions provided guidelines that
the members of the society implemented thus reducing the spread of this disease.
E. Combatting high health care prices; Kenya’s current economy enables greater priority
to provision of health services and thus realize the laid out objectives in its vision 2030
development plan. Increasing government expenditures on health to 15% of overall
government expenditures makes available to the health sector additional funds. With
this funding, the government officials address gaps in preventive services, make
progress on neglected areas such as maternal health and family planning and make
strategic investments in community-based health, national health insurance and human
resources. All these greatly contribute to the reduction of costs required to obtain health
care.
(ii). Community leaders
Community leaders are those individuals that are mostly non-salaried by the government but
volunteer to play a crucial role in public leadership in Kenya. They are mainly inclusive of
village elders. The choice of village elders has to be done in line with expected roles guided,
importantly, by the values needed for the office. Generally, some values such as altruism,
solidarity, reciprocity, equity, social justice among others are considered distinctive to active
volunteers as they influence their outcomes and prosocial behavior variation.Being in
grassroots level, they are the leaders closest to the people in terms of representing the interests
of the government. Kenyan government has embraced citizens’ involvement in the decisionmaking process to increase the efficacy of regulation and improvement of the provision of
health care services. These community leaders play an important role in conveying the people’s
thoughts and ideas about the provision of health care to the government. They also play a big
role in the provision of health education to the members of the society. They aid in enhancing
receptivity to this information to prevent diseases, immature deaths, and handicaps.
2. THE ROLES OF HEALTHCARE PROVIDERS IN THE HEALTHCARE SYSTEM
The main purpose of primary health is to improve the health of the public by providing easy
access to medical care. Primary healthcare providers play an indispensable role in the health
care system to prevent and manage common health problems. They may guide patients to make
healthy decisions and recommend treatment depending on the symptoms of diseases that
present. Their role is particularly important in the early stages of the disease.
Primary care involves a comprehensive set of services such as:
-Health promotion
-Preventive health
-Counselling
-Health Education
-Diagnosis and treatment of illnesses.
There are several types of primary health care providers who differ according to their
educational background, experience and the services they provide.
1)Primary Care Physician
The primary care physician is the first entry point for much of the general population. These
physicians are often the people who create an entry into the health care system for any medical
issues that may arise. In addition, they are responsible for coordinating the overall health care
of their patients. They are usually family medicine, internal medicine, or pediatric phycians. In
addition, many women choose an obstetrician or gynecologist as their primary care doctor.
Primary Care doctors play various roles including;
-Encouraging patients to take preventive measures for their health (e.g. stopping smoking,
exercising regularly, eating healthy)
-Promoting health initiatives to improve patient health.
-Screening patients for early signs of chronic diseases, such as heart disease and cancers.
-Educating patients about their health and giving appropriate advice when applicable.
-Diagnosis and treating illnesses based on the presenting symptoms and relevant guidelines.
Nurse practitioners
They help in providing primary health care services to the patients. They help in:
°Patient care
°Coordination
°Quality control
°Problem solving
°Education and being an agent of connectivity.
Family practice Doctors
They consult with a wide range of patients, including infants, children, teenagers, adults and
seniors. They have a broad knowledge of the body at every stage of life, which is useful for
their varied patient base.
Internal medicine doctors.
They have a deeper understanding of the structure and function of the internal organs of the
adult body.In general they may care for people aged over the age of 14 years.Some of these
practitionersvmay also provide specialist services.
Gynecologist or Obstetrician.
Plays a key role in health services of many women particularly through reproductive and
menopausal years.They have an extensive knowledge base of the structure and function of the
female organs in health and disease,and experience with sexual health.They can help in
screening and preventive care for women's cancers and common female health conditions in
the relevant stages of life.
In summary Health care providers play a role in;
-Providing patients with preventive medication.
-Preventing diseases from spreading.
-Educating people about prevention,cures and other such tips.
-Disseminating information about how to love healthy lives
3.THE ROLE OF TEACHERS IN PRIMARY HEALTH CARE
They are the most useful mediators in primary health care and their role widely ranges from
authoritarian to experts. This also means they create a first contact in primary health care
systems.
Although the teachers are at different levels still their role remains unchanged since they are
equipped with the necessary knowledge.
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The knowledge the teachers have is important as they are able to recognize common
illnesses in children and provide some preliminary care before referral of the child. This
is brought into important application in case of emergencies.
Promoting healthy eating habits by developing a whole school food policy and foods
also in canteens or in the feeding program. This is through providing weaning diet with
measures of proper hygiene put in place.
Teachers incorporate physical activity and its education in the curriculum through
adverse ways which can even be fun-like. This is important to ensure the children are
physical active which works positive to their health status.
Assessing nutritional status of children and this is associated with provision of
necessary requirements as far as food is considered.
Offering the knowledge they posses to the children that is educating them on health
care issues so that the children end up making better healthy decisions for themselves.
Teachers will also send the children home with this knowledge to share with the rest of
the community.
Inspecting hygiene standards in children considering aspects like nails, dressing, special
diet needs etc. This should be automatically associated with discipline instilled to
ensure that the children are adherent to the what is fed to them by the teachers.
Teachers as important individuals in primary health care system, act as positive role
models to the children and the community at large since what the teachers say or do is
watched to. This ensures there is no misleading from the teachers making the children
adherent to PHC system.
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Informing students of proactive ways to stay well and healthy and preventing
contraction or spread of diseases among the children or community. This is an
important objective of primary health care as they give out the insights.
Teachers are most useful in their establishments in dealing with conditions like malaria
and bleeding. They are also skilled to identify children who require immediate referral
to the hospital making sure that a proper health status is achieved promptly.
4.THE ROLE OF FAMILY(PARENTS) IN PRIMARY HEALTH CARE
The family of a patient plays a crucial role in his or her care, regardless of the medical condition
or the family. For example, the primary caregiver and other family members can serve as
informants to the provider, often filling in the gaps and supplying details that the patient is
unable or unwilling to give. Many providers (especially those in hospice care) are trained to
build a rapport with several family members to get a more complete picture of the patient’s
overall state. For this and other reasons, good rapport and trust are essential for the provider
when caring for the whole family.
The health and welfare of family caregivers has been linked to the health of persons receiving
care. In fact, many family members especially parents are so connected to the patient and her
or his compromised medical state that they can feel—perhaps experience—fear, depression,
anger, and other feelings experienced by the patient
Role of parents in Primary Health Care. Parenting is probably the most important public health
issue facing our society. It is the single largest variable implicated in childhood illnesses and
accidents; teenage pregnancy and substance misuse; truancy, school disruption, and
underachievement; child abuse; unemployability; juvenile crime; and mental illness. These are
serious in themselves but are even more important as precursors of problems in adulthood and
the next generation
The participation of parents in provision of primary health care is a topic under study.
Considering that hospitals are not a family environment, this causes changes in parental roles
and an inclination towards parents being involved in provision of primary health care of their
children. (1-4) . The hospitalization of children requires improved communication to be
established with parents and appropriate information to be provided to ensure that parents also
play a key role towards the health welfare of their children. (4-5) ,
NB: Role of parenting in primary health care has two essential components.
➢ Firstly, care protects children from harm. Care also encompasses promoting emotional as
well as physical health.
➢ Secondly, control involves setting and enforcing boundaries to ensure children’s and others’
safety, in ever widening areas of activity.
Knowledge concerning the needs of parents while attending to a sick child in the hospital
environment shows that parents become interested and involved in pediatric care, which
contributes to qualified and humanized care delivery(7) .
There are recent publications in this periodical highlighting the importance of analyzing how
parents, caregivers and health care professionals recognize adverse events in the care provided
to hospitalized children, showing changes in the organization of health facilities, moving
toward a culture of safety(8) , positive parenting based on the parents' needs, improved clinical
practice(9) , and valuing the testimonies of children concerning their interactions with
professionals in order to understand their experience in hospitals(10)
The result will be emergence of a “parenting society,” in which all citizens recognise their
shared rights and responsibilities for giving and receiving care, control, and development,
particularly to the needy, among whom children are the most prominent.
5. ROLES OF CHILDREN IN PRIMARY HEALTH CARE .
In order to ensure that primary health care is achieved, in the community , certain
responsibilities has to be taken by each and every member of the society not just at
the community level but also at the family level . It therefore means that both parents and
children have to fulfill both their duties towards realizing primary health care is being
achieved . As per the United Nations Convention On The Rights of the Child (UNCRC)
defines a child as everyone under 18 unless , *under the law applicable to the child ,
majority is attained earlier * . Or one may say a child is a young person especially between
infancy and puberty . Children receive their basic education in language beliefs and customs
from their families who also provide children with food , shelter and clothing. The roles
of the children are as follows :
Children should maintain clean environs and high standards of hygiene around them by
keeping the house clean for the family as they perform such chores .They could be
washing the clothes and mopping the house. The siblings who are older should ensure
that the younger children interact with an environment that contain surfaces that are
clean to avoid transmission or contraction of diseases such as cholera .
They should be practicing what they learn in school in regarding to health care .By
observing oral hygiene , maintaining good hand hygiene by washing their hands regularly .
Children should be practicing proper nutrition . Major cause of malady in children is
malnutrition . so they should make sure they are eating balanced diets every time .
Taking care of the patents when they are old as a form of gematric service. They can
also volunteer in community shelters and homes to help the needy and old. They could
help out by helping them in cleaning and may also cook for them .
Reporting signs and symptoms when they feel ill to the parents. This ensures prompt
actions from the parents in ensuring their sons and daughters health is back to normal.
The children should also make sure they take their medications until the doses prescribed
by the physician is complete. The children should also pay attention to the drugs they
are given at the hospitals and avoid overdosing or underdosing which may lead to the
deterioration of their health status or other family members as well.
Children should encourage their members of the families to practice behaviour change
when they learn control measures for certain diseases in schools. Diseases such as covid
19 which their control measures are like washing their hands and maintaining social
distance . practicing proper sanitations such as boiling drinking water to be used by the
household . girls should be able to dispose off their sanitary pads properly to prevent
transmission of diseases associated with poor disposal .
The children should be able to and be ready to accept certain norms that advocate for
behavior change especially when there is an outbreak of diseases . diseases like common
cold or like an outbreak of malaria which would deter them from playing in tall grasses
which are the breeding grounds of mosquitoes which cause malaria .
Children can also encourage themselves and their parents to learn first aid and emergency
methods in order to practice them when there is a problem or an accident has occurred
. such accidents maybe an act of nose bleeding , or one has fainted or when one is
unfortunately cut.
The children in the family should learn to appreciate celibacy until marriage to avoid
bad stuffs. These may include early teenage pregnancies in females . death may also
result from the delivery as the girls would be giving birth at a young age. Sexually
transmitted infections are also prone to such activities.
CONCLUSION
Each individual in a society has a specific role to play in primary health care. The coordination
and togetherness result in almost superb outcomes: Reduced illnesses, minimal infections,
excellent sanitation, organized health care provision etc. Community can take sustainable
action only when its members recognize that they have a shared interest in a better future.
REFERENCE
*Adapted excerpt from Scholl, J. C., Heuman, A. N., & Hughes, P. C. (2009). Hispanics’ use
of Hospice: Emergent data on end-of-life care from the provider perspective. Competitive
paper presented to the National Communication Association annual convention, Chicago, IL.
References Born, W., Greiner, A., Sylvia, E., Butler, J., and Ahluwalia, J. S. (2004).
Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans
and Latinos. Journal of Palliative Medicine,7(2), 247-256.
Epp, Jake. "Achieving health for all: A framework for health promotion." Health Promotion
International 1.4 (1986): 419-428.