Primary Healthcare Initiatives in India and Australia
Primary healthcare services in the developing nation of India are considered poor for a variety of reasons in comparison to that of Australia. Just like the developed nation of Australia, India is also facing the surge of ageing population as well as rise in the costly chronic care needs. However, the nation had failed miserably in meeting any of the five principles of primary healthcare that WHO had advised for every nations to incorporate in their healthcare framework (Freeman et al., 2016). The first principle could not be successfully incorporated in the healthcare strategies where universal access to care as well as coverage based on the needs could not be met. There had no commitment towards health equity done on behalf of the government and healthcare department of the nation. Therefore, development oriented to social justice seems to be a goal that the nation can hardly reach and fulfil in the coming decades (Thomas et al., 2015). This assignment would mainly compare the primary healthcare initiatives in both the nation and thereby shed more light on the social determinants of health in both the nation. It would also explain the role of nurses on a global level so as to ensure that every nations enjoys best primary healthcare services and live better quality lives.
However, the third and fourth principle of WHO in primary healthcare strategies have been tried by the nation to be fulfilled (Who.int, 2018). Each state government as well as the central government in the nation had developed their own methods of health promotion tactics as well as encouraged community participation in every state along with effective implementation of health agendas (Wakerman et al., 2017). The nation of Australia had tried to implement huge number of health promotion programs where the primary healthcare nurses are educating the people of the nation and help in developing a better living condition for every individual (Australian Government, 2013). Aboriginal and Torres Strait Islander Education Action Plan 2010-14, Community Engagement Officers, Bi-Cultural Community Health Program, Refugee Health Program (Northern Territory Medicare Local), Refugee Health Nurse Program (Department of Health, Victoria) and many others were introduced with the aim of developing the social determinants of health of people and offering them better quality lives (Baum et al., 2016). The nurses are developing programmes trying to develop a diseases free nation through literacy development, financial security, affordable healthcare services and many others. Similarly, the central government of India had introduced the Janani Shishu Suraksha Karyakaram (safety and development of health of mother and newborn child), Mission Indradhanush (aiming to either cover unvaccinated or partially vaccinated children against seven-vaccine preventable disorder within 2020), National Tobacco control programme, National Programme for healthcare and Elderly and many others.However, the power of the primary healthcare nurses in India is restricted. Although they try to educate patients who visit the primary care centres, they are not allowed to develop health promotion programs unlike Australia.
Comparison of Social Determinants of Health
Although the people of the urban areas in India have, better quality lives but people living in rural and sub-urban areas have poor quality lives. This can be linked with poor social determinants of health in the nation of India. It has been found that prevalence of poor people in India is quite high. World Bank had stated that about 800 million people live on less than USD 1.90 per day in 2013. India had been also stated to be under the international poverty line in the year 2013 with about 30% of the population living under $1.90-a- day poverty measure (Meadows et al., 2015). Besides, one of the leading daily of the nation had stated that only 10% of the students in the nation can get access to education beyond higher secondary schooling. This shows lower health literacy as well as education level. Therefore, many Indians are seen to be unaware of proper healthcare and lifestyle choices due to poor literacy level. With more than half of the population of India living in rural areas, farming had been their main occupation with poor revenue generation probably due to exploitation of wealthy landowners. Employment sector is quite competitive with only highly educated individuals getting access to good jobs and mediocre educated students failing to have jobs with sufficient income (Wills et al., 2016). Hence, all these social determinants are found to be indirectly associated with health resulting in poor lifestyle choices, inability to afford nutritious food, living better quality lives and similar others.Unlike the Australian nurses who are given the power to advocate and develop better living areas in the nation by advocating the social determinant issues to the health government, such freedom and power are not exercised by primary healthcare nurses in India. This had acted as a setback to primary healthcare centres as social determinants of health are not advocated successfully.
In spite of so many ventures, very few had been successful in meeting the aims and targets set by the healthcare and welfare departments of India. One of them is the restricted financial allocation for the healthcare services in the nation where the healthcare allocated funds do not prove to be sufficient in meeting the needs of 1.3 billion people in the nation. More allocation of funds for the healthcare services are required not only for resource allocation for the programs and the healthcare services but also for marketing, publicity and advertisements of these programs (Srivastava et al., 2015). On many instances, information about the presence of such programmes, schemes, subsidies, and similar other opportunities do not reach the knowledge boundary of many people specially the rural and sub-urban areas. Many of the social health researchers are of the opinion that improper planning, implementation and evaluation strategies often lead to failure of the programmes and wastage of the healthcare funds that were already utilised for the programmes. In comparison, Australia can be found to be quite successful in recruiting efficient experts, researchers, policy makers, and other healthcare professionals who are found to be dedicated in proper evaluation and further modification of the programmes and policies so that the already implemented programmes can reach their goals and fulfil their vision (Patel et al., 2015). Hence, such claims about the primary healthcare services in India can be considered as the factors that prevent fruitful delivery of primary healthcare services.In the nation of India, nurses are only considered as care representatives and they are not given the scope to participate in financial discussion about healthcare initiatives. This restricts the capability of primary healthcare professionals in the nation to participate in national schemes and plans and mark out their basic flaws. These nurses are the person who interacts with patients and hence their issues can be easily conveyed to the national level. However, such scopes are not given to Indian nurses unlike Australian nurses and hence the system is in poor condition in India.
Role of Nurses on a Global Level
One of the important principles of primary healthcare services put forward by WHO is the inter-sectoral approaches to health. The National Priority framework for the Primary Healthcare published in the nation of Australia by the governmental and healthcare sections of the nation focuses on one of the main important attribute of primary healthcare. The strategic framework had put significance on the raising of awareness of the health impacts from different policy domains and taking of multi-sectoral approach. This can help in tackling those issues that can improve population health and reducing economic burden of the healthcare systems. The nation focuses on a whole-governmental approach at different levels that successfully address the different social determinants of health (Agarwal et al., 2017). This help in ensuring better health outcomes and also ensures policy and planning decisions appropriately for better health outcomes on people. Therefore, the nation believes in requiring the governments in promoting engagement and involvement of different private and public organisations as well as service providers beyond the health sector. This helped in development of appropriate care pathways addressing the welfare and social needs of people.
However, no inter-sectoral approach and collaborative decision-making and actions between the private and public sectors in the nation of India can be noted. Here, the private sector can be seen to be involved in constructing the healthcare infrastructure in the nationthroughout the last twenty years. There had been active participation from the private equity players. However, researchers have not found any satisfactory outcomes and had stated “efforts are only scratching the surface of India’s healthcare conundrum”. This is said so because the healthcare services obtained from private healthcare organisations are immensely costly and hence are not affordable by all classes of people equally (Brinda et al.,2015). In such situation, another principle of primary healthcare services as stated by WHO also get neglected. The principle of universal access to care as well as that of the coverage on the basis of need were not taken in consideration as well as people from lower socio-economic background were not provided the opportunity to enjoy such healthcare services provided by private healthcare centres.For meeting India’s rapidly increasing healthcare needs, it has become extremely important for both the primary healthcare professionals in bothprivate as well as the public sector to join hands and construct infrastructures as well as skill sets that are important to deliver care. The governmental primary healthcare centres and the nursing professionals are seen to lack not only sufficient healthcare resources but also lack proper accommodation and care services for patients. Poor infrastructures and shortage in the number of efficient healthcare professionals had also made the governmental primary healthcare centres inappropriate for hygienic safe and quality care delivery (Abel-Smith et al., 2016).
Challenges Faced by Primary Healthcare Professionals in India
India is also facing different types of severe concerns in the arenas of patient care and even that of affordability. Infant mortality, lifestyle disorders, maternal mortality and even outbreaks of certain types of infectious and even that of the parasitic disorders are some of the factors that are contributing to the mounting concerns of healthcare in the nation There is an immediate need for the nation to upgrade their care systems and policies. Indians are found to be dealing with issues of accessibility and even affordability. Huge percentages of the inhabitants are still been found to be soaring on out-of-pocket expenditures. Studies show that at 60%, out of pocket expenditures also termed as OPP for health in India is considered quite high in the world and this is seen to exacerbate health inequities (Soni et al., 2016). Some of the private organisations have introduced different healthcare benefit schemes but the amount that needs to be submitted for maintaining such insurance policies are quite high for middle incomes and low income families often making them opting out from the benefit schemes due to lack of affordability. On the other hand, Australians government had tried its best to help its citizens by paying as much money in healthcare services of people as possible to be afforded by the government. Here, government had seen to fund about $115 billion or 67% of all health spending and the non-government sources are seen to fund the rest like $56 billion or 33%. Hospitals (39%) and primary healthcare services (35%) were seen to be accounting for about three quarter of all health spending (George et al., 2015). Still, statistical data in Australia had shown that cost is still preventing some people from accessing health services although the number is far less than that of Indians. Nurses play one of the major roles by ensuring proper researches and preparation of reports that would be used for advocating about the issues and engage with other sectors to bring put positive outcomes. 4.1% or 663000 of people who needed to visit the GP did not see or delayed seeing GP at least once. 18% or million people delayed or did not visit the dentist and 7.% or 974000 if people who needed prescription medication avoided or delayed them.
One of the best primary healthcare initiatives that had made the Australian government one of the best nation is that they are helping people pay for nearly 300 million prescription medicines every year under the PBS and Repatriation Pharmaceutical Benefit Scheme (RPBS). Nearly 1 in every 3 (88.4 million) PBS prescriptions were found for the cardiovascular disorders. In the year 2015-2016, $11 billion was spent on these benefit-paid pharmaceuticals. The Australian Government had tried its best by paying for most around 87% of the cost of this benefit-paid pharmaceuticals and the rest 13% was spent by contributors. Hence, the effort of the nation to ensure special justice as well as equity in the care service of the nation cannot be criticised but can be acknowledged with pride (Garcio-Moreno et al., 2015).
Conclusion
The Declaration of the Alma-Ata in the year 1978 had been found to be the landmark in the history of global health. About forty years later, the WHO had arranged for the global conference on the Primary Health care that helped in renewing the commitment on primary healthcare in pursuit of health as well as well-being for all people leaving no one behind. In each of the nations all over the globe, nursing healthcare professionals need to take up professional, legal as well as ethical responsibilities for ensuring delivery of quality primary healthcare services (McMurray & Clendon, 2015). Some of the important actions that nurses on the global level need to undertake to ensure proper health of the people of the country are firstly to incorporate personal care with health promotion along with prevention of illness and community development. Secondly, the primary healthcare nurses can also develop the health of the people of the nation by including the interconnecting principles of equity, empowerment, access, community self-determination and even inter-sectoral collaboration. Third, the nurses have the duty to encompass an understanding the social, cultural, economic as well as political determinants of health. Following this, they can develop programs in educating people of the nation and accordingly advocate about the needs of the patients to the concerned authorities and government to ensure high quality life of people in the nation. Nurses working in the primary healthcare centres all over the globe should be giving priority to those who are mostly in need of financial support and thereby address the health inequalities to ensure equal opportunities of care for all people irrespective of their caste, creed and religion (Carryer & Yarwood, 2015). In each country, nurses should be taking extra-initiative to maximise the community as well as individual self-reliance, participation and control. Nurses should also participate in effective collaboration as well as partnership with the other sectors and thereby help in health promotion in each nation of the world.
From the above discussion, it becomes clear that primary healthcare strategies are not as well developed in the nation of India as that of the Australia. The strategy of addressing social determinants of health in Australia for better health outcomes on people of the nation had helped the nation to introduce many important programs and initiatives that are trying to make people educated and helping them to alter their lifestyle choices and food diets. However, the social determinants of health in the nation of India are not well addressed and the nation had also failed miserably in developing proper primary healthcare strategies and framework so that addresses the social determinants of health. Hence, not only in the nations of Australia and India, primary healthcare nursing professionals need to undertake important responsibilities to maintain equity and social justice, develop health promotion programs and address and advocate for the social determinants of health successfully. Very nations need to ensure that they are following the five principles of primary healthcare proposed by WHO so that high quality primary care services can be ensured in every nation globally.
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