Primary Health Care in Australia - Australian Nursing and ...

1 Primary Health Carein AustraliaA Nursing and midwifery consensus view | April 2009 MYHEALTHOURHEALTHWE PRIMARYHEALTHCAREPROVIDERSWE A COMMUNITYMEAPERSONOn launching the final report of the Commission of the Social Determinants of Health , a Commission established by the World Health Organisation (WHO) Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health1, Dr Margaret Chan, the Director General of WHO said:" Health inequity really is a matter of life and death. The Commission's main finding is social conditions in which people are born, live, and work are the single most important determinantof good Health or ill Health , of a long and productive life, or a short and miserable This endsthe debate decisively. Health care is an important determinant of Health . Lifestyles are importantdeterminants of But, let me emphasize, it is factors in the social environment that determineaccess to Health services and influence lifestyle choices in the first place".

2 2 Copyright Australian Nursing Federation 2009 Prepared by: Amanda Adrian on behalf of the leading Nursing and midwifery organisations in AustraliaFunding for this publication has been provided by the Commonwealth Department of Health and Ageing. The Commonwealth makes no representation or warranty that the information in this publication is correct and accurate. The views andrecommendations expressed in this paper are those of the authors and do not necessarily reflect those of the Primary Health Care Working Group would like to thank the many nurses and midwives who gave generously oftheir time in reviewing the successive drafts and contributing their stories to the Group acknowledges the significant contribution of the ANF Journal Team in the the development of the PrimaryHealth Care in Action stories and the ANF Editing and Design Team in the production of the Adrian & AssociatesPO Box 1065 ROZELLE NSW 2039 Email: address: ISBN 978-0-909599-61-4 This work is copyright.

3 It may be reproduced in whole or in part subject to an inclusion of an acknowledgement of 2009 Primary Health care in AustraliaA Nursing and midwifery consensus view'Twas a dangerous cliff, as they freely confessed,Though to walk near its crest was so pleasant;But over its terrible edge there had slippedA duke and full many a the people said something would have to be done,But their projects did not at all tally;Some said, "Put a fence 'round the edge of the cliff,"Some, "An ambulance down in the valley."But the cry for the ambulance carried the day,For it spread through the neighbouring city;A fence may be useful or not, it is true,But each heart became full of pityFor those who slipped over the dangerous cliff;And the dwellers in highway and alleyGave pounds and gave pence, not to put up a fence,But an ambulance down in the valley.

4 "For the cliff is all right, if your careful," they said,"And, if folks even slip and are dropping,It isn't the slipping that hurts them so muchAs the shock down below when they're stopping."So day after day, as these mishaps occurred,Quick forth would those rescuers sallyTo pick up the victims who fell off the cliff,With their ambulance down in the an old sage remarked: "It's a marvel to meThat people give far more attentionTo repairing results than to stopping the cause,When they'd much better aim at us stop at its source all this mischief," cried he,"Come, neighbours and friends, let us rally;If the cliff we will fence, we might almost dispenseWith the ambulance down in the valley.""Oh he's a fanatic," the others rejoined,"Dispense with the ambulance? Never!He'd dispense with all charities, too, if he could;No! No! We'll support them 't we picking up folks just as fast as they fall?

5 And shall this man dictate to us? Shall he?Why should people of sense stop to put up a fence,While the ambulance works in the valley?"But the sensible few, who are practical too,Will not bear with such nonsense much longer;They believe that prevention is better than cure,And their party will soon be the them then, with your purse, voice, and pen,And while other philanthropists dally,They will scorn all pretence, and put up a stout fenceOn the cliff that hangs over the guide well the young than reclaim them when old,For the voice of true wisdom is calling."To rescue the fallen is good, but 'tis bestTo prevent other people from falling."Better close up the source of temptation and crimeThan deliver from dungeon or galley;Better put a strong fence 'round the top of the cliffThan an ambulance down in the the scene|The ambulance at the bottom of the cliffJoseph Malins (1895)

6 Primary Health CARE - THE CONSENSUS VIEW OF NURSES AND MIDWIVES1 Nursing AND MIDWIFERY ORGANISATIONS SUPPORTING THE Primary HEALTHCARE CONSENSUS VIEW4 Primary Health CARE - THE CENTREPIECE OF Health POLICY IN AUSTRALIA5 THE VISION OF NURSES AND MIDWIVES FOR Primary Health CARE IN AUSTRALIA11 Health11 The social determinants of health11 Primary Health care11 Care coordination and a team based approach to care12 Participation12 Partnerships for health13 Access and equity13 Education14 Innovative models of Primary Health care15 Governance and funding of Primary Health care15 Safety and quality16 Sustainability16 ACHIEVING THE VISION20 Challenges and disincentives22 The politics of health22 The oligopoly of health22 Successes and incentives - current Nursing and midwifery initiatives in Primary Health care in Australia28 Education - a vital ingredient in achieving the vision47 Taking our place as global citizens - learning from the rest of the world49 INTERIM MEASURES53 THE FUTURE FOR Primary Health CARE IN AUSTRALIA55 GLOSSARY OF TERMS57 APPENDICESA ppendix A - Consensus Statement59 Appendix B - The Declaration of Alma-Ata61 Appendix C - The Chiang Mai Declaration 200863 Appendix D - Bangkok Platform for Action64 Appendix E - ANF Fact Sheet 6 - A snapshot of nurse practitioners in Australia65 Appendix F - ANF Fact Sheet 7 - A snapshot of practice nurses in australia67 References69 Endnotes71 ContentsThis consensus view outlines a vision for primaryhealth care for people in Australia .

7 It is a visionsupported by many of the organisations representingnurses and midwives working in Australia in 2009across all sectors of Health and aged is written for the wider community; for nursesand midwives; and for others who influencehealth policy in vision sets out the values, principles andaspirations for the development of a comprehensiveprimary Health care strategy across of its features are not representative ofhealth and Health care in Australia currently. Nurses and midwives consider the current climatefor Health reform in Australia offers a uniqueopportunity to refocus our Health policy and fundingstrategies. To do this requires a shift of emphasisfrom the narrow perspectives of hospital basedcare with its treatment and cure of already established disease; to the promotion of Health ,the prevention of disease and injury and thediminution of Health inequities of all Australiansacross their should be noted there are already unique and innovative exemplars of Primary Health care teams working with communities who are currently attempting to achieve this vision inAustralia.

8 In some instances these have been in place for anumber of years. Regrettably thecommunities and the Health professionals workingin these services continue to be confronted by considerable structural impediments. Theseobstacles prevent them from realising their objectives; and also prevent other services frombeing able to emulate these national models and other successful international Primary healthcare models. While there will always be a need for an ambulanceat the bottom of the cliff, let us at last build thatfence at the top!To achieve the nurses' and midwives' vision forprimary Health care in Australia it is imperative to:!Centre Health policy in Australia around primaryhealth care for people throughout their lives - Primary Health care is demonstrably a personcentred, holistic approach incorporating body,mind, spirit, land, environment, culture, customand socio-economic status to the provision ofaccessible, essential, integrated, quality carebased upon practical, scientifically sound andsocially acceptable methods and technology for all in the Australian community.

9 !Invest in Health by funding Health promotion and the prevention of illness and injury -focussing on the social determinants of Health .!Ensure Primary Health care funding is basedon the demonstration of positive Health outcomes - for people and communities, the promotion of teamwork and collaboration and cost effectiveness.!Fund acute Health care equitably and sustainably - but recognising acute Health care is an 'effect' rather than a 'cause', and therefore it must be linked as an extension of Primary Health care.!Establish respectful partnerships between communities and individuals and Health care providers, managers, researchers and educators - centred on achieving and maintaining optimum Health for Health care The consensus view of nurses andmidwives1 Primary Health care in Australia A Nursing and midwifery consensus view!

10 Ensure citizens and others living in Australia participate individually and collectively in the planning and implementation of their Health care in a collaborative way - the development and implementation of Health policy and Primary Health care services are based on the maxim 'nothing about us without us'.!Acknowledge the skills, knowledge and experience of all Health professionals, including nurses and midwives and use these in effectivetransdisciplinary* teams - that enable individuals and communities to have equitable access to comprehensive Primary Health care services. !Invest in transdisciplinary education and research for the Health workforce - designed to meet the Health needs of the community through Primary Health care provision.!Work closely with the non- Health organisations and agencies responsible for services that can determine the Health status of individual people and communities - for example housing, education, agriculture,water resources and environmental management.