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  • Subject Name : primary healthcare

Challenges in Primary Healthcare and Development of Care Programme

Introduction of Primary Healthcare

Primary health care or PHC is a care system which encompasses various health determinants such as social, physical, mental as well as environmental aspects which participate in the well-being of an individual as well as in a broader view such that as in a community or public health (World Health Organisation, 2016). It is based on tackling the issues such as inequities in the healthcare system, such as its response to the delivery of care services in a planned and organized way to the individuals suffering with their health issues. Adaptable and equitable primary health is one of the major issues which is raising concern on an everyday basis for all the developed as well as developing and underdeveloped countries.

The primary healthcare system involves participation of various stakeholders namely, for healthcare practitioners, general practitioners, nurses, dentists and pharmacists for providing care to the patients. As per the National Primary Health Care Strategic Framework of 2013, one of the important stratagems employed in Australia in primary care sector is to enhance efficacy of access of healthcare facility to all nationals and reduce inequity for individuals inhabiting the remote areas of the country, such as the Torres Strait Islanders and the people with indigenous backgrounds. This report will focus on critical review of PHC provision in our country, and developing care plan to address the challenge of reducing the disparity of providing services of healthcare between Urban and rural Australians. In the impertinent to address the issue to healthcare inequity in primary health care considering the current public health issue of Rheumatic Heart Disease (RHD) in Australia. There are multiple effective strategies within primary health care policies that could help prevent the condition from occurring or escalating to create other health complications (Jones et al., 2019).

Contemporary Issues in The Healthcare Setting

Rheumatic heart disease is defined as a chronic condition occurring due to damage of the valves within the heart. The main reason behind it is frequent incidences of acute rheumatic fever (ARF) in an individual due to auto-immune reaction caused by a group A streptococcus infection. Numerous epidemiological factors are linked with this public health issue (Bitton et al., 2017). Various studies conducted in Australia have revealed, that the Aboriginal and Torres Strait Islanders based in a rural and remote parts of the country is at the highest risk of developing RHD and also has the highest incidence rate of mortality caused by RHD (RHD Australia, n.d.). Issues which contribute to the scenario are poor living conditions, as they areas they inhabit are densely populated and are easy source of infection to spread; poverty, having very less or absolutely no access to health services and lack of awareness regarding the disease (Health Policy Analysis, 2017). Due to these factors there is an increased ratio of RHD and ARF patients in Australia and across the world (Hoke and Seckeler, 2011; Jongen et al., 2019).

Various social determinants guide the primary health care system for RHD. These social determinants of health depend on factors like the place of birth of the individual; his lifestyle; age; gender and other environmental as well as genetics or factors pertaining to each individual’s hereditary (Australian Government, 2016; Schroeder et al., 2018). Concerning the problem related to RHD, conditions such as poor socioeconomic status, inhabitation in the rural and remote areas with limited access to health care services are evident. Inequality of a significant degree can be found in Australia in terms of accessibility of the healthcare services in certain communities. If these communities were aided with affordable and equitable health care access, the mortality rate of RHD in the country.

Consequently, it is vitally important to implement new primary healthcare strategies in order to have equity across the whole nation and to eradicate the burden of this disease. Even though both RHD as well as ARF are limited to insignificant surges within the communities which are not fully developed, Australia has a specific strategic policy in place known as Rheumatic Fever Strategy in the primary health care policy which emphasizes on reaching out to rural and indigenous populations and the smaller communities (Health Policy Analysis, 2017).

The World Health Organization defined the five major elements of the primary health care and they are, firstly, to increase the participation of the various stakeholders, secondly, introducing and ensuring effective public policy, thirdly, having a proper channel of leadership in healthcare which consist of leaders playing role of an effective leader in organizing, and effectively implementing the policies. Fourthly, to ensure end to end smooth delivery of care services, and lastly but not the least, focusing on the coverage, which means within increasing the reach of healthcare services to the remote locations (WHO, 2003). This has been possible due to advancements in technology and integration of telemedicine. All these elements have also been unified into the Rheumatic Fever Strategy, which is a ray of hope for this issue in concerning the indigenous population in Australia, as it makes it easier for them go get the available treatment for RHD. This strategy underpins the main focus of the primary health care system by addressing various social as well as epidemiological aspects within the community.

The aim of the strategy is also to develop essential healthcare related infrastructures in certain rural areas by building local outpatient clinics and hospitals at in main centre of the village. This goal is in alignment with Australian Guidelines and the WHO technical report on ARF and RHD (WHO, 2003). It also reinforces Australia’s strategy as per the t National Primary Health Care Strategic Framework, which highlights on taking appropriate action on social factors in developing care intervention or a care program (Australian Government, 2013). The output or results of “Rheumatic Fever Strategy” have been reported to be intermediate, but in the long term it is expected to be promising. Rheumatic Fever Strategy obtains adequate capital from the government to conduct studies (Health Policy Analysis, 2017). Subsequently, with the presence of these ideologies, this strategy is on track to reduce the incidence rate of RHD in Australia.

Given the opportunity within the nursing practice, Australia's health system reformation depends upon the appropriately educated and prepared for practice, nursing workforce in the community. The findings of Australian National Audits for Australian nursing standards pertaining to their competency in primary health care system reveal that Australian nursing competencies are general in their knowledge and skill (Ware, 2013). They do not reveal any particular competencies for primary health care, whereas, an undergraduate nurse student preparation for practice in primary health and community settings is does not seem to be keeping pace with reform agendas that promote expanded roles for nurses in primary health care, prevention and health promotion. The implication for nursing curriculum reform is that attention to achieving nursing graduate capacity for primary health care and health promotion is a priority. Therefore, it is very important to prepare the nurses for clinical governance, and equip them for the skill of cultural competency in order to have success in any primary health care program.

Effective Implementation of The Care Plan for Obtaining Successful Outcomes:

Use of telemedicine: Various developed countries are resolving to the issues of reaching out to remote areas by the help of technology. Mobile solutions are increasingly being implemented. Still, there is no integration of telehealth occurring worldwide telehealth in the currently existing health care systems. There are contributing factors responsible for this and they are: lack of proven large-scale activities, poor evidence-based research, inadequate execution, lack of attention to implementation's- resistance of management to change.

There are numerous other rational clarifications for the developing world, such as limited resources, unreliable energy, poor network connectivity, and high poverty-stricken costs–those most in need. Telehealth is driven by both humane and return motives enhance the system of health care in the developing as well as developed worlds. It is noteworthy that rules and regulations liked to application of telehealth have not been established so far. Very few reports are suggestive of acceptance of nations worldwide regarding telehealth. Few recommendations which are anticipated by the foundation for innovation and Information Technology consist of-

  • Standardization of telehealth: A study revealed that there are seven different federal definitions anticipated on the telehealth, the author of that report suggested that (H.R. 3750, Act of 2013) modernization of healthcare via telehealth, can be effective in treatment by implementation of real-time video, telephone, secure chat, and secure email (Harting et al., 2019). The report also suggests that the states should mandate penalties on where telehealth care services are not being implemented (Froehlich, 2019). As per WHO, definition of telemedicine is, “Telemedicine is the way of remote healing, especially in the areas where distance is a critical issue, it includes providing healthcare services by professionals with the help of information and communication technologies in order to exchange the appropriate information to carry out diagnosis, treatment and prevention of the illness and injuries, for research and monitoring purposes, aiming to provide better healthcare to the entire community (World Health Organization, 2010).”
  • licensing for telehealth service providers: All the healthcare providers must have a state recognized license which permits them to practice within the state but not outside the state, which means their practice is restricted to that state per the state law. But a bill has been proposed by the Congress under H.R. 3077, known as the TELE-MED Act, which permits a health care service provider, who is licensed in any state to deliver care services in other states as well (Schwamm et al., 2009).
  • Technology and neutral health care insurance policies: As per the of the government, certain policies and procedures in Medicare linked to re-imbursement will be renewed.
  • State run prescription drug monitoring programs collaboration: There must be some programs that follow the technical standards and allow prescription to drug monitoring programs and also share the data using health IT tools by the health service providers to support and decision makers (Harting et al.,2019)
  • Increase funding to improvise the quality of the healthcare programs. The telehealth sector is rampantly gaining roots and growing in the primary healthcare practice today, but it is also imperative that it reduces the cost of healthcare service as well as focuses on improving the quality of health services.

Conclusion on Application of Telehealth

The application of telehealth looks promising and might lead to transformation in the goal settings, practice and mode of care service delivery. Government must implement certain policies and procedures which ensure safety and efficacy of the policy makers, and various stakeholders involved in the program. They own the skillset to address and eliminate hurdles for implementation of telehealth services. Correspondingly, there is a higher need for improving the communication between the care giver and the care receiver for establishment of effective telehealth program. Telehealth system encourage the flow of information both vertically as well as horizontally without any gaps. It is concluded that Telemedicine is the future of healthcare. It has gained roots in develop as well as developing countries. With the uprise of technology, the constantly growing health issues can be addressed.

References for Primary Healthcare

Australian Government. (2013). National Primary Health Care Strategic Framework. Retrieved August 16, 2019, from https://www1.health.gov.au/internet/main/publishing.nsf/Content/nphc-strategic-framework.

Bitton, A., Ratcliffe, H. L., Veillard, J. H., Kress, D. H., Barkley, S., Kimball, M., ... & Bayona, J. (2017). Primary health care as a foundation for strengthening health systems in low-and middle-income countries. Journal of general internal medicine, 32(5), 566-571.

Froehlich, A. (Ed.). (2019). Embedding Space in African Society: The United Nations Sustainable Development Goals 2030 Supported by Space Applications. Springer.

Harting, M. T., Wheeler, A., Ponsky, T., Nwomeh, B., Snyder, C. L., Bruns, N. E., ... & Telemedicine Committee. (2019). Telemedicine in pediatric surgery. Journal of pediatric surgery, 54(3), 587-594. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022346818303129

Health Policy Analysis. (2017). Evaluation of the Commonwealth Rheumatic Fever Strategy – Final report. Canberra: Primary Healthcare Branch, Commonwealth Department of Health.

Hoke, D., & Seckeler, M. (2011). The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clinical Epidemiology. 22(3) 67-84. doi: 10.2147/CLEP.S12977.

Jones, D., Ballard, J., Dyson, R., Macbeth, P., Lyle, D., Sunny, P., ... & Sharma, I. (2019). A community engaged primary healthcare strategy to address rural school student inequities: a descriptive paper. Primary Health Care Research & Development, 20.

Jongen, C., McCalman, J., Campbell, S., & Fagan, R. (2019). Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector. BMC Health Services Research, 19(1), 1-12.

Schroeder, K., Kohl Malone, S., McCabe, E., & Lipman, T. (2018). Addressing the social determinants of health: A call to action. The Journal of School Nursing, 34(3) 182-191. doi 10.1177/1059840517750733.

Schwamm, L. H., Audebert, H. J., Amarenco, P., Chumbler, N. R., Frankel, M. R., George, M. G., ... & Levine, S. R. (2009). Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke, 40(7), 2635-2660. Retrieved from https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.109.192361

Van Weel, C., Kassai, R., Qidwai, W., Kumar, R., Bala, K., Gupta, P. P., ... & Howe, A. (2016). Primary healthcare policy implementation in South Asia. BMJ global health, 1(2), e000057.

Ware, V. (2013). Improving the accessibility of health services in urban and regional settings for Indigenous people. Retrieved August 18, 2019, from https://www.aihw.gov.au/getmedia/186eb114-8fc8-45cc-acef-30f6d05a9c0c/ctgc-rs27.pdf.aspx?inline=true

World Health Organisation. (2003). The World Health Report. Retrieved August 15, 2019, from http://www.who.int/whr/2003/chapter7/en/index3.html

World Health Organization. (2010). Telemedicine: opportunities and developments in member states. Report on the second global survey on eHealth. Geneva. Switzerland. World Health Organization

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