HSIAO-WEI HSIEH: PHC and PC in Midwifery Practice (MIDW127, 2021)

This essay provides a detailed comparison of Primary Health Care (PHC) and Primary Care (PC), highlighting their distinct definitions, principles, and applications. It emphasizes the broader scope of PHC, which addresses social determinants of health and aims to improve overall community health outcomes, contrasting it with PC's focus on direct medical treatment. The essay explores the role of midwives as essential PHC practitioners, emphasizing their comprehensive approach to maternity care, including antenatal, labor, birth, and postpartum periods. It discusses how midwives utilize PHC principles to provide holistic care, promote health literacy, and build strong relationships with women and their families, ultimately improving maternal and infant health outcomes. The essay concludes by reiterating the importance of PHC in securing the well-being of women and babies, and highlights the critical role of midwives in connecting women to secondary and tertiary care when needed.

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Declaration I of Alma-Ata (1978) defines health as “a fundamental human right”
(para. 3-4), which is not simply the state of being free from illness and injury but the
attainment of wellbeing, including physical, psychological, and social aspects.
Primary health care (PHC) is a broader conception of healthcare involving illness
prevention, health promotion, and systematic and environmental adaptations that
support wellness and wellbeing. People struggle to distinguish it from primary care
(PC), mainly focused on medical treatments with medical professionals' evaluative
time frames (Sweet,2010). It is essential for midwives as a professional to be well-
knowledge the definition and differences between PHC and PC. This essay will
explore the definition and principles of PHC compared to PC. Besides, there is a
discussion about the contribution of PHC regarding the outcomes that midwives
provide to women and babies.
Primary health care is an increasingly recognised social model of health
worldwide, which has strong public health links. Declaration of Alma-Ata (1978)
describes PHC as a comprehensive consideration of healthcare, which is influenced
by social determinants of health (SDH). Ten SDH are identified in the World Health
Organization report (Wilkinson & Marmot, 2003, , as cited in Clendon, Munns &
McMurray, 2019). – “the social gradient, stress, early life, social exclusion, work,
unemployment, social support, addiction, food, transport”, which affect people’s
ability to perform various healthy lifestyles. PHC aims to tackle communities' health
problems that are associated with the SDH. Ultimately, improving individuals’ overall
health outcomes in the communities. Since PHC is a methodology deals with various
communities’ health problems involved in economic, social, political, and educational
sectors. Global governments are responsible for formulating national and systematic
strategies, regulations, and programs of PHC. Further, effective governmental
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policies rely on the collaboration of medical professionals and health organization
personnel. They are required to deliver adequate and appropriate knowledge and
methods to relevant communities or individuals (World Health Organization,1978).
Therefore, a set of principles is formulated to create a non-bias and prejudice-free
environment of public health. For instance, Australia is a multicultural country where
exists multi-ethnic communities. Cultural awareness and cultural sensitivity are key
principles of PHC. It enables health practitioners to perform medical practice flexibly
and impartially (Clendon, Munns & McMurray, 2019, p. 16). Hence, effective public
health relies on well-organized national policies and knowledgeable health
practitioners, so it is the same with primary care.
In order to achieve a better result, Primary care professionals usually conduct a
primary health care model during the practice. Primary care is based on medical
care, in which health practitioners work to provide services to the injured or ill public
for some time. Not like PHC has a broader range designed to improve public health
in every aspect of life, PC is focused on dealing with patients' illnesses and diseases
that directly affect their physical health status (Clendon, Munns & McMurray, 2019).
However, PC providers who perform as a front line of consultation for all patients are
also responsible for shaping the communities’ and individuals’ knowledge of health
literacy. For example, patients with chronic diseases rely on health practitioner’s
advice on their diet and self-care. Appropriate health literacy leads to proper
decision-making and better quality of life for individuals. More importantly, it is a
major component to minimize health inequities, mainly in marginalized groups or
communities. According to New Zealand and Australian research, only under half of
their citizens reach the standard of health literacy (Clendon, J., Munns, A., &
McMurray, A., 2019, p. 19). Therefore, continuity of care provided by front-line
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health practitioners such as midwives, nurses, and general practitioners is needed to
build a professional relationship with their clients to fulfill the better quality of public
health outcomes.
Midwifery care is holistic and continuous maternity care, which utilizes PHC to
maintain and improve women's overall health status and their babies in the
antenatal, labour, birth, and postpartum period. Midwives as PHC practitioners apply
community-based care practice on pregnant women for supporting them physically,
psychologically, and socially. Midwives with the fully equipped capacity of PHC can
provide an adequate full scope of practice with consideration of equity, cultural
sensitivity, appropriate technology, health promotion, and intersectoral collaboration
(Clendon, Munns & McMurray, 2019, p. 13). PHC enables the midwives to build a
professional relationship with the woman and her family during a specific period.
Midwives deliver the appropriate information of women-centre care to assist the
woman and her family, informing self-health and self-determination. Moreover,
midwives act as the bridge connected to secondary and tertiary maternity care when
complications occur in pregnant women (Pairman, Tracy, Dahlen, Dixon &
Eddy, 2019). They empower the woman and strengthen her confidence in the
difficult situation in her pregnancy. As the PHC workforce, midwives customise
women's birth plans, monitor and secure women's health status with combined
referral services. (Clendon, Munns & McMurray, 2019, p. 13). Therefore, midwives
can significantly minimise the health risks of a woman and her baby; thus, the high-
quality overall wellbeing of maternal and infant health can be achieved successfully.
In conclusion, health is a fundamental element as regards the quality of life of
the public. PHC and PC's clear distinction is that PHC covers the full scope of
consideration, which is a comprehensive guideline to address the overall public
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health issues. Alternatively, PC is the entry for individuals to take initial medical
treatment to solve their health problems. Maternity care is a complexity of PHC and
PC. Midwives are the PHC workforce responsible for collaborating with other
women-centre care professionals to secure women and babies' wellbeing.
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Reference
Clendon, J., Munns, A., & McMurray, A. (2019). Community health and wellness :
principles of primary health care (6th edition). Elsevier.
Pairman, S., Tracy, S. K., Dahlen, H., Dixon, L., & Eddy, A. (2019). Midwifery as
primary health care. In Midwifery: Preparation for practice. Elsevier
Health Sciences.
Sweet, M (2010).Primary care VS primary health care? Who cares? (Part 2). Crikey.
https://blogs.crikey.com.au/croakey/2010/06/17/primary-care-vs-
primary-health-care-who-cares-part-2/
World Health Organization (1978). Declaration of Alma-Ata. International Conference
on Primary Health Care, Alma-Ata. https://www.who.int/teams/social-
determinants-of-health/declaration-of-alma-ata
HSIAO-WEI HSIEH _ S00309959 _ Assignment 1 – Part B _ MIDW127 _ 2021