Far from being over, the implementation of Primary Health Care (PHC) all over the
Kingdom of Saudi Arabia became a reality and a health system within the national strategies.
Today there are optimistic and ominous trends on all fronts facing PHC programs. There
are a variety of factors that lead to a situation of transition and mixing the priorities
for the decision makers towards health of the nation. Of these factors, the effects
of climate changes in the global food trade, the fragmented global and uncoordinated
approach to infectious emerging and re-emerging diseases control, and inadequate worldwide
information to allow global monitoring. Moreover, changes in the pattern of non-communicable
diseases (about 45% of total deaths from these causes now occur in developing world),
the effects of urbanization, the need of special groups (school-age children, and
adolescents, elderly and mental health etc.) and the health system crisis and development
are also considered in this respect.
The non-communicable diseases (diabetes mellitus, hypertension, coronary artery diseases,
asthma, and cancer), that primarily affect adults are also emerging as a major cause
of disabilities and deaths in the developing countries with escalation of cost. As
mental ill health lies at the bottom of the medical pecking order, smoking emerged
as the world's largest single preventable cause of illness and death. The increase
in percentage of elderly in world (the overall increasing rate of population aged
over 65 is 2.7% annually) will be one of the most profound forces affecting health
and social services in the next decades. These illnesses and other situations are
of the most pressing problems in the near future on the provision of specific care
for the community. One of the most difficult questions for health decision makers,
planners and politicians is trying to allocate funds. This is an area that is greatly
under researched, yet the question is assuming ever-greater importance.
To my knowledge the first priority is to complete unfinished businesses, namely the
comprehensiveness of implementation of the concept, objectives, approaches and activities
of PHC all over the Kingdom. This does not require a huge expenditure, and if the
resources are not made available, we will return to the dispensary era.
The second priority is to tackle old diseases, by taking short and long-term actions
to combat newly emerging diseases including chronic illnesses as well as genetic and
inherited diseases. At the same time, there is a need for intensive research about
these diseases for their prevention, treatment and control. Also implementing a new
successful initiatives at health centers such as shared care, mini clinic for chronic
illnesses, and promoting positive healthy life style activities such as well man,
women clinics, periodic health evaluation and the concept of counseling at the level
of primary health care.
The third priority and because of population expansion as well as growth of mega cities–
is the health infrastructure (buildings, equipment, the staff, the drugs, the disposables,
and the vehicles). This is central to good health care, specially if continuous quality
improvement is there. Services must be integrated, cost-effective and provided as
close as possible to the people who need them.
The importance of health care systems within the concept of PHC cannot be ignored.
It is responsible for preventive and curative activities. These systems should be
effective, efficient and should take care of consumer satisfaction (employees, and
patients). For that, periodic in-depth evaluation is indicated to the extent of patient's
choice of services and whose quality is, in order to balance reality with dreams.
One can ask, does the current situation of PHC represent the first step towards comprehensive
health strategy for KSA? We believe that it can be, but only if the concerned parties
recognize PHC importance, give real attention to its needs and respond critically
and effectively to the criticisms and hence establishing a long term planning and
implementation strategies. It must also take appropriate steps to ensure early integration
of the PHC strategies into both national health strategies and multi-sectorial activities.
This should take in consideration the provision of additional resources to develop
and implement PHC, action to address problems and obstacles facing PHC.
During the last 20 years, we achieved much of PHC implementation and there were great
successes and gains. The processes were very fast in the recent years. We can move
forward by building on our previous experiences, successes and learn from others.
All of these need commitment, accountability, advocacy and proper plan of action to
deal with responsibilities and bridging of the gaps. Our perception and believe that
the vision of PHC in the Kingdom of Saudi Arabia is bright and promising by the Will
of Allah.