Emergency, critical and operative care services for effective primary care

摘要

A primary health-care approach to service delivery places primary care at the core of integrated health services, ensuring that systems are responsive to people’s needs, values and preferences. At its best, primary care directly addresses most of the health care needs of most people, while also providing early recognition of dangerous conditions, timely resuscitation and targeted referral when needed. Shortly after the Declaration of Alma-Ata, World Health Organization (WHO) Director-General Halfdan Mahler said: “A health system based on primary care cannot be realized without support from a network of hospitals,”1 establishing a vision of integrated service delivery that was reaffirmed in the Declaration of Astana. Hospital-dominated health-system planning, however, has been consistently identified as an important obstacle to fully realized primary health care. The 2008 World Health Report specifies that “health systems do not spontaneously gravitate towards primary health-care values, in part because of a disproportionate [...] hospital-centrism.