CourseraのPrimary Healthcareコース終了

CourseraのＰｒｉｍａｒｙ　ｈｅａｌｔｈｃａｒｅコース無事終了しました。
100点満点中96点でした。ピアアセスメントなので評価が甘いのかも
しれません。最終回に提出したエッセイは以下のようなものです。
グラマーのミスはあるものの、よいエッセイだねというのが５人の
フィードバックのポイントでした。

From the Primary healthcare course, I learned that

-Declaration of Alma-Ata defined the primary healthcare from the experience of the Ding Xian in china and this definition become the basic concept in the world and is still respected.

-The Alma-Ata definition address the comprehensive approach which is community based.

-Primary health care is essential health care based on practical scientifically sound and social acceptable and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

-Primary healthcare is the first level of individuals, the family and community with the national health system bringing health care as possible to where people live and work, and constitutes the first element of a continuing health care process;

-Primary healthcare addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly.

-It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community.

 

Unfortunately, primary healthcare moved on focusing the selective approach in 1980’s. That is because the selective approach is relatively easy to show the effectiveness which the founder want to know quantitatively to use the limited money effectively and selectively. The debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combing the strengths of both approaches in health systems. Achievement of high and equitable coverage of integrated primary healthcare services requires consistent political and financial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and effective linkages with communities and non-health sectors. Community participation and intersectroral engagement seem to be the weakest stands in primary health care.

 

The Census-based, impact-oriented approach is important for the integrated primary healthcare because it shows the performance of the project by using the numbers which are based on the information the community home visitors gather. This approach address that the role of the community health workers is important. They visit homes to gather basic information for CBIO, teach and consult the daily life to prevent illness health, look at each condition and care by themselves or asking the clinic or hospital.

BRAC, SEARCH and Brazilian government approach, which are well-known projects succeed to decrease the mortality of children under 5 years old, used this approach as well.

 

We have good methodologies and examples to improve the health for all by the help of many forerunner’s challenge and effort. However we have to improve the technique or approach more effectively by limited resource. To do so, we have to continue to research and study comprehensively and precisely to confirm the evidence of new challenge.

 

I will do 3 things to help achieve health for all through primary healthcare from now on as follows;

1.

I want to propose a new primary health care approach which focuses on people who need care including older people in Japan. I learned that community workers play a huge role for community based primary healthcare. They visit home where mothers live and give much information to prevent the disease. And they make advice how to cure and where to access if mothers or children feel bad.

We Japanese must consider how to construct the primary healthcare for the aged people as well as for children and mothers in regional area. Now Japanese government tries to change from free access to medical facilities to clinic first hospital second. And also try to make the system of caring at home which doctors and/or nurses visit home to take care instead that patient goes to clinics by themselves.

In addition introduce the care managers who make the care plan for the elder or disabled people who are want to be cared by using national nurse care insurance. The care managers sometimes visit home to assess whether the plan is effective or not. But I think the last 1 mile is not enough. The medical stuff including care manager doesn’t have to visit the every home even if there are some people who don’t know how and where to say ” help”.I realize that we have to introduce the community workers system for elder people to confirm whether they are healthy or not frequently.

The challenge is that we have to ask the community workers to be volunteers. In old Japan, neighbors sometimes play such kind of role to say hello each other every day. But the more Japanese become urbanized, the weaker the people care of neighbors within the small regional area.

On 2011 March 11, Japanese suffer from the earthquake and Tsunami. Some medical systems in north east Japan were destructed. Some area lost the hospital, other area lost several clinics. Community was broken. There are many people who lost family or friends or neighbors. Now so many volunteers visit many kinds of home to take care of them. However those activities are temporary and not sustainable. And if we use the paid community workers, we must prepare huge money to maintain the system while Japanese government have to pay huge money for healthcare and nursing care even if  the Japanese government bonds is twice as GDP, which is the worst in the world.

I think local government and the hospitals which are certificated the support hospital for region by local government must consider making the voluntary community workers with clinic, care facilities and care managers. 

I have the responsibility to develop the certification system for the hospital management –Japan healthcare Quality club, which are supported by the Japan productivity Center Foundation.  So, I want to improve the primary healthcare by

-ad new view point to the criteria for assessment of hospital management

  For example; how do you improve the community based primary health care

-advice the top runner hospital’s top management to make own primary care system cooperated with neighbor medical clinic to collect the volunteer-based medical workers as a model

-collaborate with the doctors and supporters who immediately went to the city in the North east Japan after the Tsunami and medical system broke

 

2.

I want to show the circumstances and situations of primary healthcare to the business person who want to learn how to make a new global business. In business world, the reverse innovation is in the spotlight. It explains the phenomena that a new idea in and for the developing countries who have few resources become wonderful product and service not only for the developing countries but also for developed countries.

I think new approach of Primary healthcare have a potential to become global standard like reverse innovation.

I have a management course of the company’s inner university. Some business person may be inspired to make new business to support the primary healthcare in developing countries or to support the funds as one of the CSR activities in targeted business market.

The challenge is to change the business person’s way of thinking which they have no chance to make business by supporting the primary healthcare in the countries that has not started developing yet. I have to gather and show them many types of the example which the business succeeded economically and socially in the developing countries.

 

3.

I want to continue learning and make sure the needs of the primary healthcare. Dr. Perry showed the retreated countries in terms of the children mortality. Such countries suffer from political uncertainness. I think if national government is unstable, sometimes the leader won’t invest the primary healthcare even if their many children will die by the disease which is preventable. Honestly, I don’t make sure whether we have to support such country when the global resources like money and human resources are limited.   

The challenge for me is to overcome such a prejudice. But I will continue to learn with the Spirit of Alma-Ata in words of RajArole.

Health services, no matter how efficient, cannot change the condition of marginalized people unless they are helped to become self-reliant and the root problems addressed.

People who are poor and illiterate are like uncut gems hidden under the dirt and stone. Given the opportunities, they can reach their full potential and live as responsible, sensitive human beings, possessing self-reliance and the liberty to shed those old customs and traditions that impede health and development.