13 A WHO guide for planners, implementers and managers
What is primary care and why should palliative care be integrated into it? According to the WHO Constitution: “Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human being”
(12). Further, “health is a fundamental
human right indispensable for the exercise of other human rights”
(13). Around the world, especially in
LMICs, most people with any of the myriad types of suffering associated with serious or life-threatening
health problems lack access to palliative care. It is estimated that 40 million terminally ill people, and
millions of others not imminently dying, need palliative care every year. But 86% of those in need do not
receive it, including 98% of children in need in LMICs
(1,11). Access is least likely in the community where
most of the patients are and wish to remain. Thus, millions of vulnerable people are being denied their
right to the highest attainable standard of well-being. Most suffering due to serious or life-threatening
health problems can be relieved with inexpensive, safe and effective medicines and equipment prescribed
by any physician, clinical officer or assistant doctor with basic palliative care training. Typically, the only
care available in the community is PHC. Given these facts, it is both medically and morally imperative that
palliative care be integrated into PHC
(14,15).
What is primary care?
According to the Declaration of Alma-Ata from 1978, PHC (Annex 1): n
is essential health care based on practical, scientifically sound and socially acceptable methods and
technology;
n
should be universally accessible to individuals and families in the community;
n
should be affordable for the community and country at every stage of their development;
n
is the central function and main focus of the country’s health system;
n
is essential for the overall social and economic development of the community; and
n
is the first level of contact with the national health system and brings health care as close as
possible to where people live and work.
