Abstract
A Synthesis of the Role and Structure of Primary Care Service System: in the Context of Health Professional and Health Services A Primary Care Service System (PCSS) is believed to be the system that can enhance people’s health. However due to the unclear policy and concepts of PCSS and the policy announcement on univeral health care coverage, each health care setting creates its own management. This synthesis was made in order to find out the role and structure of PCSS and roles of health professional personnel including physicians, nurses, pharmacists and dentists in the transition period. The data were synthesized from 8 case studies. The findings were as follows : PCSS is defined as the fundamental care service aiming to provide health promotion, disease prevention, therapeutics and rehabilitation services to individual, family and community through the holistic approach and continuation. Home health service is also included. It is the health service place which is near, is easy to access, has needed services and the service is provided by professional persons who work as a team and coordinate with a community organization. There is a network of service and an effective referral system. PCSS is aimed to empower people to be health self-reliant and promote family and community participation in health building.PCU structures 1. Establishment of a PCU as on an extended OPD. It is located in the hospital building or hospital area or in an urban area. It has permanent staff or hospital staff taking turns to work in the PCU. 2. Establishing the PCU in a hospital or in an urban area to be a PCU model. Permanent staff are hired to work in the PCU. 3. Adjusting or extending the activities of social medicine or home visit teams to be multidisciplinary teams and visit both discharged patients, chronically ill patients and general people at home. 4. Development of a potential health center, public health center or community health center to become a PCU by changing personnel’s way of thinking and working, emphasizing health promotion and disease prevention , providing systematic home visit and assigning health personnel from contracted units of primary care service (CUP) to work temporarily or permanently at PCU. 5. A drug store serves as a PCU by providing knowledge on drug use and health promotion. The main persons who work in PCUs are nurses and public health personnel. Some PCSS, physicians or pharmacists may work every day or a few days per week and dentist may come occasionally. In some PCUs there are dental health worker and sanitation worker in the team. Each profession has roles as follows: Physicians : perform physical examination, make diagnosis, give treatment, teach and advice, do home visit and administer the PCU. Nurses : perform child health examinations, give vaccinations, do ANC care, teach and advise, do physical examinations and primary medical care, make home visits, do data surveys and family folders, do surveillance, build community collaboration, and administer PCUs (when there is no physician). Pharmacists: provide pharmaceutical care at PCUs and home, do drug administration, give prescribed drugs, provide suggestions or counseling on drug use. Dentists: do dental treatment including pulling teeth, filing, polishing the enamel surface, giving pain control medicine; provide oral health promotion and prevention including dental advice, advise use of fluoride in those who risk tooth decay and provide advice for oral care.Conditions for the success of PCU include: 1. Understanding and experience of administrators and personnel in doing similar projects. 2. Participation of administrators and personnel in policy identification and guidelines development. 3. Building difference and creating value to the service. 4. Paradigm shift and change of working style among personnel. 5. Provision of essential knowledge and skill for personnel. 6. Building understanding and clarity in role and responsibility of each personnel building morale. 7. Good attitude toward teamwork and respect for others. 8. Adequate manpower and appropriate workload. 9. Having professional people as required. 10. Understanding primary case concepts and commitment of administrators. 11. Strong support from community organization. 12. Provision of appropriate budget by the government. 13. Building more knowledge on primary care through continuous research.
