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The Primary Health Care (PHC) approach emerged in the late 1970’s Through its emphasis on making health care accessible to local communities, socially and culturally acceptable but also affordable basic health services had laid the groundwork for the emerging Primary Health Care approach.

In 1978 the World Health Organisation (WHO) established the goal of "Health for All by the year 2000" with the following definition:

"Health for All" means that health is to be brought within reach of everyone in a given country. And by "health is meant a personal state of well-being", not just the availability of health services - a state of health that enables a person to lead a socially and economically productive life. "Health for All" implies the removal of the obstacles to health - that is to say, the elimination of malnutrition, ignorance, contaminated drinking-water, and unhygienic housing - quite as much as it does the solution of purely medical problems such as a lack of doctors, hospital beds, drugs and vaccines.

"Health for All" means that health should be regarded as an objective of economic development and not merely as one of the means of attaining it.

"Health for All" demands, ultimately, literacy for all. Until this becomes reality it demands at least the beginning of an understanding of what health means for every individual.

"Health for All" depends on continued progress in medical care and public health. The health services must be accessible to all through primary health care, in which basic medical help is available in every village, backed up by referral services to more specialised care. Immunisation must similarly achieve universal coverage.

"Health for All" is thus a holistic concept calling for efforts in agriculture, industry, education, housing, and communications, just as much as in medicine and public health. Medical care alone cannot bring health to hungry people living in hovels. Health for such people requires a whole new way of life, and fresh opportunities to provide themselves with a high standard of living.

The adoption of "Health for All" by a government implies a commitment to promote the advancement of all citizens on a broad front of development, and a resolution to encourage the individual citizen to achieve a higher quality of life.

The basis of the "Health for All" strategy is primary health care.

The implications of "Health for All’’ are interpreted, under the heading Health Reform, as requiring fundamental changes in public policy ie.

• Restatement of health policy to reflect equity in health
• Reallocation of resources
• Restructuring of health delivery services
• Redirection of educational preparation of health personnel

In 1979 the International Council of Nurses (ICN) confirmed the nursing profession’s commitment to the WHO goals. This, in turn, automatically committed RANF and the Australian nursing profession to action designed to meet these goals.

In its shortened version, PHC is defined by WHO as:

In the Alma-Ata Declaration, 1978, P.H.C. is declared as the strategy for achieving "Health for All". It establishes the broad based principles that give to people the right to health services where they live, work and play and also enables them to take on the responsibility of promoting their own well-being and that of their community.

Nurses have been identified as the key personnel in implementing the changes essential to the acceptance and expansion of P.H.C. The potential of nurses to take their place in the forefront of the "Health for All" and to play a crucial role therein was outlined in 1985 by the Director General of the WHO Halfdon Manler:

    ¾ The role of nurses will change; more of them will move from the hospital to the very day life of the community, where they are badly needed.

    ¾ Nurses will become resources to people rather than resources to physicians; they will become more active in educating people on health matters.

    ¾ Nurse leaders will increasingly innovate and participate in program planning and evaluation.

    ¾ Nurses will participate more actively in interprofessional and intersectoral teams for health development.

    ¾ More and more nurses will become leaders and managers of primary health care teams; this will include guiding and supervising non-professional community health workers.

    ¾ Nurses ill thus assume greater responsibility for taking decisions within health care teams.

Four major factors are recognised as fundamental in supporting these changing roles and functions of the nurse:

• nurse attitudes and values
• reorientation of education programs
• better resource allocation
• well defined policies and plans for the development of nursing personnel.

The key role of nursing in implementing the essential changes in primary health care is clear. Nurses have the power to facilitate health for all by examining health promotion, cost effectiveness and policy over and above their role in clinical intervention.

Nurses thus have a responsibility to lead the change. They need to identify the strategies and actions that will be required to exercise their full leadership potential. They need to look beyond the expansion of traditional nursing roles of mere cosmetic changes in the educational programs to a deeper understanding of the philosophy of primary health care and a commitment to its values and goals.

Defining areas of action, eliciting and evaluating response, argument and advocacy are also part of the process. The complex task of implementing change demands that leaders for Health for All have a:

    ¾ Clear understanding of the Health for All Strategy and its broad principles;

    ¾ Capability to identify critical issues affecting the implementation of the Health for All Strategy and to focus energy on resolving them, and to convert obstacles into opportunities;

    ¾ Capacity to motivate others, especially other prominent colleagues and influential groups, to mobilise their commitment to the values of Health for All and to solve problems;

    ¾ Commitment to guide national policy toward social equity and to reduce health inequality and related socioeconomic inequity among, and people, and

    ¾ Comprehension of the health aspects of policies of other sectors and an aptitude to argue for health in an intersectoral setting.

R.A.N.F. ACCEPTS THIS RESPONSIBILITY AND CALLS UPON:

    · EDUCATIONAL INSTITUTIONS/SCHOOLS OF NURSING (wherever sited)

    · POLICY MAKERS (however titled)

    · NURSE REGISTERING AUTHORITIES

    · EMPLOYING AUTHORITIES

to review all relevant policies and programs to reflect and incorporate the principles and values of the Health for All strategy. Importantly this will include among many other significant issues the promotion of P.H.C. as a fundamental component of nursing education, and the implementation of career structures which allow flexibility for nurses to be innovative and to exercise leadership.

Acknowledgment: In preparing this position paper RANF has drawn on the WHO publication "Leadership in Nursing for Health for All, A Challenge & Strategy for Action", April, 1986 (published 1987).

September, 1987