SIX RECOMMENDATIONS TO ADDRESS THE NEW CHALLENGES OF PRIMARY CARE. A REFLECTION IN THE LIGHT OF THE NEEDS OF CURRENT SOCIETY

Abstract

Primary Care is involved in a crisis caused by the exhaustion of the model created from the declaration of Alma Ata in 1978, a model that was successful but now needs updating to safeguard its principles: universal access, community orientation, focused on people, proactive attitude, and problem-solving capacity. To make the reforms viable, it is first necessary to analyse the ballasts that are holding them back, of which the following stand out: the quota allocation system, the indiscriminate management of agendas, the excessively compartmentalized organizational model, the scant emphasis on community health, the hierarchical and bureaucratic management model and the isolation from other services, both those that operate in the same territory and hospitals.

To preserve the principles and combat the burdens, six recommendations are proposed that should be developed in a new framework with a larger budget than the current one. The proposed recommendations are the following: better demand management, a key issue to break the bad image of closed health centres, creation of comprehensive teams to offer more and better services, reorganization according to the needs of the different population groups, redefinition of community health programs in light of the evidence and the real characteristics of each neighbourhood, expansion of the portfolio of diagnostic and therapeutic services, while creating cross-sectional clinical trajectories with hospital specialists and, finally, greater involvement of users and professionals in a more open management that learns to be accountable instead of being subject to so many prior controls.