The Future of Primary Care in Nepal

For patients in countries with established primary care infrastructure, your local primary care facility is where you go when you feel unwell, your first point of contact in the community for non-emergency care. Your Primary care provider ensures people receive quality comprehensive care - ranging from promotion and prevention to treatment, rehabilitation and palliative care.

Something that is often overlooked in South Asia, focusing instead on seeking specialist care when health problems arise. This creates the illusion that healthcare has advanced in every aspect, but this is far from the truth. 

The consequence of inadequate primary care can be detrimental to your health, often leading to higher healthcare costs, unnecessary investigations and over-prescription of medicine, which does more harm than good.

So, what does effective primary care look like?

Primary health care is about holistic, personalised care. In essence, it is based on caring for the person rather than a specific disease. This means that professionals working in general practice are generalists with a broad range of skills and knowledge and deal with a wide range of physical, psychological and social problems on a daily basis. An essential role for primary care doctors is acting as the patient’s advocate and coordinating their care.

The importance of this really becomes apparent when working and living in countries that do not have primary care infrastructure. In Nepal, patients are burdened with navigating through ad-hoc clinics, pharmacies and internet search engines to find information on their condition and hazard a guess on which speciality they should seek help from.

This often results in patients paying for several different doctors until they finally find the right doctor for them. All of this would have been avoided if they had a primary care facility they could rely on. Primary health care involves providing treatment for common illnesses, the management of long-term conditions such as diabetes and heart disease and preventing future illnesses through advice, immunisation and screening programmes.

The world is undergoing a digital revolution, particularly in healthcare which the Coivd-19 pandemic has only accelerated.

Why is Primary care desperately needed now?

Around the world, we are seeing another pandemic, which has been rapidly rising right under our noses—the pandemic of non-communicable disease (NCD). NCDs refer to a group of conditions not mainly caused by an acute infection, resulting in long-term health consequences and often creating a need for long-term treatment and care. 

 These are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. NCDs account for 71% of all deaths globally, and 77% of all NCD deaths are in low- and middle-income countries. 

The root cause of many of these conditions lies in our lifestyle risk factors and our genetics. However, there is light at the end of the tunnel - risk factors can be modified, and disease can be prevented. 

 Who better to help with this than your primary care physician? The therapeutic relationship established in primary care allows the clinician and their team to identify patients and their risk of disease to intervene early. In contrast, hospital specialists will typically only see patients regarding a particular condition in a snapshot setting and hence miss this opportunity. 

 Going one step further and innovating in primary care to reduce administrative tasks and streamline services means primary health care providers have more time to engage with their patients. Optimising patients’ lifestyles, risk factors, and chronic illnesses will ultimately help them live their happiest, healthiest life.

 It is clear that good PHC is an essential precondition for any healthcare system, and so going forward, it is clear that implementing effective primary healthcare infrastructure will lay the foundations of better health for all.

Source: Burgeoning burden of non-communicable diseases in Nepal, www.biomedcentral.com