EXPERIMENTACIÓN CON TRANSPORTE DE SEDIMENTOS EN RÍOS Y CANALES

A WHO (2008) report on primary health care identified impatience with the inability of health services internationally to deliver levels of national coverage to meet changing health and societal need. The report clearly indicated the necessity for a renewal of primary health care systems as an alternative to the “quick fixes currently touted as cures for the health sector ills” (p.xiii). A primary health care paradigm privileges a broader remit than the provision of episodic care for ill health. It works toward the development of health by putting the emphasis on prevention, community involvement and working with sectors outside of health (Keleher, 2000; Sweet, 2010).

The significance of primary health care to the health of individuals and communities was declared at the Alma Ata conference (1978). This conference called for urgent action and for “all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world”(WHO, 1978, p.1). Primary health care was defined as

essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination (WHO, 1978, p.1).

As an integral part of the country's health system, primary health care brings health care as close as possible to where people live and work. It constitutes the first element of a continuing health care process.

The Alma Ata Declaration suggested a paradigm shift by providing a set of primary health care principles and challenging the way communities and health professionals perceived health and ill health (Holdaway, 2002; MoH, 2001; Sheridan, 2005; Thomas, 2006; WHO, 1978, 2008). The Declaration identified the need for health care to focus on the prerequisites of health and the basic elements of health care. It reaffirmed health as a fundamental human right and asserted that people had a right to be active participants in planning and implementing their health care. Three key principles were identified that underpin an effective primary health care system:

1. Equity

2. Promoting good health 3. Multisectoral cooperation

The diffusion of innovation theory proposes that the objective benefits of an innovation on their own do not guarantee widespread adoption. What matters more is the degree to which it is perceived as advantageous by those making the adoption (Rogers, 2003). Undeniably the WHO faced significant obstacles when trying to operationalise primary health care following Alma Ata (Thomas, 2006). The application of the principles proved internationally inconsistent (Neuwelt & Crampton, 2005). Despite clear evidence to encourage the benefits of providing primary health care (Abel, Gibson, Ehau, & Tipene Leach, 2005; MoH, 2001; Starfield, 2006; WHO, 2008), western governments did not begin acknowledging the social determinants of health, health inequalities, or the strengths of community involvement until the 1990s (International Council of Nurses, 2008a). In New Zealand, it took twenty five years for the language of primary health care to make its way into New Zealand health policy (Neuwelt & Crampton, 2005).

The diffusion of innovation theory argues that many innovations require a lengthy period of years from the time the innovation becomes available to the time it becomes widely adopted (Rogers, 2003). Even so called “evidence based innovations undergo a lengthy period of negotiation among potential adopters, in which their meaning is discussed, contested, and reframed”

(Greenhalgh et al., 2004, p.594). Despite delays in operationalising a primary health care approach, there is a renewed commitment to invigorating the public health agenda internationally so that primary health care is firmly at the centre of health care delivery (McMurray & Cheater, 2004; Thomas, Reynolds & O’Brian, 2006).Growing awareness of the importance of health promotion and disease prevention juxtaposed with increasingly scarce health care resources has activated this commitment (Bailey, Jones & Way, 2006; Jerden, Hillervik, Hansson, Flacking & Weinehall, 2006; WHO, 2008).

In the New Zealand context significant policy change was signalled in 1999 when a change of government saw the left-wing Labour Party form a coalition with the Alliance Party (1999-2008). The coalition’s health policy agenda was concerned with building patient confidence in the health system with a strong focus on patients. It signalled a move away from a targeted approach of supporting primary health care to certain groups of the population, toward a universal approach where all New Zealanders were eligible for government funding for primary health care (Cumming & Gribben, 2007).It emphasised local decision-making by democratising service governance while orientating health policy and services toward upstream public health goals (Gauld, 2009a). Upstream approaches in public health seek to understand cause of disease and preventable disability so that the source can be addressed through prevention rather than treatment (Royal College of Nursing, 2012).

In 2001 the government released the Primary Health Care Strategy as a stimulus for primary health care development in this country. The Strategy outlined the most significant proposed change to the scope of New Zealand’s public health system and concurrently provided the opportunity for nursing to advance its contribution (Carryer, 2005; Finlayson et al., 2011; Hefford et al., 2010; Sheridan, 2005; Tully & Mortlock, 2005).