Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Leadership in Primary Health Care: An International Perspective

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Leadership in Primary Health Care: An International Perspective

Article excerpt


Leadership is a topic high on the global nursing agenda. It is especially important to those practising in areas where they have the capacity to achieve the goals of primary health care (PHC): promoting access, equity, empowerment, and intersectoral partnerships to improve health, prevent illness or injury, and assist people in their recovery and rehabilitation. A PHC approach is strategic, and takes place across the health illness continuum in specialised arenas such as school and occupational health, community midwifery, chronic disease management (diabetes education, cancer prevention), practice nursing (PN) and other types of practice that revolve around health promotion and continuity of hospital, home and community care. In each of these contexts, nursing is based on client mobility rather than a residential model of care, and nurse-client interactions may be intermittent but long term (PorterO'Grady 2003).

This paper addresses the convergence of primary health care and leadership as an essential foundation for practice. In the case of PN this foundation is pivotal to the evolving role, which stretches the boundaries of traditional nursing practice. In contemporary general practice, PNs require a depth and breadth of leadership skills that are responsive to health needs, appropriate in the social and regulatory context of nursing, and visionary in terms of balancing the constraints of a shrinking workforce with persistent and multidimensional client needs.


Primary health care is a well worn phrase which, in today's Healthcare environments, attracts critical debate even among its earliest advocates. The rhetoric has changed only slightly since the Declaration of Alma Ata three decades ago, but the expectations of primary health care have changed considerably, particularly in pondering the failure of the 'Health for All' movement to achieve its ambitious goal by the year 2000 (World Health Organization 2005). In recognising some of the shortcomings of primary health care and Health for All in the latter part of the last century, the World Health Organization (WHO) has recently reframed its strategic directions around the social conditions of life that create inequitable conditions for health in our communities. We now have a global understanding that the social and economic conditions of a person's life are responsible for around 50% of their health status, with 25% being attributed to health care systems, 10% to the physical environment, and the remaining 15% to biology and genetic endowment (Canadian Institute for Advanced Research 2002). In May 2008, the WHO is to produce its final report identifying actions to address the vast disparities that have accompanied global economic expansion and widespread political turmoil (Schofield 2007).

In 2005, the newly established WHO Commission on the Social Determinants of Health, provided a series of background papers to guide debate (WHO 2005). In one of these, members of the WHO argued that, as a global movement PHC has always presented 'a compelling narrative of justice, human flourishing and social transformation' (WHO 2005:43), however, they criticised the rhetoric of PHC for being 'draped in moral language, technically vague and financially unrealistic' (WHO 2005: 17). In the context of 'social determinants', the idealised notions purveyed in the Declaration of Alma Ata have not adequately addressed the political solutions required to resolve the deep marginalisation and impotence of poor, rural people throughout the world, including those in our rather privileged nation. The plight of the poor and vulnerable in society has also come into clearer focus since globalisation. Today, we see unprecedented wealth among a small minority of citizens and, despite rapid developments and greater understanding of health and wellbeing, the gap between rich and poor continues to widen. This has been called 'modernity's paradox' (Keating & Hertzman 1999) and it is a core inequity issue of concern to nurses. …

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