Immigrant Women and PHC

Introduction

Primary health care is the first contact a person has to health system and relates to people who are not admitted to any hospital. Primary healthcare in Australia is controlled by the general practitioners (GP), but also includes nurses, midwives, aboriginal health care worker, dentists and pharmacists. The focus of primary health care is to provide equal health care to all, considering general practice services, early intervention, management and treatment and prevention and screening. The PHC services can be provided at home or community wide set ups. The primary goal of Primary Health Care Networks (PHNs) is to reduce the number of visits to emergency departments, chronic and complex illnesses are promoted and provided through an affordable system to make this happen (Health, 2018). According to the Alma-Ata (1978) the principles of primary health care are:

• “universal access and coverage on the basis of need
• health equity as part of development oriented to social justice
• community participation in defining and implementing health agendas
• and intersectoral approaches to health” (Organization, 2003)

The principles of primary health care have been accepted by countries under World Health Organization (WHO). The role of PHNs is to provide primary healthcare for all the population without any biases. Vision of Alma-Ata was to make primary health accessible to everyone without exception, the community should participate and the affordability has to be according to the country’s economic conditions. Another aspect of the Alma-Ata was that the treatment of the diseases should first be decided to be acceptable to all communities that is nothing was to be enforced. Australia and WHO has a strategy planned for 2018-22 namely the Australia -WHO country cooperation strategy (CCS) 2018-22, this is to provide collaboration between WHO and Australian Government Department of Health. According to this CCS WHO will contribute to the health sector of Australia, Australia will       create awareness of health priorities nationally and globally and both will work hand in hand to promote a healthy lifestyle for all (health, 2017).

Primary health care networks (PHNs) were created to provide health care especially for the sector od the population that are more vulnerable to bad health due to limited access and lack resources. This includes minorities such as Immigrant women. Mental health, Aboriginal and Torres Strait Islander health, population health, health workforce, digital health, aged care, and alcohol and other drugs these are the 7 priorities set by the department of health for the PHNs. The PHNs are funded through Commonwealth set up by the Health care department, the PHNs are to follow given set of rules and work within the subject of the activity to be conducted, the records and the results are to be provided to the healthcare department for check and balance. 31 PHNs were set up by the government in 2014-2015 and a total of $852 million has been allocated to these PHNs for three years from 2015-2016 onwards. The eligibility criteria for PHNs include having skill based boards, qualified workers, general practitioner led clinical councils and PHNs must have connections with local hospitals to get closer to the people (health, 2018).        

Immigrants Australia

Looking at the population of Australia, in 2016 the total number of people above the age of 15 were 19.1 million of which 6.8 million were immigrants and of these 6.8 million around 1.9 million were born elsewhere and were 15 or over at arrival which was after 2006. This represents 10% of Australia’s population and 57% of these immigrants migrated recently and 588,200 had a permanent visa and 360,200 became Australian citizens (Statistics, 2017). All this is to show that the immigrant women (considering 50% of the total number of these recent migrants) is a minority in Australia but is still a significant part of the population and requires attention of the PHNs set up to serve all people in Australia.

Immigrant Women

All women need sexual and reproductive healthcare (SRH). Immigrant women in Australia are not able to get optimal SRH according to a research based on interviews of Health care professionals (HCPs). The problems pointed out by the HCPs were lack of knowledge of SRH, SRH in the country of origin of the migrant, lack of involvement of male partners which all constitutes on the matter of decision making on part of the migrant woman. Apart from the constraints generated from the difference of origin HCPs said lack of funds, limited resources, time constraint and lack of service contributed to the less than optimal SRH for immigrant women (Mengesha ZB, 2017). One of the HCPs explains:

 “They're not things that the community just discuss openly, so I think because of that it's actually kind of hard to find out what services exist because if you're asking about the services, you're asking about the—you're opening the topic of the sexual and reproductive health issues…if you've got a vaginal discharge I think that's quite difficult to talk about that to somebody, so therefore how do you know where to go? I think it's just about what the issues are that we deal with, make it hard to find out where the services are” (Mengesha ZB, 2017). 

The problems that immigrants face in Australia are that the ethnic groups also have divisions in them such as classes and genders. Australia like Canada and New Zealand has immigrants that settle, that is the the immigrants come in with families.

The healthy migrant effect states that the health benefits that immigrants get in the start is high but declines as their stay prolongs relative to the native background Australian. As reported by AIHW in 2002 migrants have better health as compared to local born people, they are hospitalized less and have lower death rates, but this does not only show that migrants are treated in a better way but is due to the fact that migrants have to meet a certain health level to become eligible to earn the migration. As diverse as Australia is language barriers still is concern for women who do not speak the native language- 28.1% of Australia’s population is diverse linguistically and culturally- these women have less accessibility to PHC due to lesser knowledge of the language (Smith, 2015)

The accessibility factor for immigrant women comes in due to lack of understanding of language which leads to lesser knowledge of the health care opportunity she has access to, to emphasize the language problem cancer in Armenian means death. Apart from language finding out about what services they have been accustomed to is hard as well for the HPCs. The gender roles in some culture do not allow a women to include their male partners to sexual diseases or the mental health due to sexual tensions is never realized. Women seeking asylum in Australia may also have been subject to medical torture or have gone through interrogation procedures which have been traumatizing for the immigrating women, hence getting these people to receive medical help is very hard. Many of these refugee women have not come across social workers or occupational health workers in their country of origin so their first interaction has to be dealt by people who can empathize with them. Some women from Middle East find it terrifying that any male doctor would diagnose them, this makes it hard on the doctors and the patients. So many different cultures mean the health workers have to learn what is acceptable to each individual even if they were to communicate to understand or to teach the barriers are many (Ahmed, 2003).

Apart from these the expenses to be paid for health care is also a problem for many of these migrating women. 8-10% of the immigrant population is considered to be refugees who have left their belongings and careers in their countries and are low in financial resources (Glenn, 2015).  People like Sara, an Iranian refugee, who moved to Australia fleeing from war find it very difficult to adjust. Sara was just 13 when the war on Iraq began and instead of attending school she was hiding from bullets being fired at her house. After three years of war in Baghdad Sara and her family fled to Syria and applied for immigration to Australia. The Humanitarian settlement services provider gave kitchenware and basic furniture to Sara’s family once they moved here, this emphasizes the low financial state these people are in when they migrate here. Sara couldn’t speak any English when she arrived and had to learn the language before she could understand what healthcare benefits she can afford, to afford living here she had to juggle two jobs all while carrying on her studies at TAFE. This shows the affordability of the overall lifestyle in Australia (services, 2018).

Read More