Læknablaðið - 01.04.1979, Blaðsíða 87

LÆKNABLAÐIÐ
107
Hákan Hellberg, M.D.
ORGANIZATION OF PRIMARY HEALTH CARE
IN FINLAND
1. GENERAL BACKGROUND
Development and organization of PHC in
Finland should be considered against a long
tradition of local self-government originally
based on the local church parish and from the
1860s on rural and urban municipalities exer-
cising political self-government. The influence,
guidance and control of central government is
carried out through legislation determining
certain tasks and responsibilities of local muni-
cipalities as well as financial support provieded
by eentral government and also through direc-
tives and planning mechanisms. The responsi-
bility for delivering health care to the popula-
tion lies with the municipalities who partLy
finance such services through local taxation and
develop the service functions within the frame-
work of government legislation and directivies.
The first directives to local municipalities
were given in 1865 concerning communicable
diseases and in 1879 municipal health boards
were established, one of their defined tasks
being occupational health. The first medical
officer was employed by a municipality in 1882
and in 1886 it was agreed to start paying cen-
trai government subsidies to municipalities for
medicsil officers employed by them. Thus an
important model was established for the future
relationship between municipalities and central
government in the field of health care.
2. DEVELOPMENT OF BASIC HEALTH
SERVICES
Based on the above model, the municipalities
gradually developed basic health services for
the local populations with a „vertical" approach
tackling problem areas one by one. During the
first half of the 20th century, this naturally
meant preoccupation with treatment and con-
trol of communicable diseases.
Vaccination programmes were introduced and
the response from the population very soon
became positive and good coverage achieved.
From 1952 no immunizations in Finland have
been compulsory for the general population
but the coverage is very good with e.g. 98% of
the children receiving PDT and BCG vaccine.
Also a vaccination campaign in 1974—75 for
the age bracket of 3 months to 18 years due
to an epidemic of meningitis achieved a cover-
age of 87%.
Health care staff was employed by the
Hákan Hellberg er yfirlæknir hjá finnsku
heilbrigðisst.iórninni.
municipalities on a salary basis but doctors
also had private practice. Norms were deve-
loped whereby rural municipalities received
subsidies for employing one public health nurse
and one midwife for every 3000 people and a
doctor for every 8000. In urban areas there were
different and more flexible norms, but during
most of the period in question the majority of
the population was rural.
Already before World War II maternal and
child health services were developed here and
there in the country but from 1945 these
services were by legislation extended to cover
the entire population regardless of location and
wealth. From the beginning, the emphasis was
on health promotion and disease prevention.
Contacts with public health nurses and mid-
wives were regular thus providing continuity
of care, good social contact and mutual con-
fidence. The services were provided free and
early and regular attendance Ied to certain
social benefits that no doubt assisted towards
rapidly developing utilization and acceptance.
The improvements in Finnish maternal and
child health statistics from 1945 to the present
must to a very large extent be attributed to
he MCH services.
Infant mortality rates in selected countries
1935—1972
1935 1950 1961 1972
Finlomd 66.8 43.5 20.5 12.0
Sweden 45.9 21.0 15.3 9.9
U.S.A. 55.7 29.2 25.3 18.5
The close social contacts and the continuity
of the MCH work based on a relationship bet-
ween the family especiaily the mother and the
public health nurse/midwife including aspects
of nutrition not only of infants and children but
the whole family, hygiene and home develop-
ment etc., would seem to justify identifying
this type of MCH work not only as basic health
service but as primary health care. It not only
involved delivery of services by the peripheral
health system but also participation by the
community. The schools and different civic
organizations accepted the same goals and
methods as those provided by the municipal
MCH services thus multiplying the efforts
originating in the peripheral basic health ser-
vice.
The role of the doctor in the development
of basic health services and early forms of