Discussion

Over the years, the prevalence of chronic disease has become a major concern for people all across the world. Primary health care services have been implemented with the basic aim of proving care and support to patients along with the establishment of a therapeutic relationship (Gabe, Harley & Calnan, 2015). However, there are disparities in the health care services observed across the world that increases the mortality rate due to the chronic disease (Wang et al., 2016). The major purpose of the paper is to provide a comparative study of the various health care strategies followed in Australia and India to gain the understanding the difference in the health care system that contributed to the burden of chronic disease. Various social determinants of health are followed with the aim of a better future and a healthy environment. Therefore, this paper will illustrate differences in primary health care between two nations and the impact of nurses in them in the following paragraphs. 

Due to increased prevalence of severity of the chronic disease, a considerate number of individuals are suffering from the health disability amongst the around the globe. Australia and India, two major countries are not an exception of it.  A study by Diwan et al. (2016), suggested that in Australia, one in two individuals are suffering from chronic disorders such as arthritis, back pain, and cardiovascular disease that affected the quality of life. Another study by Thawesaengskulthai, Wongrukmit, and Dahlgaard (2015), suggested that due to the prevalence of the chronic disorder the date rates are five times higher than any other countries. Although the metropolitan part of Australia has become advanced in terms of the health care system, the aboriginal populations are still deprived of the health care facilities due to social demographic status and lack of adequate educations and distinct cultural beliefs. On the other hand, considering the third world country such as India, the prevalence of chronic disease is higher compared to Australia. A study suggested that chronic disease such as obesity, back pain, and cardiovascular disease affected approximately 45 % of the individual. Another study highlighted that approximately 1600 out of 100000 individuals are suffering from asthma in India.  Philip et al. (2018) suggested that approximately 35% of the hospital stays in India are observed because of the non-communicable chronic disease that not affected the physical condition but also affected the psychological condition of individuals.  Social, determinates play a crucial role in causing these differences. Soet al. (2016), suggested that in Australia, the economic status and financial performance is greater compared to India which contributed to better health care facilities for the nurses. The poverty rate of India is 8 times higher compared to Australia, whereas the mainly aboriginal individual is suffering from the health care disparities (Philip et al. 2018). Besides, the unemployment in rate is higher in India where because of the strong educational system and prevalence of the trending business, the unemployment rate is lower in Australia. Consequently, in India, 3 out 10 individuals are suffering from the major depressive disorder and anxiety disorders (Saramma et al., 2016).  Therefore, global burden of the disease is significantly higher in India compared to Australia. 

The Role of Nursing Professionals in Primary Healthcare

Nurses being the frontline health care professionals, contributed mostly in the enhancing the health care process in order to achieve a positive outcome from the patient. A study identified that there is a considerate number of differences observed in the primary hear care system, the major one is lack of adequate power in nursing professionals (Stubbs, 2017). In Australia,   physicians incorporate in nurses in the care plan while deciding accurate interventions for the patient in order to provide patient-centered care (Davey et al., 2015). In contrast to Australia, in India, the nurses play the very superficial role in deciding accurate treatment procedures, in the majority of the cases they follow the instructions of the physicians, and therefore India failed to address the accurate need of the patient that in turn affected the patient satisfaction. In India, nurses’ courses are very limited compared to Australia where the nursing courses divided into different sectors. Moreover, the existence of the stereotypical role such as women are meant to perform the nursing jobs is identified in the India (Willis et al., 2016). Only very few private health care sectors are successful in India to recruit men as a nurse to provide patient-centric care whereas in government health care sectors only women are recruited as nurses(Davey et al., 2015). Therefore, these stereotypical and attitude of society affected the primary health care setting.  India failed to address the social justice, only the private sectors in India are able to provide all of the facilities and individuals with higher economic status able to afford the cost of these facilities and people with lower economic conditions failed to receive these care services (Patel et al., 2015). This issue highlighted the loss of social justice in India compared to Australia where health sectors maintain the equity of care (Das et al., 2015).  The prevalence of the major depressive disorders is higher in me that due to different stigma present in the society in India, the majority of the individuals are afraid to seek the clinical assistance. Therefore, adolescents developed a chronic disease such as major depressive disorders at a very young age and failed to receive clinical attention (Wakerman et al., 2016). Consequently, the lack of clinical assistance contributed to an increase in the mortality and morbidity rate. 

The primary healthcare system of Australia is far more developed than the primary healthcare system of India. The primary healthcare system in Australia is seen to be comprising of huge number of providers as well as services across the public, private and even the non-for profit organizations (Prinja et al., 2016). Most of the Australians are seen to get healthcare services from the general practitioners.  Nurses also act as important representative of the system where they work as general practice nurses, nurse practitioners as well as community nurses. Allied healthcare professionals, midwives, pharmacists, densities and aboriginal healthcare providers also form part of the primary healthcare system. The nursing professionals working under the system are well educated and have realized the importance of following the bio-psychosocial model of care (Halcomb et al., 2016). They are seen to provide comprehensive care for the patients that involve continuous as well as person-centered approach. They try to manage the social, biological and psychological determinants of heath of all patients irrespective of their economic status and backgrounds.

Primary Healthcare System in Australia

On the contrary, the primary healthcare system of India is quite different and it has not been able to meet up the standards of care provided by nursing professionals of Australia. The primary healthcare units that had been developed in India do not allow comprehensive care to all inhabitants of the nation as they mainly base their care on managing the biological determinants of health. The urban areas mainly exhibits personal clinics that are held by doctors and nursing professionals are not employed in such systems (Anant et al., 2016). Here, the physicians are seen to conduct their diagnosis and treatment procedures. The concept of nursing professionals caring for people in a community based manner is entirely absent. Nursing professionals are only seen to be important members in hospitals and secondary and tertiary care units. They are not appointed in the urban clinics. However, few nurses are allowed to work in the government aided small units in the rural areas but their power is quite limited unlike that of the primary healthcare nurses in Australia. 

However, both the government of India as well as that of health department of Australia had undertaken huge number of initiatives in handling the chronic disorder burdens in their respective nations. In the Alma Ata declaration in India, India had pledged to include eight important elements in their primary healthcare systems. The first one is the provision of medical care, development of maternal-child health along with family planning, safe water supply and sanitation and that of collection and reporting of vital statistics (Patel et al., 2015). The other four include education about health, national health programs, referral services, training health guides, workers, local dais and others. Although, such actions are mentioned in the Alma Ata declaration in India for carrying on primary care health structures, very few initiatives had proved to be successful. Huge number of programs had been initiated in the nation of India. These are Integrated Disease Surveillance Project (IDSP), National Leprosy Eradication Programme, National Aids Control Programme, National Mental Health Programme, National Cancer Control Programme and many others like Pradhan Mantri Swasthya Suraksha Yojana , Rajiv Gandhi National Drinking Water Mission (RGNDWM). Researches state that India becomes successful in implementing huge number of programs but very few programs can meet their goals or achieve success. This might be because of the nursing professionals who are interacting with the citizens are not involved in decision making, policy development and implementation procedures. The doctors and the nursing professionals providing care in primary healthcare services are never included in policy making procedures as well as developing health promotion programs (Davey et al., 2015). Therefore, the needs of the common Indians are never transferred to the higher levels and hence the programs that are developed never meet the successful outcomes.

Primary Healthcare System in India

Three important arenas are also found to be present that distinguishes the primary healthcare system between the two nations. These are the technical insufficiency, administrative inanity as well as operational capacity. In India, all the three aspects are found to be quite poor with nursing professionals working in the primary healthcare centers allocated from government have no access or contribution in any of the three aspects. However, the private healthcare centers appoint nurses who have good knowledge in the above mentioned three aspects but the cost of services in private healthcare centers are quite high. Hence, equity and social justice in healthcare is not followed at all. The private sectors have developed technical sufficiency and the care provided is also of high quality (Das et al., 2015). However, people belonging to low socioeconomic class of people cannot afford services from nurses of private organizations. They can afford governmental healthcare services which are cheaper but cannot ensure quality care. However, such social injustice and equity cannot be found in the healthcare services of the primary healthcare organizations in the nation of Australia ensuring equal quality care to all.

On the other hand, the healthcare department of Australia is also seen to publish many programs for health promotion. Different programs that had been established in the nation are The Aboriginal and Torres Strait Islander Education Action Plan 2010-14, Bi-Cultural Community Health Program, Community Engagement Officer, Refugee Health Program and many others. One marked difference that had been found is that nurses in Australia are provided opportunities for advocating on behalf of the people of the nation and communicate their issues to the health department of the nation (Wakerman et al., 2016). As a result of this, the programs that are developed are shown to provide positive outcomes. Even nurses of this region are given the responsibility to arrange for health promotion and education sessions where they can educate communities on the different chronic ailments. Nurses are provided the power to develop policies along with the policy-makers and provide their valuable inputs. Such gestures are not provided to nurses in India resulting them to enjoy very little scope to contribute to development of patient health.

The nursing professionals working in the primary healthcare centers of Australia are found to be more culturally competent. The healthcare education system of the nation puts focus on the budding nurses where they help nurses to develop cultural awareness and cultural knowledge and overcome cultural sensitivity (Willis et al., 2016). It has been found that nursing professionals working in primary healthcare centers in India are not culturally competent.  Evidences of nurses treating dalits (considered as untouchables) in the nation inhumanly or denying care services had been reported in leading dailies quite frequently. Social justice and equity is not at all followed by the healthcare professionals in the nation of India and hence people from backward castes and classes are seen to not attend the healthcare services with the fear of being humiliated and discriminated (Ducket et al., 2015). On the other hand, Australian healthcare system has ensured equity and social justice while caring for the Aboriginals and the other indigenous people in that nation ensuring dignity and autonomy. 

Conclusion:

Thus, it can be concluded that Due to increased prevalence of severity of the chronic disease, a considerate number of individuals are suffering from the health disability around the globe.  In terms of the prevalence of chronic disease, the predominance of chronic disease is higher in India compared to Australia. The social determinants such as poverty, social justice, biases of the society are highlighted as a major contributor for an increase in the chronic disease in India compared to Australia. The nursing role plays a crucial derides in this case. In India, the power of nurses is very limited, they lack cultural competency, and they do not involve the policymaking. Therefore, the disparities in health care contributed to the chronic disease. 

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