Primary Health Care-2
By
Col Naseer Alam Tariq (Retd)
Primary Health Care
From Alma-Ata Declaration
to 21st Century
Primary Health Care
• The main goal of the governments
and the World Health Organization in
the coming years should be
The attainment by all people of the
world by the year 2000, a level of
health that would permit them to
lead a socially and economically
productive life.
Primary Health Care
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
country and community can afford
Principles of PHC
• Equity
• Appropriate technology
• Community Participation
• Intersectoral Coordination
Components of PHC
• Health Education
• Promotion of proper food and nutrition,
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Adequate supply of safe water and
sanitation
MCH including Family Planning
Immunization against major diseases
Prevention and control of locally endemic
diseases
Appropriate treatment of common
diseases and injuries
Promotion of mental health
Provision of essential drugs
PHC- Global Targets
• All people in every country will have
ready access at least to essential health
care and to first level referral facilities
• All people will be actively involved in
caring for themselves and their families,
as far as they can, in community action
for health
• Communities will share responsibility for
their health
• Safe drinking water and sanitation will be
available to all people.
PHC- Global Targets
• All people will be adequately
nourished
• All children will be immunized
against major diseases
• All possible ways will be applied to
prevent and control noncommunicable diseases and promote
mental health through influencing
life styles, and controlling the
physical and psychological
environment
PHC-Extended Elements in 21st Century
• Expanded options of immunizations
• Reproductive Health Needs
• Provision of essential technologies for
health
• Health Promotion
• Prevention and control of noncommunicable diseases
• Food safety and provision of selected food
supplements
Millennium Development Goals
• Eradicate extreme poverty and hunger
• Achieve universal primary education
• Improve maternal health
• Reduce child mortality
• Combat HIV/AIDS, malaria, and other
communicable diseases
• Promote gender equity
• Ensure environmental sustainability
• Develop global partnership for
development
Obstacles to implement PHC Strategy
• Misinterpretation of the PHC Concept
• Misconception that PHC is 2nd rate
health care for the poor
• Resistance to Change
• Lack of political will
• Centralized planning and
Management infrastructure
Primary Health Care
CAUSES OF FAILURE
CAUSES OF FAILURE
–Managerial Deficiencies
–Service Delivery Failure
–Community Causes
MANAGERIAL DEFICIENCIES
• Lack of trained managers
• Lack of selection and training criteria
for managers
• Lack of proper performance
evaluation of health managers
• Lack of motivation leading to
professional and financial corruption
SERVICE DELIVERY FAILURE
• Accessibility problems
• Utilization Failure
• Efficiency problems
ACCESSIBILITY ISSUES
• 25 – 30 % of PHC facilities have been illplanned and care usually out of reach of
the rural community where logistics
problems is as big issue as is poverty.
• Such facilities are a big problem for nonresident PHC staff, which further
augments the problem, and promotes
quackery in such areas.
UTILIZATION FAILURE
• Since its inception, PHC has been
promoted as an alternative for curative
care. This image has been promoted by
professional as well as political forces.
• The result is that the concept of PHC has
been buried and PHC has been
synonymously taken as 2nd degree
medical care for the poor.
UTILIZATION FAILURE
(CONTD)
• PHC has been down looked upon resulting
in the vacuum being filled by virtually
non-committed untrained staff, which has
offered a parallel system of tertiary care
in PHC facilities at minimal or no cost.
• Lack of training and proper monitoring /
check and balance on the PHC staff.
UTILIZATION FAILURE (CONTD)
• Not being a government priority
• Lack of quality of care yardsticks for
Primary Health Care
• No active research in this field
• Government one step forward, two steps
backward approach to PHC, resulting in
lack of consistency in various PHC
program.
EFFICIENCY PROBLEMS
• Lack of standardized management
protocols for common PHC problems
• Off and on and un-rational drug policy of
the Health Department
• Lack of clear cut policy, regulatory and
organizational mechanisms resulting in
haphazard experimentation.
COMMUNITY CAUSES
• Community participation has been
virtually non-existent in PHC
• Gap in Community and Public sector has
widened the bridge.
• Health education has been given a
backseat in PHC.
• Low literacy levels and economic
deprivation has forced people to shift
entire responsibility of their health on
state shoulders.
COMMUNITY CAUSES (CONTD)
• Cultural peculiarities have hindered the
way of whatsoever little implementation
of PHC in NWFP. Worst hit areas have
been the western cultural zone, and the
mid and mid-north cultural zones.
• Alternatively quackery has filled in the
vacuum due to cultural considerations.
FIVE COMMON SHORTCOMINGS
OF HEALTH – CARE DELIVERY
INVERSE CARE
• People with most means – whose needs
for health care are often less – consume
the most care, whereas those with the
least means and greatest health problems
consume the least.
• Public spending on health services most
often benefits the rich more than the poor
in high and low income countries alike.
IMPOVERISHING CARE
• Wherever people lack social protection
and payment for care is largely out of
pocket at the point of service, they can be
confronted with catastrophic expenses.
• Over 100 million people annually fall into
poverty because they have to pay for
health care.
FRAGMENTED CARE
• The excessive specialization of health
care providers and the narrow focus of
many disease control program discourage
a holistic approach to the individuals and
the families they deal with and do not
appreciate the need for continuity in care.
• Health services for poor and marginalized
groups are often highly fragmented and
severely under-resourced, while
development aid often adds to the
fragmentation.
UNSAFE CARE
• Poor system design that is unable to
ensure safety and hygiene standards
leads to high rates of hospital – acquired
infections, along with medication errors
and other avoidable adverse effects that
are an underestimated cause of death and
ill – health.
MISDIRECTED CARE
• Resource allocation clusters around
curative services at great cost, neglecting
the potential of primary prevention and
health promotion to prevent up to 70% of
the disease burden.
• At the same time, the health sector lacks
the expertise to mitigate the adverse
effects on health from other sectors and
make the most of what these other
WAYS TO MOVE AHEAD
• Health has to be linked with education
and poverty alleviation
• PHC has to be redefined in Government
books
• Managerial competencies needs to be
developed through intensive training and
very strict monitoring.
WAYS TO MOVE AHEAD(CONTD)
• Ongoing PHC training for all PHC staff
with proper monitoring and evaluation
and made must for all promotions in PHC.
• Financial investment in PHC needs to be
increased with help of donors.
• Health should further be de-centralized
with involvement of community and
mechanism be made for partly community
funding of PHC.
WAYS TO MOVE AHEAD
(CONTD)
• Precise, clear cut and unambiguous,
policy, regulatory and organizational
paradigms should be constructed for PHC.
• Health department should be prepared
for change management with clear and
unconditional backing of NGO’s, political
forces, and Government.
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