Primary Health Care
Presented by:
Dr: Amira Yahia
Learning out comes
• To discuss the ALMA ATA DECLARATION
• To describe the goals and targets of health
for All
• To enumerate the Themes Leading to
Alma Ata
• To define primary health care
• To discuss the objectives of PHC
Cont……
• To enlist the COMPONENTS OF PHC
• To discuss the Obstacles to the
Implementation of PHC Strategy
• To identify Levels of Care
• To discuss the Primary health care
• To identify the PRINCIPLES OF PHC
ALMA ATA DECLARATION
‘The main goal of Governments and World
Health Organization in the coming decades
was 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’
GOALS AND TARGETS OF health
for All



An increase in life expectancy and in the quality of life
for all
Improved quality in health between and within
countries
Access for all to sustainable health systems and
services
An initial set of targets will guide the implementation
of the HFA policy and define priorities for action for
the first two decades of the 21st century
Themes Leading to
Alma Ata
1. Changing theories of health & development: shift
away from GNP as measure of development
towards recognition of the need of social
development
2. Concerns about poverty & population control
3. Increasing reliance upon alternative approaches
to medical care model
4. Success of CHWs & associated emphasis on
community participation
5. of interest in public health; tackling causes of ill
health rather than symptoms
PRIMARY HEALTH CARE
PHC is 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
community and the country can afford…
Objectives of primary health care
Prevention of
health hazards
Early detection and
treatment of illnesses
Rehabilitation
Prevention of
illnesses and
accidents
Disability
limitation
Primary Health Care
Preventive services
Curative services
Outpatient clinic (referral)
General services
Care of vulnerable groups
Health education
Monitoring of environment
Prev.&control of endemic
diseases
Health office services
Maternal &child health s.
School health services
Geriatric health services
Occupational health services
Laboratory services
Dispensary
First aid and emergency
services
Levels of Care
• Primary health care
• Secondary health care
• Tertiary health care
Con…..
Primary health care
• The “first” level of contact between the individual
and the health system.
• Essential health care (PHC) is provided.
• A majority of prevailing health problems can be
satisfactorily managed.
• The closest to the people.
• Provided by the primary health centers.
Cont….
Secondary health care
•
•
•
•
More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1st referral level
Tertiary health care
• Offers super-specialist care
• Provided by regional/central level institution.
• Provide training programs
LEVEL OF PHC
1-HOME LEVEL :
• Refer to the basic unit in any community :
House hold
Family member e.g.: mother or head of house
Person from neighborhood
• Home visiting community worker
2-Communal level :• Activities at this level concern the health
of whole community (village. town .group
of village s)
• Common facilities or voluntary effort of
community member
3-Health system
• First health facility level :- refer to the first
level where trained health professional and
facilities are available .
• First referral level :-there is two type of :
Clinical referral system which include s the
supervision of performances at lower level
The second is administrative referral system
usually the district health office this level
involved planning .management and support
of activities related to health education
,information and disease control
PRINCIPLES OF PHC
1. Health Prevention & Promotion
2. Equity
3. Appropriate Technology
4. Community Participation
5. Intersectoral Coordination
6. Decentralization*
Equity
“Countries developed national health policies stating
equity as one of the objectives ….
…. it meant a reallocation of limited resources, which
led to taking away resources from the already overfunded services serving the urban
The equity policy objective was therefore not fully
implemented”
Community participation
“although community participation has been argued as
the core of PHC policies, it has largely remained
problematic, calling for more review and definition …
…Village health worker programmes in many countries
have disintegrated”
And then there were the TBAs ….
Appropriate technology
• Generic drugs
• Basic radiological units
• Donkey, bicycle, motorcycle ambulances (eRanger
ambulance)
“this challenge continues to grow especially as
globalisation takes root and the health profession’s
education, training and practice continues to be
driven by the medical model instead of the health
model”
Health sector reforms
• Rationalisation of MoH
• Decentralisation of planning, management
and implementation of health services
• Introduction of new financing mechanisms
• Recognition of the role of the private sector,
NGOs, and others
Health sector reforms
“these initiatives were aimed to achieve greater access
to services, improved efficiencies in resource
utilisation … and improved quality of health services.
Yet there has been no improvement in health systems
performance. In fact evidence available shows that in
many countries the health status of the people has
worsened”
COMPONENTS OF PHC
1. Education concerning prevailing health problems &
the methods of preventing & controlling them
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic
sanitation
4. MCH including FP
5. Immunization against major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and
injuries
8. Provision of essential drugs
9.
mental health.
8 Elements of Primary health care
Safe
water
supply,
basic
sanitatio
n
Prevention
and control
of endemic
diseases
Objectives
of PHC:
-Food supply
- Proper
nutrition
Comprehensive
maternal and
child health
care
Health
education
Provision
of
essential
drugs
Immunization
of children
Health promotion& prevention of health
hazards
Early detection and treatment of illnesses
Treatment
of
common
diseases
Obstacles to the
Implementation of PHC Strategy
1. Misinterpretation of the PHC Concept
2. Misconception that PHC is a 2nd rate health
care for the poor
3. Selective PHC Strategies
4. Resistance to Change
5. Lack of political will
6. Centralized Planning & Management
Infrastructure
SELECTIVE
PRIMARY HEALTH CARE
PHC implies that if one cannot afford to
offer universal coverage for even the most
basic of health care, one could would offer
treatment & preventive strategies for the
few diseases identified as having the
greatest threat to mortality, & which are
amenable to prevention / cure at low cost.
Comprehensive PHC
ADVANTAGES
DISADVANTAGES
1.Looks at total health care
2.Involvement of
community
3.Covers all elements of
PHC
4.Ensures equitable
distribution of resources
5.Facilitates effective
referral system
1. More costly to
implement
2. Takes long time to see
impact
3. Long time to process
4. Lack of specialized
treatment
5. Expensive
6.Government goal
6. Inefficient referral
system ???-- misuse
Selective PHC
ADVANTAGES
1.Donor friendly
2.Elimination of
selected disease
3.Easy to plan &
implement
4.Is focused & have
more impact
5.Easy to manage &
measure output
6.Require limited
resources
7.Improve quality of
services
1.
2.
3.
4.
5.
6.
DISADVANTAGES
Disease rather than
health oriented
Doesn’t ensure equity
Top down decision
making
Neglect other problems
Leads to outbreak
Resources (tight) might
not be available for
urgent needs
(emergencies)
7. Less community
involvement– donor
priority
PHC: FROM ALMA- ATA
TO 21st CENTURY
1. PHC as an approach has provided impetus
and energy to progress towards HFA
2. Some progress has been made in ensuring
access to the original eight PHC elements
3. PHC remains valid as the point of entry
into a comprehensive health care system
4. Intersect oral action for health has not
been fully achieved
5. Reorientation of health services and
personnel to PHC principles remains
elusive
6. Community participation takes time and
dedication by all
PHC in the 21st Century:
Policy Objectives to Reinforce the
PHC Approach
1. Make health central to development and
enhance prospects for intersect oral action
2. Combat poverty as a reflection of PHCs
concern for social justice
3. Promote equity in access to health care
4. Build partnerships to include families,
communities and their organizations
5. Reorient health systems towards promotion of
health and prevention of disease
PHC: provision of essential health care which is:
Socially
Accessible to all
individuals
Acceptable
Scientifically
Economically
Equitable
Distribution
Appropriate
technology
Multi
-Sectorial
Principles of Primary health care
Community
Participation
Primary Health Care Reform
Medical model
Primary Health Care
 Illness
 Health promotion
 Health
 Cure
 Prevention, care, cure
 Episodic care
 Continuous care
 Specific problems
 Comprehensive care
 Individual practitioners
 Teams of practitioners
 Health sector alone
 Intersectoral collaboration
 Professional dominance
 Community participation
 Passive reception
 Joint responsibility
 Treatment
MDGS
1.
2.
3.
4.
5.
Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality
Improve maternal health
Combat HIV/AIDs, malaria, and other
communicable diseases.
6. Ensure environmental sustainability.
7. Global partnership for development.
Role of CHN in primary health care
• In 1974 WHO executive board recommended
way in which nursing could have critical
impact on the urgent health problems
throughout the world.
Recommendations are:• Reformulation of basic and post basic nursing
education to prepare all nurses for CHN.
• Support of nursing in the national
developmental plans.
• CHN to work in schools, and all kinds of
setting.