Primary health care concepts

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in
Thailand

The Thai PHC is based upon local culture and
tradition.
Traditionally, health care was a family responsibility.
Our PHC attempts to utilize local manpower and
technology to the fullest extent.

Village Health Volunteer (VHV) is a home-grown
concept.
True to the word, VHV has no salary, only free medical
care and other possibility of support from Government
(e.g.contract to develop community-based programs etc.)

To be effective, the ratio of volunteer to household
must be adequate.
In our case, we use a ratio of 1 : 15, based on
natural communication network within a community.
Hence, the number of health volunteers ranges
between 10 – 15 in any given village ( 800,000+ in all).
Community-based program needs enough village
manpower to run.
In a community context, adequate number of manpower
leads to better decision-making and coverage is more
complete.

Community behavioral change needs a critical number of
converts to become effective.
At least 3 groups should be organized and defined
i.e.:
a) health volunteer ( to employ certain skills)
b)
interest group (intended as change agent)
c) target group (must be well-defined)


Build up critical mass by creating common vision or goal
to which everyone adheres .
The health worker, working with the people, must
be prepared to convince them of their problems. The
tactic is to invite them to do their own survey, impart
upon them simple planning technology then let them
make their own choice.
Never force one’s own idea upon the people.



In the PHC context, people make their own decision and
initiate. If they are not ready, no order can be given. The
health worker plays a facilitator role.
The most common fallacy is the belief among health
workers that volunteers are created to alleviate their work,
thus they (volunteer )are regarded as subordinates.
Volunteers work for their fellow villagers, not for the
health worker.
Health workers never substitute for what people can do
for themselves.
PHC was derived from the concept of cost-effectiveness,as such:
1.
Refinement of the target group is key to better efficiency.
Under-privileged families must be identified,accessed and
taken care of.
2.
Efficiency is dictated by pattern of manpower deployment.
Matching of level of skill of manpower with severity of
problem is essential. Example:The use of volunteers to take
care of simple health and environmental problems.
3.
As a consequence, program for screening and referral of cases
must be put in place (through health insurance scheme in our
case)
( continued)
Community manpower can be trained to become proficient
in every aspect of PHC
Real problem remains with the attitude and
acceptance of the health worker.
5. Major hurdle to overcome is inter-sectoral collaboration.
In our case, we use the Basic Minimum Need
approach. All government agencies use the same set of
indicators for Quality of life which is multi-dimensional.
6.
Community involvement goes hand-in-hand with degree of
decentralization ( decision-making and budgeting )
Here, national policy has a role to play.
4.
Choice has to be made between
1. Application of PHC concept into nutrition intervention
activities or
2. Integration of nutrition intervention activities into
PHC program.
Which choice should bring about better results and
why ?






Stage of development of nutrition vis-a’-vis PHC program.
Coverage of the target groups ( 3 degrees of PEM ).
Main intervention measures to be applied ( surveillance,
supplementation, education etc.).
Collateral health development activities ( sanitation, CDC
control, medical care, IEC, health system reform etc.)
Policy and strategy concerning development approach.
Decentralization and budgeting policy.
In our case, we opt for the integration of nutrition into PHC.
1.
2.
3.
Weighing of children should be done by VHV with the help
of mothers. Primary objective of the activity is to make
them realize that the problem exists. Accuracy of
measurement is secondary in importance.
If the mother is convinced, she becomes more receptive to
advice and tends to act with or without external help.
Normally, redistribution of nutritious foods toward the
child will happen within the family.
This phenomenon generally affects the decrease of first
degree PEM, while those with second degree may need
extra supplementation and third degree medical attention.
(continued)
4. Make wise choice among 4 intervention measures
4.1 Increase food production and nutrition education.
4.2 Food supplementation.
4.3 Food fortification
4.4 Direct treatment.
Each has its own benefits and drawbacks.
Priority for consideration remains in the above order.
5. Choice and acceptance of food supplement by the people is
paramount. Technical aspect comes after choice is made, not
the other way around.
6.
7.
8.
Choice must be made between development or welfare
approach. Technically, development approach is
preferable, but politically, welfare approach stands a
better chance of acceptance and support.
Choice must be made between organizing new vertical
program or upgrading existing health service system and
programs. If decision is to integrate nutrition into PHC,
then vertical program is out of question.
We never had success with fortification programs carried
out in its own sake. This confirms the fact that nutrition
problem is multi-dimensional which needs a combination
of measures.
According to people-centered development concept,
 chance of success rests upon people “ playing right role.”
The 3 major roles that people must play:
1. self-care.
2. Care of various aspects of environment.
3. Involvement in community programs.

What are factors which influence their decision to play such
roles?
1.
2.
3.
4.
5.
6.
7.
Skill development
Analysis and acknowledgement of problem.
Right information and personal experience.
Networking of similar-interest individuals and groups.
Appropriate support systems (planning,organization,
finance, coordination, supervision etc.)
Leadership development.
Strengthened spiritual aspect
(trust,confidence,consciousness,faith, community-spirit
etc.)
Effective process to address above factors will contribute to the
success of community-based nutrition/PHC program.
1.
2.
3.
4.
5.
6.
7.
Build up conscience and confidence to make changes in life.
Provide appropriate setting for learning experience.
Basic need fulfillment ( food, housing and environment, CDC,
medical care etc.)
Involvement in social activities(health campaigns, conservation
etc.)
Promote spiritual uplift activities ( religious practices,
meditation, rest and recreation, exercise etc)
Promote better lifestyle.
Promote right concept and vision, leadership.
The End
The End
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