PRIMARY HEALTH CARE
By
Dr Naseer Alam Tariq
Health
• Health is a fundamental human right
• State responsibility for the health of its
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people
National Govt all over the world are
striving to expand and improve their
health care services
The current situation is
– Urban oriented
– Mostly curative in nature
– Accessible to a small part of population
Health
Health is a state of complete
physical, mental and social wellbeing
and not merely absence of disease or
infirmity
(WHO Definition of Health 1948)
Primary Health Care
• At the international level, the Universal
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Declaration of Human Rights established a
breakthrough in 1948, by stating in Article 25:
“Everyone has the right to a standard of
living adequate for the health and
wellbeing of himself and his family”
The preamble to the WHO Constitution also
affirms that it is one of the fundamental rights
of every human being to enjoy “The highest
attainable standard of health”
Primary Health Care
• Increasing importance given to social
justice and equity, recognition of the
crucial role of community
participation, changing ideas about
the nature of health and
development, the importance of
political will called for new
approaches to make medicine in the
service of humanity more effective.
Primary Health Care
• Against the above background, the 30th World
health Assembly resolved in May 1977 at
Almata , that
“the main social target of governments and
WHO in the coming decades should be
The attainment by all citizens of the world by
the year 2000 of a level of health that will
permit them to lead a socially and
economically productive life”
• This culminated in the international objective
of HEALTH FOR ALL by the year 2000 as the
social goal of all governments.
Primary Health Care
• The joint WHO – UNICEF international
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conference in 1978 at Alma – Ata (USSR)
the governments of 134 countries and
many voluntary agencies called for a
revolutionary approach to health care.
Declaring that “The existing gross
inequality in the health status of people
particularly between developed and
developing countries as well as within
countries is politically, socially and
economically unacceptable”
Primary Health Care
• Health for all means that health is to be
•
brought within the reach of every one in a given
community.
It implies the removal of obstacles to health –
that is to say the elimination of
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Malnutrition
Ignorance
Disease
Contaminated water supply
Unhygienic housing etc
• It depends on continued progress in medicine
and public health.
• Alma Ata Declaration called on all
governments to formulate national
policies, strategies and plans of action to
launch and sustain primary health care as
part of a national health system.
• It is left to each country to innovate,
according to its own circumstances to
provide primary health care
• This was followed by the formulation and
adoption of the Global Strategy for Health
for all by the 34th World Health Assembly
in 1981.
• Primary Health care got off to a good start
in many countries with the theme “Health
for All by 2000 AD”
Primary Health Care
• Primary Health Care is a new
approach to health care, which
integrates at the community level all
the factors required for improving
the health status of the population.
Concept of PHC
• PHC is for all specially the needy
Regardless of social and economic status every
individual in the nation must have access to good
health care
• The services should be acceptable to the
community and there must be active involvement
of the community
• The health services must be effective, preventive,
promotive and curative
• The services should form an integral part of the
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country’s health system
The programme must be efficient, multi- sectorial
because health does not exit in isolation
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
Levels of Health Care
Levels of Health Care
3 level of health care service
Levels of Health Care
3 level of health care service
• Primary care level
• Secondary care level
• Tertiary care level
Levels of Health Care
• Primary care level
– First level of contact of individual, family
and community with health system
– Most effective and close to the people
– PHC
– BHU, RHC, THQ
– Clinics
– RMO
– GP
Levels of Health Care
• Secondary care level
– Higher level of care
– More complex problem are dealt with
– DHQ
– THQ
– Health centers
– Hosp
Levels of Health Care
• Tertiary care level
– Specialized health care
– Specific facilities
– Specialized health workers
– Teaching hosp,
– Regional hosp
– Central hosp
– Specializes hosp
• AFIC
• AFID
• NICVD
Primary Health Care
PHC is essential health care made
universally accessible to individuals
and families in the community by
means acceptable to them, through
their full participation and at a cost
that the community and country can
afford
PRINCIPLES OF
PRIMARY HEALTH CARE
PRINCIPLES OF PRIMARY HEALTH CARE
• Equity
• Community Participation
• Intersectoral Coordination
• Appropriate Technology
Equity/Equitable Distribution
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The first key principle in primary health
care strategy is equity or equitable
distribution of health services
Health services must be shared equally
by all people irrespective of their
ability to pay and all( rich or poor,
urban or rural) must
have access
to health services
health services are mainly in towns
Inaccessibility to majority of
population
Social injustice
Availability -Insurance/NHS
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Community Participation
Overall responsibility is of the State
The involvement of individuals,
families, and communities in
promotion of their own health and
welfare is an essential ingredient of
primary health care
PHC coverage cannot be achieved
without the involvement of community
in planning, implementation and
maintenance of health services
Polio. FP
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Intersectoral Coordination
Declaration of Alma –Ata states that
PHC involves in addition to the health
sector all related sectors and aspects
of
national and community
development, in particular education,
agriculture, animal husbandry, food,
industry, education, housing, public
works, communication
To achieve cooperation planning at
country level is required to involve all
sectors
Appropriate Technology
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Technology that is scientifically
sound, adaptable to the local needs,
and acceptable to those who apply it
and those for whom
it is used and
can be maintained by the people
themselves with the resources of the
community and country can afford
luxurious hospitals, costly equipments
80:20
Essential Component / Elements
Essential Component / Elements
1.
Education concerning prevailing health
problems and the methods of identifying,
preventing and controlling them
2.
Promotion of food supply and proper
nutrition, an adequate supply of safe
water and basic sanitation
3.
Maternal and child health care including
family planning
4.
Immunization against major infectious
diseases
Essential component / Elements
5.
6.
Prevention and control of locally
endemic diseases
Treatment of common diseases and
injuries
7.
Promotion of mental health
8.
Provision of essential drugs
Millennium Development Goals
• MDG,s place health at the heart of
development and represent
commitments by governments
throughout the world to reduce
poverty and hunger and to tackle ill
health
Millennium Development Goals
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Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equity
Improve maternal health
Reduce child mortality
Combat HIV/AIDS, malaria, and other
communicable diseases
Ensure environmental sustainability
Develop global partnership for
development
Primary Health Care in Pakistan
Basic Health Unit (BHU)
Total BHU’s 5374
BHU serve a population of 5,000-10,000
Services provided at BHU are—MCH services,
childcare, immunization, diarrheal diseases,
malarial control, child spacing, mental and school
health service
Rural Health Centre (RHC)
Total No
595
5-10 BHU are linked with RHC
25 beds, laboratory, X-ray, minor surgery ,dental
Dispensaries
4842
MCH Centers
909
Primary Health Care in Pakistan
Tehsil Hospital
50-100 bedded hosp
laboratory, X-ray, surgery ,dental, spec
District Headquarters hospital
100-200 bedded hosp
laboratory, X-ray, surgery ,dental, all spec
Primary Health Care in Pakistan
• Hospital
• Doctors
• Dental Surg
972
153567
11740
Medical/ Dental Colleges
Public
Private
Total
G Total
Medical
38
50
88
Dental
10
27
37
125
Medical Per Addition in 2011-12
• Doctor
• Dentist
• Nurses
• Paramedics
4300
450
3000
4500
PHYSICIAN
A physician is a person who, having been
regularly admitted to a medical school,
duly recognized in the country in which it
is located, has successfully completed the
prescribed courses of studies in medicine
and has acquired the requisite
qualification to be legally licensed to
practice medicine (comprising prevention,
diagnosis, treatment and rehabilitation)
using independent judgment to promote
community and individual health
WHO
HOSPITAL
Hospital is a residential
establishment which provides shortterm and long-term medical care
consisting of observational,
diagnostic, therapeutic and
rehabilitative services for persons
suffering or suspected to be suffering
from a disease or injury and for
parturient
WHO 1963