Primary Health Care

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Dr. Huda Adnan Habib
Assist. Prof.
Family Medicine Consultant
Head of Community Medicine
Department
INTRODUCTION TO
PRIMARY HEALTH CARE
WHO
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The World Health Organization (WHO) : is a
specialized agency of the United Nations that is
concerned with international public health.
WHO
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It was established on 1948,
Since its creation, it has been responsible for playing a
leading role in the eradication of smallpox.
Its current priorities include communicable diseases, in
particular, HIV/AIDS, malaria and tuberculosis;
the lessening of the effects of non-communicable
diseases;
sexual and reproductive health,
development, and aging; nutrition,
WHO
food security and healthy eating;
 occupational health;
 substance abuse; and
 drive the development of reporting, publications,
and networking.
 WHO is responsible for the World Health Report, a
leading international publication on health, the
worldwide World Health Survey, and World Health
Day.

DEFINITION OF HEALTH
it is a state of complete physical , mental
and social wellbeing and not merely the
absence of disease or infirmity
( WHO
1948) .
 Then , spiritual is added to this definition . In
recent years the statement is amplified to
include the ability to lead a socially and
economically productive life .

DEFINITION OF HEALTH

it is a state of complete physical , mental
,social and spiritual wellbeing , the ability to
lead a socially and economically productive
life and not merely the absence of disease
or infirmity.
DETERMINANTS OF HEALTH
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Generally, the context in which an individual lives
is of great importance for his health status and
quality of life.
It is increasingly recognized that health is
maintained and improved not only through the
advancement and application of health science,
but also through the efforts of lifestyle choices
of the individual and society.
DETERMINANTS OF HEALTH
According to the World Health Organization
WHO, the main determinants of health include:
 the social and economic environment,
 the physical environment, and
 the person's individual characteristics and
behaviors.
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DETERMINANTS OF HEALTH
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More specifically, key factors that have been found to influence whether people are
healthy or unhealthy include:
Income and social status.
‫الحالة االجتماعية واالقتصادية‬
Social support networks.
‫الدعم االجتماعي‬
Education and literacy.
‫االمية والتعليم‬
Employment/working conditions.
‫المهنة وظروف العمل‬
Social environments.
‫البيئة االجتماعية‬
Physical environments.
‫البيئة الجوية والمكان‬
Personal health practices skills.
‫العادات الصحية‬
Healthy child development.
‫بيئة التنشئة‬
Biology and genetics.
‫الوراثة‬
Health care services.
‫خدمات الرعاية الصحية‬
Gender.
‫النوع االجتماعي‬
Culture.
‫الحضارة‬
Social environments. culture that the individual was educated or lives in, and the people
and institutions with whom they interact
ASSIGNMENT: ‫واجب بيتي‬
Choose any determinant of health , explain its
role as a negative or positive effect on health or
the occurrence of any health problem?
HEALTH SYSTEM IN IRAQ
Ministry of Health (MoH)
 General Health Directorate.
 Health Care Institutions: Could be:
 (health centers, hospitals and specialized
centers)
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MEDICAL CARE – HEALTH CARE
The difference between the medical care and
the health care is that the:
 medical care is the personal service provided
by the physician i.e. it is only given by a
physician and only when there is a disease or
abnormality.
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MEDICAL CARE – HEALTH CARE
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Health care services is provided to individuals
or communities by health service professionals
for purpose of promoting ‫الترويج‬, maintaining,
monitoring & restoring health i.e. it is given by a
physician and health workers and for the
community as a whole.
LEVELS OF CARE
Primary health care
 Secondary health care
 Tertiary health care
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LEVELS OF CARE
Primary health care
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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.
LEVELS OF CARE
Secondary health care
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More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1st referral level
LEVELS OF CARE
Tertiary health care
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Offers super-specialist care
Provided by specialized center (institution).
Provide training programs
PRIMARY HEALTH CARE:
It is concerned with establishing a system of
health which meets the essential needs of
most of the population.
 PHC aims to achieve full coverage with
essential health care by distributing resources
in order to obtain maximum benefit to people
as a whole with lowest cost.
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DEFINITION OF PHC (WHO)
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Primary Health Care is essential health care
made accessible at a cost a country and
community can afford, with methods that are
practical, scientifically sound and socially
acceptable.
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*Reference: Alma Ata Declaration, WHO, Geneva, 1978
DEFINITION OF PHC (WHO)

PHC form integral part of both country's health
system of which its central function and the
overall social & economic development of the
community.
WHAT IS PRIMARY HEALTH CARE?
It includes the following:
health promotion
 illness prevention
 care of the sick
 advocacy
 community development

PRIMARY HEALTH CARE
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PHC is the first level of contact with individuals,
family & community with national health
system bringing healthcare as close as possible
to where people live & work, it constitute the
first element of continuing health process.
PRIMARY HEALTH CARE
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PHC conceded to be the most peripheral level
of the health system, this include such
institutes as health centers, clinics, sub
centers, general practitioners offices & poly
clinics, the name varying from one country to
another.
PHC - ALMA- ATA DECLARATION:
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In 1978, ministries from 134 countries met
at the Alma- Ata conference in the former
USSR to declare a common mission for
governments, international organizations &
health workers worldwide (health for all by
the end of year 2000), they thus declare the
strategy of PHC as the key to realize this
vision.
PHC - ALMA- ATA DECLARATION:
They called for urgent & effective local, global
efforts to develop & implement PHC through
out the world particularly in developing
countries.
 Iraq firstly adapted this strategy and started
PHC programs in different sectors in 1978 in
about 80-82 district over the country.
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• so;
•Primary health care (PHC) became a core policy
for the WHO with the Alma-Ata Declaration in 1978
and the ‘Health-for-All by the Year 2000’ Program.
•The commitment to global improvements in health,
especially for the most disadvantaged populations,
was renewed in 1998 by the World Health Assembly.
•This led to the ‘Health-for-All for the twenty-first
Century’ policy and program, within which the
commitment to PHC development is restated.
PHILOSOPHY OF PHC:

1-Health is fundamental related to availability
& distribution of resources (not just health
resources such as doctors, nurses, medicines)
but also by other socioeconomic resources
such as education, water supply, & food supply.
PHILOSOPHY OF PHC:
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2-PHC is concerned with equity to ensure that
the available health& social resources are
distributed wisely with due consideration for
those whose needs are greatest.
PHILOSOPHY OF PHC:
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3- Health is an integral part of the overall
development, thus factors which influence
health care are social, cultural, economic as
well as biological & environmental.
PHILOSOPHY OF PHC:
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4- To achieve better health, requires much
more development by people themselves as
individuals & families, communities in taking
action on their own behalf adapting health
behavior & ensuring healthy environment.
STRATEGIES OF PHC:
‫االستراتيجية‬
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1- Development of basic health infrastructure.
(Safe water supply, basic sanitation).
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2-Development of human resources for health,
preparation of health workers, health visitors, &
traditional birth attendance (TBA).
STRATEGIES OF PHC:
3- Incorporation of traditional medical system &
encouragement of its positive aspect like :
 )herbal medical medicine, TBA, man who fix
fractures & circumcision(,
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with doctor, those people can be identified
trained well in a manner that can contribute to
PHC system according to their specific activity.
STRATEGIES OF PHC:
4-Health promotion & disease prevention:
 It help healthy people from sickness by
immunization, health education, water
sanitation etc. &providing curative,
rehabilitative services.
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STRATEGIES OF PHC:
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5-Equity in distribution of health services in
urban &rural areas with relevance of the
programs to the community health problems
that is the program meets the needs of
population & the cost effectiveness to get the
best effect with lowest cost.
STRATEGIES OF PHC:
6-Community participation: people should
participate inPHC programs to promote their
health.
 7- Ensure inter-sectoral cooperation, in addition to
health sector, it involves all related sectors &
aspect of national community development in
particular education, community education, helps
people to understand their health problems & find
possible solutions.
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STRATEGIES OF PHC:
Ensure inter-sectoral cooperation :
 Agricultural sector which can ensure food
production for family consumption, industrial
sector can support PHC by establishing
industries for essential foods and drugs, also
important to create employment to improve the
local economic base and earning power.
 Housing good housing with clear water supply
and proper sanitation is important for health.
STRATEGIES OF PHC:
Ensure inter-sectoral cooperation :
 Communication and mass media help to
provide valid information on health promotion
and improving health practices within the PHC
and how to get benefit of these services. So
PHC demands the coordination effort of all
these sectors
STRATEGIES OF PHC:

8-Referal system Competent two way referral
system between the various health services
delivery levels.
STRATEGIES OF PHC:
basic health infrastructure.
 human resources.
 factors which influence health care.
 Health promotion & disease prevention.
 Equity .
 Community participation.
 Ensure inter-sectoral cooperation.
 Referal system.
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ELEMENTS OF PRIMARY HEALTH CARE
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ELEMENTS OF PRIMARY HEALTH CARE
1. Health Education concerning prevailing health
problems and the methods of preventing and
controlling them
ELEMENTS OF PRIMARY HEALTH CARE
2. Promotion of food supply and proper nutrition
ELEMENTS OF PRIMARY HEALTH CARE
3. An adequate supply of safe water and basic
sanitation
ELEMENTS OF PRIMARY HEALTH CARE
4. Maternal and child health care, including
family planning
ELEMENTS OF PRIMARY HEALTH CARE
5. Immunization against the major infectious
diseases
ELEMENTS OF PRIMARY HEALTH CARE
6. Prevention and control of locally endemic
diseases
ELEMENTS OF PRIMARY HEALTH CARE
7. Appropriate treatment of common diseases
and injuries
ELEMENTS OF PRIMARY HEALTH CARE
8. Basic laboratory services and provision of
essential drugs.
ELEMENTS OF PRIMARY HEALTH CARE
9. Training of health guides, health workers and
health assistants.
ELEMENTS OF PRIMARY HEALTH CARE
10. Referral services
Mental health
 Physical handicaps
 Health and social care of the elderly
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EFFECTIVENESS OF PHC SERVICES
Effectiveness of PHC services need two
components :
 1- Efficient PHC services : quality , resources ,
health system.
 2- Satisfactory utilization of the public for
services.
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REQUIREMENT OF EFFICIENT PHC SERVICES:
efficient
1.
2.
3.
4.
5.
6.
7.
PHC services must be :
Accessible
Acceptable
Affordable
Efficient administrative, professional and technical
procedures.
Community participation
Comprehensiveness
Continuity
REQUIREMENT OF EFFICIENT PHC SERVICES:
Provided PHC services must be :
 1. Accessible :
suitable site, roads and
transport for consumers to reach the
centers and units .
 2. Acceptable : to the public , when
convinced with given care .
 3. Affordable :
 On the national and community levels :
services are planned within available
resources , including financing .
 To the public who can pay for utilization of
services when necessary .
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REQUIREMENT OF EFFICIENT PHC SERVICES:
 4.
Efficient administrative, professional
and technical
 procedures which include:
 Convenient hours and flow of work.
 Satisfactory resources including health
team.
 Organized referral, feedback and follow
up system.
 Precise registration, filing and statstical
procedures.
REQUIREMENT OF EFFICIENT PHC SERVICES:
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5.Community participation :
 Primary heath care requires People’s
involvement in the planning and
implementation of health programs
 Primary
health care involve in addition to
the health sectors , all related sectors
and aspects of national and community
development in particular , agriculture , food
industry , education, housing ,
communications and other sectors and
need coordination of all these sectors
THE BASIC REQUIREMENTS FOR SOUND
PHC (THE 8 A’S AND THE 3 C’S)
Appropriateness
 Availability
 Adequacy
 Accessibility
 Acceptability
 Affordability

Assessability
 Accountability
 Completeness
 Comprehensiveness
 Continuity
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APPROPRIATENESS
Whether the service is needed at all in relation
to essential human needs, priorities and
policies.
 The service has to be properly selected and
carried out by trained personnel in the proper
way.
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ADEQUACY
The service proportionate to requirement.
 Sufficient volume of care to meet the need and
demand of a community
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AFFORDABILITY
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The cost should be within the means and
resources of the individual and the country.
ACCESSIBILITY
Reachable, convenient services
 Geographic, economic, cultural accessibility
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ACCEPTABILITY
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Acceptability of care depends on a variety of
factors, including satisfactory communication
between health care providers and the
patients, whether the patients trust this care,
and whether the patients believe in the
confidentiality and privacy of information
shared with the providers.
AVAILABILITY
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Availability of medical care means that care can
be obtained whenever people need it.
ASSESSABILITY
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Assessebility means that medical care can be
readily evaluated.
ACCOUNTABILITY
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Accountability implies the feasibility of regular
review of financial records by certified public
accountants.
COMPLETENESS
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Completeness of care requires adequate
attention to all aspects of a medical problem,
including prevention, early detection, diagnosis,
treatment, follow up measures, and
rehabilitation.
COMPREHENSIVENESS
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Comprehensiveness of care means that care is
provided for all types of health problems.
CONTINUITY
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Continuity of care requires that the
management of a patient’s care over time be
coordinated among providers.
TO SUMMARIZE
Primary care is an approach that:
 Focuses on the person not the disease,
considers all determinants of health
 Integrates care when there is more than one
problem
 Uses resources to narrow differences
Forms the basis for other levels of health
systems
 Addresses most important problems in the
community by providing preventive, curative,
and rehabilitative services
 Organizes the resources aiming at promoting
and maintaining health.
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THANK YOU
REFERENCES:
Who . Org.
 ^ Jump up to:a b c World Health Organization. The
determinants of health. Geneva. Accessed 12 May
2011.
 Jump up^ Public Health Agency of Canada. What
Determines Health? Ottawa. Accessed 12 May
2011.
 ^ Jump up to:a b c Lalonde, Marc. "A New
Perspective on the Health of Canadians." Ottawa:
Minister of Supply and Services; 1974.

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