Dr. Huda Adnan Habib Assist. Prof. Family Medicine Consultant Head of Community Medicine Department INTRODUCTION TO PRIMARY HEALTH CARE WHO The World Health Organization (WHO) : is a specialized agency of the United Nations that is concerned with international public health. WHO 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 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. DETERMINANTS OF HEALTH 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) 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. MEDICAL CARE – HEALTH CARE 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 LEVELS OF CARE 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. LEVELS OF CARE Secondary health care More complex problems are dealt with. Comprises curative services Provided by the district hospitals The 1st referral level LEVELS OF CARE Tertiary health care 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. DEFINITION OF PHC (WHO) 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. *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 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 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: 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. • 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: 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: 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: 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 1- Development of basic health infrastructure. (Safe water supply, basic sanitation). 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(, 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. STRATEGIES OF PHC: 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. 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. ELEMENTS OF PRIMARY HEALTH CARE 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 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. 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 . 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: 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 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. ADEQUACY The service proportionate to requirement. Sufficient volume of care to meet the need and demand of a community AFFORDABILITY The cost should be within the means and resources of the individual and the country. ACCESSIBILITY Reachable, convenient services Geographic, economic, cultural accessibility ACCEPTABILITY 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 Availability of medical care means that care can be obtained whenever people need it. ASSESSABILITY Assessebility means that medical care can be readily evaluated. ACCOUNTABILITY Accountability implies the feasibility of regular review of financial records by certified public accountants. COMPLETENESS 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 Comprehensiveness of care means that care is provided for all types of health problems. CONTINUITY 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. 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.