Primary Health Care (PHC)

Dr. Humaira Nazneen

Associate Prof.
Community Medicine
 PHC
A new approach to health care
came into existence in 1978,
following an international
conference at alma-ata
(USSR). This is known as
''primary health care''.
It has all the hallmarks of a
primary health care delivery,
first proposed by the bhore
committee in 1946 and now
espoused world-wide by
international agencies and
national governments.
 Bhore Committee
 Bhore Committee was set up firstly by Government
of India in 1943. It was a health survey taken by a
development committee to assess health condition
of India.
 The development committee worked under Sir Joseph
William Bhore, who acted as the chairman of
committee.
 Bhore Committee contd….
 The major aim of the committee was--
--to survey the then existing position regarding
the health conditions and health organization in
the country and
--to make recommendations for future
development, in order to improve public
health system in India.
 Bhore Committee
 Some of the important recommendations of the
Bhore Committee were:
1.Integration of preventive and curative services of all
administrative levels.
2. Development of Primary Health Centers
3. Major changes in medical education which includes 3
month training in preventive and social medicine to
prepare “social physicians”.
 Alma-Ata declaration
 In September 1978, the International Conference on Primary
Health Care was held in Alma-Ata, USSR (now Almaty,
Kazakhstan).
 The Declaration of Alma-Ata, co-sponsored by the World
Health Organization (WHO)
 It expressed the need for urgent action by all governments, all
health and development workers, and the world community to
protect and promote the health of all people.
 It was the first international declaration underlining the
importance of primary health care.
 Alma-Ata declaration contd…
 The primary health care approach has since then been accepted by
member countries of theWorld Health Organization (WHO) as the
key to achieving the goal of “Health For All” but only in developing
countries at first. This applied to all other countries five years later.
 The Alma-Ata Declaration of 1978 emerged as a major milestone of
the twentieth century in the field of public health,
 It has been expressed as "the need for urgent action by all
governments, all health and development workers, and the world
community to protect and promote the health of all the people of the
world."
 It was the first international declaration stating the importance of
primary health care and outlining the world governments' role and
responsibilities to the health of the world's citizens.
Before alma-ata, primary health
care was regarded as
synonymous with
'basic health services' ,
' first contact care' ,
'easily accessible care' ,
'services provided by
generalists' , etc.
 The alma-ata conference defined
primary health care as --
 " primary health care is an essential
health care made universally
accessible to individuals and
acceptable to them, through their full
participation and at a cost the
community and country can afford."
 The primary health care is equally valid
for all countries from the most to the
least developed, although it takes
varying forms in each of them.
 The concept of primary health care has
been accepted by all the countries as
the key to the attainment of health for
all by 2000 AD.
 It has also been accepted as an integral
part of the countries health system.
essential health Means basic, essential and utilitarian services.
care
universally Services should be made reachable to all
accessible segments of the population
acceptable Services are provided in such a way that the
people should be accept them
full participation Provision of these services should start from
the people of the community, so that the
service becomes successful
Affordability The Services must be economical and cost-
effective so that Government can provide The
Services to the people
Adaptability The Services provided should be flexible to suit
the given situation
Availability 'Round the clock' presence of the service

appropriateness The Services should be relevant to the needs

and demands of the people
Closeness The proximity between the health care provider
and the consumers. in other words, the services
are made available to the individuals doors
Continuity The Services provided from 'womb to tomb'
comprehensivenes The Services should be preventive, promotive,
s curative and rehabilitative to the community

Co-ordinativeness These basic services requires the cooperation of

various health related departments.
 BANGLADESH SCENERIO
 Bangladesh is a signatory to the declaration in the International
Conference on Primary Health Care (PHC) held at Alma Ata in
1978, where the concept of primary health care (PHC) as the
strategy for achieving the goal of health for all (HFA) was laid.
Bangladesh started with pilot projects in 6 Upazilas in
 the year 1979-80 in the light of which subsequently PHC
Program started in Bangladesh in 1980.
 The basis of the policy of the government was to provide health
care to the un-served and underserved population as far as
possible, at their door steps, at an affordable cost. Since then,
considerable progress has been made in this sector, but due to
lack of adequate investment the full potential of PHC services is
yet to be realized.
Strategy of PHC in Bangladesh
 Strategy for PHC in Bangladesh was started
with several basic steps like-

1. Health education in order to make people

more about health problems and their
probable solutions

1. Development of active community

leadership to organize health and family
planning committees with community
participations.
3. Human resources development
by training of rural health
volunteers and other health and
family planning personnel

4. Intersectoral support for overall

socio-economic development.
Goals for Primary Health Care in
Bangladesh
Provision of reinforcement for
delivery of health care to poor
communities, rewarding good work;

Wider and wiser use of the vaccines,

drugs and commodities available now;
 Objective contd….
 Research and innovations for better use of
existing tools and devices;

 Reduction of the impact, within poor

communities, of high mortality diseases
linked to poverty that is ARI, AIDS, malaria,
measles, parasitic diseases and tuberculosis -
together with unsafe pregnancy.
 Approaches Of Primary Health Care in Bangladesh:
 some of the innovative Approaches has been taken for strengthening the
PHC program—
➢ Integrated approaches
➢ Emphasis on outreach program
➢ Mechanism to bring out the concerns of PHC beyond the walls of health
sectors and involve other sectors
➢ Formation of health consumers group empowering the community
to have more in planning and implementations of health program
➢ More emphasis on planning and management to ensure maximum
use of scarce resources and avoid waste
➢ Increasing emphasis on health promotion through formal and
informal health education program
➢ Learning by doing approach
Elements Of Primary Health Care:

 The alma-ata declaration has outlined 10

essential components of primary health care.
1. Education concerning prevailing health
problems and the methods of preventing and
controlling them;
2. Promotion of food supply and proper
nutrition;
3. An adequate supply of safe water and basic
sanitation;
4. Maternal and child health care, including
family planning;
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 common essential
drugs;
9. Integration of oral health;
10. Incorporation of mental health
services.
Principles Of Primary Health Care:

1. Equitable distribution of health

services
2. Community participation
3. Intersectoral coordination
4. Appropriate technology
Equitable distribution of health services

The first key principle in the primary health

care strategy is equity or equitable
distribution of health services.
Health service must be shared according to
priority of the needs irrespective of their
ability to pay, cast creed, community and all
(rich/poor, urban/rural) must have access
to health services.
 at present health services are mainly
concentrated in the major towns and cities
(where 25% people live, but 75% budget is
spent; health services is mainly curative
oriented) resulting in inequality of care to the
people in rural areas.
 on the other hand, the needy and vulnerable
groups of population like poor rural and the
urban slums (where three quarters people live,
but 25% budget is spent) are neglected and who
deserve the services most.
primary health care aims to redress
this imbalance by shifting the centre of
gravity of the health care system from
cities to the rural areas and bring this
services as near people's home as
possible.
 Community participation:-

 Not withstanding the overall

responsibility of the central Governments.
 the involvement of individuals, families
and communities helps in promotion of
their own health and welfare, which is an
essential ingredient of primary health
care.
 there are three ways in which a
community can participate-

1. The community can provide in the shape of

facilities, man power, logistic support, and possibly
funds
2. The community can be actively involved in
planning, management and evaluation
3. An equally important contribution that people can
make is by joining and using the health services.
 One approach is that use of health
worker and trained dais who provide
the primary health care to the community
they belong and free of charges in the
ways that are acceptable to the community
by overcoming cultural and
communication barrier.
 These concepts are taken from china
where community participation in the
form of bare- foot doctors.
 Intersectoral coordination:-
 There is an increasing realization of the fact that
the components of primary health care cannot
be provided by the health sector alone.
 The declaration of alma-ata states that "primary
health care involves in addition to the health
sector, all related sectors and aspects of national
and community development, in particular
agriculture, animal husbandry, food, industry,
education, housing, public works,
communication and others sectors".
 To achieve such cooperation, countries may
have to review their administrative system,
reallocate their resources and introduce
suitable legislation to ensure that coordination
can take place. This require strong political
commitment. An important element of
intersectoral approach is planning-planning
with other sectors to avoid unnecessary
duplication of activities.
 Appropriate technology:-
 Technology has been defined as "
technology that is scientifically sound,
adaptable to local needs and acceptable
to those who apply it and those for
whom it is used, and that can be
maintained by the people themselves in
keeping with the principles of self
reliance with the resources the
community and country can afford".
 'Appropriate' means
 it must be simple,
 scientifically valid,
 practically adaptable to local needs,
 culturally acceptable,
 economically cheaper and
 operationally convenient.
example –

 home made ORS,

 Rice water
 Chira water
 Dub water
 delivery kits-thread, blade for domiciliary midwifery
services,
 support breaking bones by bamboo stick,
 bio gas plant,
 smokeless chulas.
 The primary health care is qualitatively a different
approach to deal with the health problems of a
community.
 The previous approaches (basic health services,
integrated health care, vertical health services)
provide health services to the doors of the people,
 but primary health care approach starts
with the people themselves. This approach
has been described as health by the people,
placing people's health in people's hand.
Accessible Acceptable Adaptable Affordable Applicable
universally culturally practically economically scientifically

Primary health care

Essential Health Care