04/09/20

Background
•  30th World Health
Assembly
•  Geneva
•  May 1977
•  Health for All by the
year 2000

Background
•  Alma Ata Declaration
•  Kazakhstan, USSR 1978
•  Ministers of 134
Countries / WHO /
UNICEF
•  Primary Health Care
•  key to the attainment
of HFA

Socially Universally
Acceptable Accessible

Essential
Health Care

Participatory
Affordable
Approach

Primary Health Care

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The first level of

contact of individuals,
the family and
community with the
national health
system bringing
health care as close
as possible to where
people live and work,
and constitutes the
first element of a
continuing health
care process.

Preventive
Curative
Rehabilitative
Promotive

Provides services that are …

Health Education
Treatment of Locally Endemic Diseases
Expanded Program on Immunization
Maternal and Child Health
Provision of Essential Drugs
Nutrition
Treatment of communicable and non-communicable
diseases
Safe water and good waste disposal
8 Essential Elements

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Community Intra and Inter-
Empowerment
Sectoral Linkages


Use of Support
Appropriate Mechanism
Technology

4 Pillars of PHC

PHC REFORMS

•  Promote and protect the health of

Communities (public policy reforms);
•  pursuing collaborative models of
policy dialogue to make health
authorities more reliable (leadership
reforms);
•  reducing exclusion and social
disparities in health (universal
coverage reforms);
•  organizing health services around
people's needs and expectations
(service delivery reforms); and

Community Diagnosis
•  A method of assessing a community’s needs
and characteristics that takes into account its
social dynamics and other factors affecting
internal problem-solving capacity.
•  Community diagnosis may couple the
assessment process with community
organizing and capacity building.
Eng & Blanchard, 1990-91

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Community Mapping
•  In community mapping, the assets of a
community are diagrammed in primary,
secondary, and potential building blocks
according to their source and locus of control
(i.e., within or external to the community).

CDC, 1998; McKnight & Kretzmann, 1990

Community Organizing Activities

A.  Area/Site Selection
B.  Entry/Integration into the Community
C.  Community Study
D.  Spotting Potential Leaders
E.  Core-Group Formation
F.  Formation of a Community Organization
G.  Mobilization
H.  Evaluation
I.  Follow-up and Expansion

A. Area/Site Selection

Criteria:
•  economically depressed
•  population of 100-200 families per 2 new COs
•  no strong resistance from the community
•  acceptable peace and order situation

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CONCERNS OF ADMINISTRATION
TECHNICAL •  fulfill the mandate of the agency
•  identify the problem and match them
COMMERCIAL with the services and resources

FINANCIAL •  raises capital

SECURITY •  provides safeguards

•  evaluate the financial operation

ACCOUNTING
•  directing function
MANAGERIAL

The art of getting things done through

MANAGEMENT
people by proper allocation and choice
of human resources materials funds and
methods

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EFFECTIVE • doing the right things right

EFFICIENT • doing things right

• being fair in financing and utilization,

EQUITABLE providing equal opportunities

• active ownership, participation and

EMPOWERING transparent decision making

FOUR “E” OF A WELL-PERFORMING

HEALTH SYSTEM

— Health Attainment (Effectiveness)

— Responsiveness (Efficiency)
- basic amenities, social support,
respect,
confidentiality, autonomy, choice,
communications
— Fairness in Financing (Equity)
- distribution of risks, social
protection

WHO Health Systems

Performance Assessment

United Kingdom •  National Health Services Model

Canada •  National Health Insurance Model

Germany •  Social Insurance Model

•  Social Insurance with Voluntary

Australia Private Insurance

USA •  Voluntary Health Insurance

Singapore •  Medisave

Six Models of Health Care

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•  Administrative authority is transferred to

Deconcentration regional or local health offices. (Central
Europe)

•  a well defined set of tasks, functions and authority are

Delegation transferred to organizations outside the central
government (Autonomous local health authorities)

•  a set of functions, power and authority is

Devolution transferred from the national government to
local governments

•  government functions are transferred to non

Privatization governmental organizations.

DECENTRALIZATION