PRIMARY HEALTH CARE 2.
Health Service Reforms - organizing health
An Approach To Community Health
BRIEF HISTORY
 International Conference for Primary Health
Care (WHO and UN Children’s Fund)
 Sept. 6 – 12, 1978 in Alma Ata, USSR
“Alma Ata Declaration on PHC”
Declarations:
 Health is a basic fundamental right.
 There exists global burden of health inequalities
among population.
 Economic and social development is a basic
importance for the full attainment of HFA.
 Government have a responsibility for the health
of their people.
IN THE PHILIPPINES…
 PHC was established through Letter of
Instruction (LOI) 949 signed on Oct. 19, 1979
by then President Marcos one year after the
First International Conference.
 Theme: “Health in the Hands of the People by
2020”
DEFINITION OF PRIMARY HEALTH CARE (ALMA ATA
DECLARATION)
 PHC is 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 full participation and at a
cost that the community and country can afford
to maintain at every stage of their development
in the spirit of self-reliance and self-
determination.
GOAL OF PRIMARY HEALTH CARE
 "Health for All (HFA) by the year 2000"
OBJECTIVES OF PRIMARY HEALTH CARE
 Promotion of healthy lifestyles
 Prevention of diseases
 Therapy for existing conditions
5 KEY ELEMENTS IN ACHIEVING HFA
1. Universal Coverage - reducing exclusion and
social disparities
services around people’s need
3. Public Policy Reforms – integrating health into
all sectors
4. Leadership Reforms – pursuing collaborative
models of policy dialogue
5. Increasing stakeholders participation
8 ESSENTIAL HEALTH SERVICES (ELEMENTS)
KEY PRINCIPLES OF PHC
1. 4 A’s Of Health Services
 Affordability
 refers to the individual or family’s capacity
to pay for basic health services.
 also involves the capacity of the
government or the community can afford
the basic health services
 (WHO) also considers the out-of-the-pocket
expenses for health care.
 Accessibility
 refers to the physical distance of a health
facility or the travel time required for
people to get the needed or desired health
services.
 (WHO) health care facilities should be
within 30 minutes from the community
 Acceptability
 means the health care offered is in
consonance with the prevailing culture and
traditions of the population.
 Availability
 is a question of whether the basic health
services required by the people are offered
in the health care facilities or is provided on
a regular and organized manner.
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2. Support Mechanism
 Health programs and projects have better
outputs when there is collaboration
 A multi-sectoral approach is needed for an
efficient utilization of resources.
3. Multi-Sectoral Approach
 Health and diseases are outcomes of inter-
related factors, PHC requires 3C’s within
and among various sectors
 3C's:
 Communication
 Cooperation
 Collaboration
 Requires intra-sectoral and inter-sectoral
linkages
4. Community Participation
 An educational and empowering process in
which people identify the problems, their
needs and assume responsibilities to
assess, plan, manage, and control actions
that are proven to be necessary.
 Clients are not recipient of care but active
participants
5. Equitable Distribution Of Health Resources
 PHC advocates for care that is community-
based and preventive in orientation
 There should be an inventory of health
resources, facilities and manpower
6. Appropriate Technology
 Refers to the technology that is suitable to
the community that will use it and includes
tools drugs, methods, procedures and
techniques
 Criteria:
 Safety
 Effectiveness
 Affordability
 Simplicity
 Acceptability
 Feasibility and Reliability
 Ecological effects
 Potential to contribute to individual and community
development
STRATEGIES OF PHC
1. Utilization Of The 4As Of Health Services
 Health services must be delivered where
the people are
 Indigenous/ resident volunteer workers
must be tapped as health care providers
 Use of traditional medicine must be used
together with essential drugs
2. Partnership Between The Community & Health
Agencies
 Establishment of an effective health referral
system
 Information, education and communication
support using multi media
 Collaboration between gov’t and NGO
3. Community Participation
 Small group meetings
 Community building & community
organizing
 Formation of health committees
4. Self-Reliance
 community gives support ( cash, kind or
labor) to the health program)
 use of local resources ( human, financial or
material)
 training of the community in leadership and
management skill
5. Recognition Of Inter-Relationship Between
Health & Development
 integration of the PHC into national
regional, provincial, municipal & barangay
development plans
 coordination of activities with economic
planning, education, agriculture, industry,
housing, public works, communication &
social services
6. Social Mobilization
 Establishment of an effective health referral
system
 Information, education and communication
support using multi media
 Collaboration between gov’t and NGO
7. Decentralization
 Re-allocation of budgetary resources
 Re-orientation of health professionals on
PHC
 Advocacy for political will & support, from
the national leadership down to the
barangay level
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