NCM 21O - COMMUNITY HEALTH NURSING

Primary Health Care 🧑‍⚕️ DESIATA, LYRIZZA

Primary Health Care PRIMARY HEALTH CARE (PHC)

OPTIMUM LEVEL OF FUNCTIONING

The modern concept of health refers it to
the “ optimum level of functioning” (OLOF) of
individuals, families and communities which is
affected by several factors in the ecosystem, as
follows:
FACTORS
1. POLITICAL
● politics have power and authority to
regulate the environment or social
climate
● Example: laws or legislative acts are “Essential health care made universally accessible
often related to promoting safety and to individuals & families in the community by
people empowerment. means acceptable to them through their full
2. BEHAVIORAL participation & at cost that the community &
● a person’s level of functioning is affected country can afford at every stage of
by certain habits while their lifestyle, development“
health care and childrearing practices (WHO).
are determined by their culture and ● Primary health care (PHC) is the first level of
ethnic heritage contact for individuals, the family, and the
3. HEREDITARY community with the national health system
● understanding of genetically-influenced and “addresses the main health problems in
diseases and genetic risks the community, providing health promotion,
4. HEALTH CARE DELIVERY SYSTEM preventive, curative and rehabilitative
● primary health care is a partnership services accordingly.”
approach to the effective provision of ● Primary Health Care is a strategy to ensure
essential health services that are that there is effective provision of essential
community-based, accessible, health services that are community-based,
acceptable, sustainable, and affordable accessible, acceptable and sustainable
5. ENVIRONMENTAL INFLUENCES ● Multiple sectors working together to bring
● the menace of pollution, communicable care closer to home with the involvement of
diseases due to poor sanitation, poor the community
garbage collection, smoking, utilization
of pesticides
6. SOCIO-ECONOMIC INFLUENCES
● families in lower income group are the
ones mostly served
● Example: Unemployed, underemployed,
lack of education, lack of decent
housing
 HISTORY OF PRIMARY HEALTH CARE
May 1977
The 30th World Health Assembly adopted
resolution WHA 30:43
● This resolution decided that the main social
target of governments and of WHO should be
attainment by all the people of the world by
the year 2000 a level of health that will permit
them to lead a socially and economically
productive life
September 6-12, 1978
International Conference on Primary Health Care
was held in this year in Alma Ata, USSR
● The conference came up with what is known
popularly as the Alma Ata Declaration, which
represents a global ideal, a new vision about
how to achieve world health. The
Declaration stated that primary health care is
the key to attaining the health-for- all goal
● The Declaration stated that primary health
care is the key to attaining the health for all
goal
● The global goal as stated in the Alma Ata
Declaration is Health for All by the year 2000
through self-reliance
● The Health for All goals does not mean
however that nobody will be sick or disabled
anymore. Nor does it mean that health care
professionals will provide care for everybody
in the country or the world for all their existing
ailments
● Underlying theme of (before/ previous):
○ Health For All by Year 2000 (WHO, 1978)
○ “Health in the Hands of the People by
2020”
Alma Ata Declaration, 1978
● The conference strongly reaffirms that health is a
fundamental human right
● The existing gross inequality in the health status
of the people particularly between developed
and developing countries as well as within
countries is politically, socially, and economically
unacceptable”
October 25-26, 2018
Astana, Kazakhstan
● On the 40th anniversary of the Alma-Ata
Declaration, global health leaders and
stakeholders returned to Kazakhstan to renew
the promise of primary health care as the
most effective and efficient means to
achieve universal health coverage (WHO,
2018)
● Declaration of Astana
● Astana Declaration 2018 aim to meet all
people’s health needs across the life course
through comprehensive preventive,
promotive, curative, rehabilitative services
and palliative care
GLOBAL HEALTH LEADERS COMMITS TO:
● Make bold political choices for health across
all sectors
● Build sustainable primary health care
● Empower individuals and communities
● Align stakeholders to support national
policies, strategies and plans
WHAT IS PHC NEW CONSENSUS?
● A whole of society approach to health that
aims to ensure the highest possible level of
health and well being and their equitable
distribution by focusing on people’s needs
and preferences (as individual, family, and
community) as early as possible along the
continuum from health promotion and
disease prevention to treatment,
rehabilitation and palliative care and as
close as feasible to people’s everyday
environment
A PRIMARY HEALTH CARE APPROACH INCLUDES
THREE COMPONENTS:
● meeting people’s health needs throughout
their lives;
● addressing the broader determinants of
health through multisectoral policy and
action; and
● empowering individuals, families and
communities to take charge of their own
health.
PHC’S GOAL IS ANCHORED IN THE VISION OF DOH
● Filipinos are among the healthiest people in
Southeast Asia by 2022, and Asia by 2040
Mission
● To strengthen the health care system by
increasing opportunities & supporting the
conditions wherein people will manage their
own health care
LEGAL BASIS OF PHC IN THE PHILIPPINES ELEMENTS OF PRIMARY HEALTHCARE
October 19, 1979
● The President of the Philippines (Pres. ELEMENTS OF PRIMARY HEALTH CARE
Ferdinand E. Marcos) issued Letter of
E Education about prevailing health
Instruction (LOI) 949 which mandated the
problems and methods of preventing
Ministry of Health to adopt Primary Health
and controlling them
Care as an approach towards design,
development, and implementation of
L Prevention and control of locally
programs, which focus health development
endemic diseases
at the community level
Universal Declaration of Human Rights, Article 25,
E Provision of essential drugs
Section 1
● “Everyone has the right to a standard of living
M Maternal and child health care;
adequate for the health and well-being of
including family planning
himself and of his family, including food,
clothing, housing and medical care and
E Expanded immunization against major
necessary social services and the right to
infectious diseases
security in the event of unemployment,
sickness, disability, old age, widowhood , or
N Promotion of food supply and proper
lack of livelihood.”
nutrition
Philippine Constitution of 1987, Article XIII, Section
11
T Appropriate treatment of common
● “The State shall adopt an integrated and
diseases and injuries
comprehensive approach to health
development which shall endeavor to make
S Adequate supply of safe water and
essential goods, health and other social
basic sanitation
services available to all the people at
affordable cost. There shall be a priority for
the needs of the underprivileged sick, elderly,
disabled, women, and children. The State
shall endeavor to provide free medical
services to paupers”
WHO (1995)
● Governments have a responsibility for the
health of their people which can be fulfilled
only by the provision of adequate health and
social measures
FOUR CORNERSTONES / PILLARS IN PRIMARY
HEALTH CARE
1. Active Community participation
2. Multi Sectoral Linkages
3. Use of Appropriate Technology
4. Support Mechanism made available
COMMUNITY PARTICIPATION
● A process in which people identify the
problems and needs and assumes
responsibilities themselves to plan, manage
and control
● People should take a role or contribute, for
example people should be part in the
planning process
MULTI SECTORAL LINKAGES
● Multisectoral
○ Intra-sectoral
■ Two-way referral system:
Communication, cooperation and
collaboration within the health sectors
○ Inter-sectoral
■ Between the health sector and other
sectors like education, agriculture, and
local government offices
APPROPRIATE TECHNOLOGY
● Method used to provide a socially and
environmentally acceptable level of services
or quality product at the least economic cost
● Health technology includes tools, drugs,
methods, procedures, techniques; and
people and indigenous technology
SUPPORT MECHANISM
● 3 MAJOR RESOURCES
○ People (example: BHW, Mothers,
Community Leaders
○ Government
○ Private sector.
KEY PRINCIPLES
4 A's
1. Accessibility
● Distance or travel time required to get to
the healthcare facility or service
● Can be reached by the majority of the
population
2. Affordability
● Inexpensive healthcare services
● Most health services are covered by the
government insurance system known as
PhilHealth
3. Acceptability
● Compatible with the culture and tradition
with the population
● Meets the requirements and needs in the
area
4. Availability
● Services/ programs are offered, provide on
regular basis in an organized manner
Example:
● Botika ng Bayan
● Ligtas Tigdas and Pinas.
Community-based
● delivered where the people are
Sustainable
● health services should be successfully utilized,
maintained and continued
Feasibility of Use
● possibility of use at all times
Effective
Scope of Technology
● is safe and secure
TYPES OF PRIMARY HEALTH CARE WORKERS
● Various categories of health workers make up
the primary health care team.
● The types vary in different communities
depending upon:
1. Available health manpower resources
2. Local health needs and problems
3. Political and financial feasibility
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
HAVE BEEN IDENTIFIED:
1. Grassroots or Village or Barangay Health
Workers (V/BHWS).
● This refers to trained community health
workers or health auxiliary volunteer or a
traditional birth attendant or healer.
2. Intermediate level health workers.
● General medical practitioners or their
assistants, Public Health Nurse, Rural
Sanitary Inspectors and Midwives may
compose these groups
Basic primary health care team:
● Physician, public health nurse, midwife
LEVELS OF PREVENTION LEVELS OF HEALTH CARE AND REFERRAL SYSTEM
1. Primary Level of Care
PRIMARY Goal: Decrease vulnerability:
● Primary care is devolved to the cities and the
reduce risk factors. Prevent
municipalities. It is health care provided by
disease and dysfunction.
center physicians, public health nurses, rural
Activity: Health promotion:
health midwives, barangay health workers,
reduction of risk factors.
traditional healers and others at the
Who? Healthy People.
barangay health stations and rural health
Examples: ◦ Quit smoking ◦
units.
Avoid/ limit alcohol intake ◦
● The primary health facility is usually the first
Exercise regularly ◦ Reduce fat
contact between the community members
and increase fiber in diet ◦
and the other levels of health facility
Take adequate fluids ◦
○ Rural Health Unit Community
Complete immunization
Hospitals and Health Centers
Private
SECONDARY Goal: Halt pathological
Practitioners/Puericulture
process, shorten duration and
Centers Barangay Health
severity of disease, limit or
Stations
delay disability.
2. Secondary Level of Care
Activity: Screening for early
● Secondary care is given by physicians with
diagnosis and prompt
basic health training. This is usually given in
treatment.
health facilities either privately owned or
Who? People with undetected
government operated such as infirmaries,
disease or disability.
municipal and district hospitals and
Example: Screening ◦ Early
out-patient departments of provincial
detection ◦ Early treatment ◦
hospitals.
Mass screening like Operation
● This serves as a referral center for the primary
Timbang, Operation BP ◦
health facilities.
Case-finding like Sputum exam
● Secondary facilities are capable of
for Tuberculosis, Stool Exam or
performing minor surgeries and perform some
Kato-Katz for Schistosomiasis ◦
simple laboratory examinations.
Contact tracing like COVID
○ Provincial/City Health Services
positive exposed individuals ◦
Provincial/City Hospitals
Surveillance of disease like HIV
Emergency/District Hospitals
3. Tertiary Level of Care
TERTIARY Goal: Restore person to highest
● Tertiary care is rendered by specialists in
level of functioning within limits
health facilities including medical centers as
of disease. Prevent further
well as regional and provincial hospitals, and
deterioration from a fixed or
specialized hospitals such as the Philippine
irreversible disease.
Heart Center.
Activity: Rehabilitation.
● The tertiary health facility is the referral center
Who? People with fixed or
for the secondary care facilities.
irreversible disease.
● Complicated cases and intensive care
Example: ◦ Rehabilitative or
requires tertiary care and all these can be
prevention of disability care/
provided by the tertiary care facility.
services ◦ Helping client live
○ National Health Services
productively with limitations ◦
Medical Centers Training and
Self-monitoring of blood
Teaching Hospitals Regional
glucose ◦ Physical therapy
Health Services Regional
after cerebrovascular
Medical Centers And Training
accident
Hospitals
 NOTE ❗
If you will be asked (like a PNLE question) of the
three levels of primary health workers, the first
level is the grassroots or village workers, second
is the intermediate and the third level are the
first line personnel who are considered as the
specialists. The latter establish close contact
with the village or intermediate health workers
to promote continuity of care from the hospital
to community to home.

UNIVERSAL HEALTH COVERAGE What is Universal Health Coverage/Care?

● The Universal Health Care Act of the ● All people having access to quality health
Philippines was signed last February 2019. services* without suffering the financial
● Health sector reform in the Philippines has hardship associated with paying for care
been accelerated by the passage of - All people (population coverage)
Republic Act 11223, more commonly known - having access to quality health services
as the UHC Law (service coverage)
- without suffering financial hardship
associated with paying for care (financial
risk protection)
*including prevention, promotion, treatment,
rehabilitation and palliation

The diagram below shows the link of the PHC, as

the foundation of UHC, both aim in the attainment
of the SDGs
Universal Health Care and its Aim
● Universal Health Care (UHC), also referred to
as Kalusugan Pangkalahatan (KP), is the
“provision to every Filipino of the highest
possible quality of health care that is
accessible, efficient, equitably distributed,
adequately funded, fairly financed, and
appropriately used by an informed and
empowered public”
● The Aquino administration puts it as the
availability and accessibility of health services
and necessities for all Filipinos
● It is a government mandate aiming to ensure
that every Filipino shall receive affordable
and quality health benefits. This involves
providing adequate resources – health
human resources, health facilities, and health
financing
● UHC’s Three Thrusts
○ To attain UHC, three strategic thrusts are
to be pursued, namely:
■ 1) Financial risk protection through
expansion in enrollment and benefit
delivery of the National Health
Insurance Program (NHIP);
■ 2) Improved access to quality hospitals
and health care facilities; and
■ 3) Attainment of health-related
Sustainable Development Goals
(SDGs).
● Financial efforts shall be provided to allow
immediate rehabilitation and construction of
critical health facilities. In addition to that,
treatment packs for hypertension and
diabetes shall be obtained and distributed to
RHUs
● The DOH licensure and PhilHealth
accreditation for hospitals and health
facilities shall be streamlined and unified
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