(‫األفضل تنتقل بالجدول من فوق لتحت )تدرس عمود عمود‬

Primary health care (PHC) (lecture 1) ‫ ويا رب يكون مفيد‬،‫بالتوفيق‬

Community medicine: it’s a Health: is a dynamic state of -

Spectrum of health:
ealth for all: health needs to brought
H
branch of medicine distinct from complete physical, mental, social & positive health (highest) → better
within reach (accessible by everyone)

public health spiritual well being, not merely the -It’s a holistic concept (comprises
-focuses on how factors a ect absence of disease & in rmity health → freedom from disease →
coordination among various sectors)

health
(weakness) unrecognized disease → mild disease -It depends on continuous progress in
-Requires a multidisciplinary -It cannot be de ned as a state
→ severe disease → death (lowest) both medical care & public health
approach (should have a team of
because it’s everchanging
experts in medical elds) -Health results from a person Levels of care:

-transition is often gradual PHC: rst level of contact between the

interaction/adaptation to his
environment. person & health system, the closest to
people, essential health care, the
Community: a group of people The interaction of ve domains -Determinants of health: factors that majority of prevailing health problems,
living in the same place or determines health state:
in uence health ‫ وموجودين‬،‫)سهلني‬ provided by primary health care
having particular characteristics 1.genetic makeup,
(‫ إذا بدكم تراجعوهم‬٢٦‫ و‬٢٥‫ و‬٢٤‫
بساليد‬ centers

in common 2.social circumstances (education,

-Social determinants of health (SDH): Secondary HC: more complex
income & poverty),

the conditions in which people are problems, curative services, 1st

3.environmental conditions (toxic &
born, grow, work, live & age & the referral lever, provided by hospitals

microbial conditions),

Primary objective (goal) of wider set of forces & systems shaping

4.behavioural choices (diet, physical Tertiary HC: super-specialist care,
community medicine: preventing activity & substance use & abuse),
daily life

disease & promoting health in a 5.the availability of quality medical provides training programs, referral
community + reducing demand from Primary & secondary HC,
care provided by regional/central level
of curative & rehabilitative health
services institution, (e.g. plastic surgery)
Core subjects in community -Health dimensions: (important)
Alma-Ata international conference:
-PHC is an essential component in
medicine:
Physical (perfect body functioning, -calls for urgent actions to protect community medicine discipline

-Epidemiology
physical tness, activities of daily and promote the health of all people -PHS is the most basic package of
-Health care delivery system living ADL)
(PHC)
essential health services needed to
including primary health care
Mental (ability to think clearly, reason - rst international event underlining prevent diseases, promote health &
-biostatistics
objectively, a state of balance the importance of PHC
manage illnesses

-public health nutrition

between the individual & surrounding -Health is a fundamental right
-The World Bank estimates that 90%
-Social behavioural, world, free from internal con icts, -The inequality in health status of the of all health needs can be met at the
environmental, and management aware about himself, having a good people is political, socially & primary health care level.

sciences self control, coping with stress)

economically unacceptable.
-Primary care: one element of PHC,
Emotional (self-e cacy & self- -Governments have a responsibility it’s only related to management of
Public health: the science of esteem)
for the health of their people (can be illnesses
protecting & improving the Social (ability to have satisfying ful lled by a provision of adequate
health of people and their relationships)
health & social measures).

communities (works on Environmental (appreciation of the -An acceptable level of health can by
understanding the spread of external environment & one’s role in attained through a further & better
disease)
caring for it)
use of the world’s resources
-Similar goal with community Spiritual (feeling as part of a greater
health but di erent approach spectrum of existence)
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 PHC (lecture 2)

PHC: essential health care that is Core activities of PHC (elements):

The basic requirements for sound 9.Completeness:

socially appropriate, universally -Health education

PHC:
requires adequate attention to all
accessible, scienti cally sound, -Identifying & controlling prevailing health 1.Appropriateness (suitable):
aspects of medical problems, including
rst level of care provided by a problems
-Whether the service is needed at all in prevention, early detection, diagnosis,
suitable trained workforce -promotion food supply & proper nutrition
relation to essential human need, treatment, follow up measures &
supported by integrated referral -provision of safe water & basic sanitation
priorities & policies -The service is rehabilitation (e.g. providing
systems in a way that gives priority-maternal & child health care, including family properly selected & and carried out in physiotherapy for the hemiplegia
to those most in need, maximizes planning
the proper way. Appropriateness is (paralysis of one side), & continuous
community & individual self- -immunisation (vaccination) against the major important for the availability & follow-ups for diabetic patients after
reliance & participation & involves infectious diseases (e.g: measles, meningitis accessibility
describing drugs)

collaboration with other sectors & tuberculosis)

2.Adequacy:
10.Comprehensiveness:

(Intersectoral collaboration) -prevention & control of locally endemic -The service proportionate to care is provided for all types of health
disease
requirement. -Su cient volume of care problems.

-appropriate treatment of common diseases & to meet the need of the community.
11.Continuity:

PHC includes (essential health care injuries

3.A ordability:
-Management of patients’ care over time
services):
-promotion of mental health -provision of The cost should be within the means coordinated among providers -Important
-health promotion
essential drugs & basic laboratory services
and resources of the individual and the for chronic diseases such as diabetes,
-illness prevention
-training of health guides, health works & country
hypertension, ischemic heart diseases,
-care of the sick
health assistance
4.Accessibility:
Because if they aren't controlled they will
-advocacy
-referral services reachable, convenient services & cause severe problems
-community development geographically, economically &
culturally accessible

Functions of PHC:
Primary Health Care is di erent in each 5.Acceptability:
PHC:

-to provide continuous & community depending upon:

depends on satisfactory -focuses on the person not the disease,
comprehensive care
-Needs of the residents;
communication between health considers the determinants

-to refer to specialist & hospital -Economy of the country;

providers & patients, whether the -integrates care when there’s more than
services
-Availability of health care providers;
patients trust the care, whether the one problem

-to co-ordinate health service for -The community's geographic location; &
patients believes in the con dentiality -uses resources to narrow di erences

the patient
-Proximity to other health care services in the & privacy of his information
-address most important in the
-to guide the patient within the area 6.Availability:
community

network of social wellfare & public Care can be obtained whenever -PHC embodies a spirit of self-reliance
health services
people need it
and self- determination.

-to provide the best possible 7.Assessability:

-PHC is rooted in contemporary
health & social services in the light Medical care can be readily evaluated. conceptualizations of health as bio-
of economic consideration (people are able to evaluate the psycho-social phenomenon
services)

Principles of PHC:
Equity of health services:

8.Accountability:

-social equity
1.equivalent health needs (horizontal
-The feasibility of regular review of
-nation-wide coverage
equity)

nancial records by certi ed public

-self-reliance
2.greater health needs (vertical equity)
accountants
-inter-sectoral coordination

-people’s involvement in the

planning & implementation of
health programs
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 PHC (lecture 3)

A team: is a group of people who make Primary Health Care Initiatives Project:
Health Education:
Approaches of HE:

di erent contribution towards the -380 PHC clinics

-First line of Prevention
1. The medical approach involves
achievement of common goal (a limited -Renovation and provision of furniture -Skeleton of primary health care medical intervention to prevent ill health
number of members with complementary and specialized medical
services.
using a persuasive method and expects
skills)
equipment.
-Essential for Health Promotion and patients to comply with the
Characteristics of teamwork
-Clinical training of service providers.
Preventive Services.
recommended intervention. (medical
-The members share a common purpose -Establishment of performance -Helping people to understand their approach is conceptualized around
which binds them together.
improvement review systems.
behavior and how it may a ect their absence of disease ( focuses mainly on
-Each member has a clear understanding of -Improvement of the management health.
physical dimension)

his own functions & recognises common
interests.
-The team works by pooling knowledge
skills, and resources & all members share
information system. -is the translation of health 2. The educational approach provides
knowledge into desirable individual information and helps people to explore
and Community behavioral patterns their values and make their own
by means of educational process. decisions.

the responsibility for outcome. 3. The change in behaviour approach

involves changing people’s attitudes so
Composition of PHC team
Top cause of deaths:
Who is the health educator?
that they adopt healthy lifestyles as
The composition should adapt for the In low-income countries: lower -Specialist: person who is especially de ned by the health promoters. It can
speci c characteristics of the health system respiratory infections > coronary heart trained to do health education work.
be applied using locally available
and the community. Therefore, there are no disease > diarrhea
-Any health worker who is methods and media such as lea ets

universal models that can be used to In middle-income countries: stroke concerned with helping people
and posters.

prescribe a composition that is valid for all cerebrovascular disease > coronary -Any person in the Community can 4. The individual-centered approach
places, communities, or social contexts
heart disease > chronic obstructive participate in health education considered the individual to have a right
-Family health services, administered by pulmonary disease
process
to control his own health, so he should
Family Health Service Authorities (FHSAs), In high-income countries: coronary (Health education is the be helped to identify his concerns, and
include the four practitioner services:
heart disease > stroke cerebrovascular responsibility of every person in the gain the knowledge he needs to make
1.GPs (General Practitioners)
disease > lung cancer
Community.)
changes happen.

2.Dental practitioners.
5. The change in society approach
3.Pharmacists.
(in middle & high income countries In Jordan, health education (HE) is aims at changing the society rather than
4.Opticians.
there’s a decrease in deaths from in an important pillar of the work of the the individual by putting health on the
-Community health services, include:
infectious diseases & increase from in Ministry of health. political agenda at all levels, and by
1.Community doctors
non-communicable diseases) shaping the environment so that it
2.Dentists
Main goal of health education is:

To improve the quality of life becomes conductive to health. (should

3.Nurses, midwives, and health visitors
make a change in the environment, so it
4.Other allied professions such as chiropody In Jordan the total population growth individual and Community in all
rate has increased and is still aspects: health, social, economic becomes conductive to health)

and physiotherapy

-PHC may also involve:

increasing mainly due to immigration.
and political, taking in consideration
& this high population growth rate is that health is a state of complete -In Jordan, the traditional health
1.Counseling social workers, education approach used was aimed
2.psychologists, and psycho- therapists.
one of the challenges encountering physical, psychological and social
3.Administrative
PHC in Jordan well being and not the mere absence solely at changing people to t the
of diseases.
environment (without intervening the
4.Reception of clients/ for making
appointments
Target groups for health education:
surrounding environment) and did little
-Women
to make the environment a healthier
5.Secretarial / clerical work place to live in. (Educational approach)
-Children

-Elderly.
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 Health status has improved signi cantly in Jordan.
Educational programs:
Three main reasons for PHC in Jordan 1986 MOH
-Life expectancy at birth increased to reach 73.5 (72.8 Psychological Counselling
study visits are:

males and 74.2 females) in 2017

Cancer
a. 33% respiratory diseases.

-Infant mortality decreased to 17 per 1000 live births in Diabetes

b. 14% infectious and parasitic diseases.

2017.

Education and Support Groups

c. 10% digestive diseases.

-Total fertility rate dropped to 2.7 in 2017 (Fertility declines in

Fitness and Exercise

Jordan have contributed to slowing the population growth

rate down)
Health Screenings
So almost more than 50% of visits to PHC clinics
-SmallPox was eradicated, Measles, polio prevalence rates Nutrition and Weight Management
were for curative reasons rather than preventive or
were decreased a lot
Older Adults
consultive ones .

-Population Growth Rate (2.4%) in 2017

Parent Education
( The limited resources can be used in the medical
-Population Doubling Time (29 years) in 2017
Pregnancy and Childbirth
eld must be directed in a way by which it can meet
-Singulate mean age of females at rst marriage is 26.3 Programs for Families
the community’s needs )
years in 2017
Programs for Men

-The urban population increased to 90.3% in 2017.

Programs for Women

-The proportion of the population under 15 years of age Safety and CPR

declined to 34.3 by 2017

Sleep Disorders

-The proportion of those age 65 and over has been rising to

Special Programs

3.7% by the year 2017 (because of the improved health care

services provided to the community members in general)
Stress Busters

-the age structure of the population has changed – the

result of changes in fertility, mortality, and migration
dynamics.

Top causes of death in Jordan:

In 1979:
Proportionate Mortality Ratio: (in order)

1.Cardiovascular diseases
1.Disease of circulatory system

2.Respiratory diseases
2.Neoplasm's

3.Diarrhea
3.Accidents and adverse e ects

4.Conditions originating in the perinatal period

In 1991:

‫ إذا مش حفظ فشق‬،‫في حال الزم نحفظ النسب هيهم‬ 1.Cardiovascular diseases, arterial diseases & Hypertension

🤝 🌚 ‫
عن هاض العمود‬ 2.Accidents

3.Malignancies

‫الدكتورة قرأت كل النسب املوجودة باملحاضرة‬
‫ ألنه هي حاطة تحتهم خط‬2017 ‫فهون حطيت تبعون‬ In 2010:

‫بالساليدات‬ 1.Ischemic Heart Disease

2.Cancer

3.Stroke

4.Diabetes

5.Congenital abnormalities & chronic kidney disease & road

injuries

Raneem Al-Zoubi
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