COMMUNITY PARTICIPATION

PRIMARY HEALTH CARE

"PHC is a whole-of-society approach to health that aims at ensuring the highest
possible level of health and well-being and their equitable distribution by focusing on
people’s needs and 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."
WHO and UNICEF. A vision for primary health care in the 21st century:
Towards UHC and the SDGs
PHC (Primary Health Care)
- it is an essential care made universally accessible to individuals and families
by means acceptable to them through their full participation and at a cost
that the community and country can afford at every stage of development.
- forms the integral part both of country's health system, its the central
function and main focus of the social and economic development of the
community.
! Process in which community are engaged and participated in
making decisions about their own health
! Community identifies their health needs, planning, organizing,
decision making, and implementation of health programs
! If lacking, health programs cannot run smoothly and
universal achievement by primary health care cannot be
achieved.
INTRA - and INTERSECTORAL COORDINATION
! delivering health care ser vices in an integrated way.
! Involvement of private and public sectors is important.
! Ensure different sectors to collaborate and function
interdependently to meet the health needs of the people.
APPROPRIATE TECHNOLOGY
! using cheaper, scientifically valid, and acceptable equipment
and techniques
! for improving the availability and accessibility of services.
! Appropriate technology should be:

- Scientifically reliable and valid

- Adapted to local needs
- Acceptable to the community
- Accessible and affordable by local resources

SUPPORT MECHANISM
! Focused to develop the quality of life
! Includes personal, physical, mental, spiritual, and
instrumental support to meet goals of primary health care
! Depends on the adequate number and distribution of
trained physicians, nurses, health workers, allied health
professionals, working as a team and supported by local and
referral systems.

- the first level of contact of individuals, the family, and the community with
the national health system, bringing health as close as possible to where Principles of Primary Health Care
people live and work, and constitutes the first element of a continuing health
care process.
- Community
SERVICES PROVIDED IN PRIMARY HEALTH CARE Participation
- Intersectoral
! Promotive Collaboration
! Preventive - Integration of Health
! Curative Care programs
! Rehabilitative - Equity
- Self- Reliance

8 ESSENTIAL ELEMENTS OF PRIMARY HEALTH CARE

Education for health
(control of)
Locally endemic disease control COMMUNITY PARTICIPATION
Expanded program for immunization
Maternal and child health, including - Address the felt health needs of the people
• Advantages:
responsible parenthood
• Increase program acceptable and leadership
(provision of)
• Ensures that the program meets the local needs
Essential drugs • Reduced cost of program implementation
Nutrition • Commitments to the decision is facilitated
Treatment of communicable and non-communicable
diseases
Safe water and sanitation INTERSECTORAL COORDINATION
- Primary care involves all related sectors and aspects
FOUR PILLARS OF PRIMARY HEALTH CARE of national and community development:

• Formation of joint coordination committee

- Community Empowerment
- Intra- and Intersectoral Linkages
- Use of Appropriate Technology
- Support Mechanism
• Defining roles and responsibilities of participatory
agencies
• Participatory decision making
• Develop formal system of interaction
• Spelling out strategies and procedures
Equity FOURTH DECLARATION
• Health care resources should be accessible and affordable to all
• Essential drug services available at all levels and at low cost - the right and duty to participate individually and
• National health insurance scheme – people contribute to the health collectively in the planning and implementation of their
services of those who cannot afford health care.
• Julian Tudor Hart – “Inverse care Law”

SELF - RELIANCE FIFTH DECLARATION

! Involves the use of technological methods maintained by the
community
! Can be in terms of human resources, money, or materials
• Money: to ensure that there is financial backing
• Material: can be in form of physical facilities, drugs or other
biological resources
Integration of Health Care Programs/Services
! Coordination of various primary healthcare components into a
whole program and made available at all times.
Advantages:
• It ensures efficient use of all resources and removes areas of
wastage
• It ensures sustainability of program
• It reduces opportunity cost
- Governments have a responsibility for the health of their
people. the attainment by all peoples of the world by the
year 2000 of a level of health that will permit them to
lead a socially and economically productive life. Primary
health care is the key to attaining this target as part of
development in the spirit of social justice.
SIXTH DECLARATION
- universally accessible to individuals and families in the community
thru their full participation and at a cost that the community and
country.
- forms an integral part both of the country's health system. It
is the first level of contact of individuals, and constitutes the
first element of a continuing health care process.

SEVENTH DECLARATION
1978 Alma - Ata Declaration - PHC addresses the main health problems in the community,
providing promotive, preventive, curative and rehabilitative
ser vices accordingly.
- promotes maximum community and individual self-reliance
• First International Conference on Primary Health Care and participation and the ability of communities to
• Alma-Ata, Kazakh Soviet Socialist Republic, Soviet Union participate.
• Now Almaty, Kazakhstan - should be sustained by integrated, functional and mutually
• September 6-12, 1978 supportive referral systems
• Goal: “Health for All by 2000” - giving priority to those most in need.

- Primary health care relies, at local and referral levels, on

health workers, including physicians, nurses etc...

EIGHTH DECLARATION

- governments should formulate national policies, strategies and

plans of action to launch and sustain primary health care. Necessary
to exercise political will, to mobilize the country's resources.

NINTH DECLARATION

- All countries should cooperate in a spirit of partnership and

service to ensure primary health care because it directly concerns
and benefits every other country.

TENTH DECLARATION

- An acceptable level of health for all the people of

the world by the year 2000.
- A genuine policy of independence, peace, détente and
disarmament could and should release...

SECOND DECLARATION

- existing gross inequality in the health status within countries politically,

socially and economically unacceptable of common concern to all countries.

THIRD DECLARATION

- economic and social development, based on a

New International Economic Order, to the
reduction of the gap bet ween the health
status of the countries.

- promotion and protection of the health of

the people to a better quality of life and to
world peace.
2018 DECLARATION OF ASTANA

From Alma-Ata to Astana

Millennium Development Goals
• Reaffirming the commitments in:
- Alma-Ata of 1978
(MDGs) and Sustainable Development
- 2030 Agenda for Sustainable Development Goals (SDGs)
• Astana, Kazakhstan
• October 25-26, 2018

FIRST DECLARATION
- We strongly affirm our commitment to the
fundamental right of every human being to the
enjoyment of the highest attainable standard of
health without distinction of any kind.
SECOND DECLARATION
MILLENNIUM DEVELOPMENT GOALS
► Eight goals for year 2015
► Established during the Millennium Summit of the United Nations in 2000,
upon the adoption of United Nations Millennium Declaration
► Each goal has specific targets and dates in achieving the targets

- strengthening primary health care (PHC) MDG 1 ERADICATE EXTREME POVERTY AND HUNGER
is the most inclusive, effective and
efficient approach to enhance people’s ► Target 1A: Halve, bet ween 1990 and 2015, the proportion of people living on
physical and mental health. less than $1.25 a day
► Target 1B: Achieve Decent Employment for Women, Men, and Young People
THIRD DECLARATION
► Target 1C: Halve, bet ween 1990 and 2015, the proportion of people who
suffer from hunger
- people in all parts of the world still have
unaddressed health needs. We will continue to
address the growing burden of noncommunicable MDG 2 ACHIEVE UNIVERSAL PRIMARY EDUCATION
diseases,
- Promotive, preventive, curative, rehabilitative ► Target 2A: By 2015, all children can complete a full course of Primary
services and palliative care must be accessible to education/primary schooling, girls and boys
all.
MDG 3 PROMOTE GENDER EQUALITY AND EMPOWER WOMEN
FOURTH DECLARATION

- Make bold political choices for health across all sectors. ► Target 3A: Eliminate gender disparity in primary and secondary education
preferably by 2005, and at all levels by 2015.

FIFTH DECLARATION MDG 4 REDUCE CHILD MORTALITY

- Build sustainable primary health care.
SIXTH DECLARATION
- Empower individuals and communities.
- Target 4A: Reduce by t wo-thirds, bet ween 1990 and 2015, the under-five
mortality rate
► Under-five mortality rate
► Infant (under 1) mortality rate
► Proportion of 1-year-old children immunized against measles

SEVENTH DECLARATION MDG 4 RESULTS LAST 2015

-Align stakeholder support to national policies, ► The global under-five mortality rate has declined, dropping from 90 to 43
strategies and plans. deaths per 1,000 live births bet ween 1990 and 2015.
► the number of deaths of children under five has declined from 12.7
million in 1990 to almost 6 million in 2015 globally.
The success of Primary Health Care will be driven by:
► Since the early 1990s, the rate of reduction of under-five mortality has
• Knowledge and capacity-building more than tripled globally.
• Human resources ofor health - In sub-Saharan Africa, the annual rate of reduction of under-five
• Technology mortality was over five times faster during 2005–2013 than it was
• Financing during 1990–1995.

► Measles vaccination helped prevent nearly 15.6 million deaths bet ween
2000 and 2013. Measles cases declined by 67 per cent for the same
period.
► About 84 per cent of children worldwide received at least one dose of
measles-containing vaccine in 2013, up from 73 per cent in 2000.

MDG 5 IMPROVE MATERNAL HEALTH

► Target 5A: Reduce by three-quarters, bet ween 1990 and 2015, the maternal
mortality ratio

► Maternal mortality ratio

► Proportion of births attended by skilled health personnel
► Target 5B: Achieve, by 2015, universal access to reproductive health
► Contraceptive prevalence rate
► Adolescent birth rate
► Antenatal care coverage
► Unmet need for family planning
MDG 5 RESULTS FOR 2015
Since 1990, it has declined by 45 per cent worldwide, and most of the
reduction has occurred since 2000.
► In Southern Asia, it declined by 64 per cent bet ween 1990 and 2013,
and in sub-Saharan Africa it fell by 49 per cent.
► More than 71 per cent of births were assisted by skilled health
personnel globally in 2014, an increase from 59 per cent in 1990.
► In Northern Africa, the proportion of pregnant women who received
four or more antenatal visits increased from 50 per cent to 89
percent bet ween 1990 and 2014.
► Contraceptive prevalence among women aged 15 to 49, married or in
a union, increased from 55 per cent in 1990 worldwide to 64 per cent
in 2015.
MDG 6 COMBAT HIV/ AIDS MALARIA AND OTHER DISEASES
► Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
- HIV prevalence among population aged 15–24 years
- Condom use at last high-risk sex
- Proportion of population aged 15–24 years with comprehensive correct knowledge of
HIV/AIDS
► Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those
who need it
- Proportion of population with advanced HIV infection with access to anti-retroviral
drugs
► Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and
other major diseases
MDG 7 ENSURE ENVIRONMENTAL SUSTAINABILITY
► Target 7A: Integrate the principles of sustainable development into country
policies and programs; reverse loss of environmental resources
► Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant reduction
in the rate of loss
► Target 7C: Halve, by 2015, the proportion of the population without sustainable
access to safe drinking water and basic sanitation
► Target 7D: By 2020, to have achieved a significant improvement in the lives of at
least 100 million slum-dwellers
MDG 8 A GLOBAL PARTNERSHIP FOR DEVELOPMENT
► Target 8A: Develop further an open, rule-based, predictable, non-discriminatory
trading and financial system
► Target 8B: Address the Special Needs of the Least Developed Countries (LDCs)
► Target 8C: Address the special needs of landlocked developing countries and small
island developing States
► Target 8D: Deal comprehensively with the debt problems of developing countries
through national and international measures in order to make debt sustainable in
the long term
► Target 8E: In co-operation with pharmaceutical companies, provide access to
affordable, essential drugs in developing countries
► Target 8F: In co-operation with the private sector, make available the benefits of
new technologies, especially information and communications
SUSTAINABLE DEVELOPMENT GOODS GOALS
► Seventeen interlinked objectives
► “Shared blueprint for peace and prosperity for people
and the planet now and into the future”
► Formulated in 2015 by the United Nationals General
Assembly
► Adopted to be called as ”2030 Agenda”
► Each goal may have 8 to 12 targets with one to four
indicators used to measure progress toward reaching the
target
SDG 3
1. By 2030, reduce the global maternal mortality ratio to less
than 70 per 100,000 live births.
2. By 2030, end preventable deaths of newborns and children
under 5 years of age, with all countries aiming to reduce
neonatal mortality to at least as low as 12 per 1,000 live
births and under-5 mortality to at least as low as 25 per 1,000
live births.
3. By 2030, end the epidemics of AIDS, tuberculosis, malaria and
neglected tropical diseases and combat hepatitis, water-borne
diseases and other communicable diseases.
4. By 2030, reduce by one third premature mortality from non-
communicable diseases through prevention and treatment and
promote mental health and well-being.
5. Strengthen the prevention and treatment of substance
abuse, including narcotic drug abuse and harmful use of alcohol.
6. By 2020, halve the number of global deaths and injuries from
road traffic accidents.
7. By 2030, ensure universal access to sexual and reproductive
health-care services, including for family planning,
information and education, and the integration of reproductive
health into national strategies and programmes.
8. Achieve universal health coverage, including financial risk
protection, access to quality essential health-care ser vices
and access to safe, effective, quality and affordable essential
medicines and vaccines for all.
9. By 2030, substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water and soil
pollution and contamination.
a. Strengthen the implementation of the World Health
Organization Framework Convention on Tobacco Control in all
countries, as appropriate.
b. Support the research and development of vaccines and
medicines for the communicable and non-communicable diseases
that primarily affect developing countries, provide access to
affordable essential medicines and vaccines, in accordance
with the Doha Declaration on the TRIPS Agreement and Public
Health, which affirms the right of developing countries to use
to the full the provisions in the Agreement on Trade-Related
Aspects of Intellectual Property Rights regarding flexibilities to
protect public health, and, in particular, provide access to
medicines for all.
c. Substantially increase health financing and the recruitment,
development, training and retention of the health workforce in
developing countries, especially in least developed countries
and small island developing States.
d. Strengthen the capacity of all countries, in particular
developing countries, for early warning, risk reduction and
management of national and global health risks
 Comprehensive definition of Public health (Charles-Edward Amory
Winslow, 1920 ):
Introduction to Public Health,
History, Health Delivery System, “The science and art of preventing disease, prolonging life, and promoting
health and efficiency through organized community effort for:
Economic and Political Impact
• The sanitation of the environment
• The control of communicable infections
• The education of the individual in personal hygiene
• The organization of medical and nursing
ser vices for the early diagnosis and preventive
HEALTH
treatment of disease, and
• The development of the social machinery to
- a state of complete physical, mental and social well-
ensure everyone a standard of living adequate for maintenance of
being and not merely the absence of disease or infirmity.
health So, organizing these benefits as to enable every citizen to realize
his birth right of health and longevity.

Public Health Specialist and Clinician

• In the medical field, clinicians treat diseases and injuries of one

patient at a time. But in public health, we prevent disease and injury.

• Public health researchers, practitioners and educators work with

communities and populations.

• They identify the causes of disease and disability, and they

implement large scale solutions.

• Many deaths are premature.

• A substantial proportion of death can be
avoided.
• Public Health is related to preventing
premature and avoidable deaths.

PUBLIC HEALTH

- Measures directed to group of people (not individuals) to promote,

protect and preserve health.

Public health may be conceptualized as:

• Analyzing the health of a population and the

threats it faces is the basis for public health.
• Science of protecting the safety and improving the health of
communities through education, policy making and research for disease
and injury prevention.