Community Health Nursing 2 Key Principles of Primary Health Care
(Family, Population Group and Community as
Clients)
Brief History Primary Health Care
●September 6-12, 1978- health leaders from around
200 countries attended the International Conference
for Primary Health Care held at Alma Ata, USSR
initiated by the WHO and United Nations Children’s
Fund.
●Alma Ata Declaration on Primary Health Care made
the following declarations:
– Health is a basic fundamental right. – There exists
global burden of health inequalities among
populations.
– Economic and social development is of basic
importance for the full attainment of health for all.
– Governments have a responsibility for the health of
their people
●The PHC strategy was later adopted in the
Philippines by virtue of Letter of Instruction(LOI) 949
0f 1979.
●Philippines- the first country in Asia to embark on
meeting the challenge of PHC
What is Primary Health Care?
● 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
their full participation and at 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.
8 essential health services listed in
Alma Ata Declaration
E- Education for health
L- Locally endemic disease control
E- Expanded program for immunization
M- Maternal and child health including responsible
parenthood
E- Essential drugs
N- Nutrition
T- Treatment of CD and NCD
S- Safe water and Sanitation
4 As: Accessibility, affordability, acceptability and
availability
●Support mechanisms
●Multisectoral approach
●Community participation
●Equitable distribution of health resources
●Appropriate technology
The 4As of PHC
1. Accessibility- refers to physical distance of a health
facility or the travel time required for people to get the
needed or desired health services.
*WHO guidelines states that facilities must be within
30 minutes from the communities to be considered
accissible.
*Barangay Health Stations(BHSs)- are facilities
intended to provide accessible health services at the
community level.
2. Affordability- a matter of wether the community or
the government can afford services, not only in
consideration of the individual and family’s capacity
to pay for basic health services.
*out-of-pocket expenses- one of the factors in
determining affordability of health care
3.Acceptability- means that the health care offered is
in consonance with the prevailing culture and
traditions of the population.
4.Availability- a question 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
Support Mechanisms
●Resources for essential health services come from
three major entities:
1.People themselves
2.Government
3.Private Sector *Health programs and projects
provide better outputs when these three entities are
involved
Multisectoral approach
●PHC requires communicatiion, cooperation, and
collaboration within among various sectors. This is
exeplified through intrasectoral and intersectoral
linkages.
● Intrasectoral linkages- refer to communication,
cooperation, and collaboration withing the health
sector: among members of the health team and among
health agencies.
Example: two-way referral system
● Intersectoral Linkages- encompass the
communication, cooperation, and collaboration
between the health sector and other sectors of society
like education, public works, agriculture, and local
government officials.
Example: Rabies Prevention and Control Program-
which requires collaborative effort effort among the
Department of Health(DOH), Department of
Agriculture(DA), Department of Education(DepEd),
and LGUs.
Community Participation
● It is an educational and empowering process in
which people, in partnership with those who are able
to assist them, identify the problems and needs and
increasingly assume responsibilities themselves to
plan, manage, control, and assess the collective actions
that are proved necessary.
Equitable distribution of health resources
●Effectiveness – The technology should accomplish
what is meant to accomplish. ●Affordability –
Measures for health promotion and disease prevention
are cost effective in comparison to treatment of
diseases.
●Simplicity – The technology that requires readily
available simple materials and that involves a simpler
process in its use can be more easily adopted by the
people in the community
●Acceptability – Technology is effective only when it
is used by those who need it. – Culture- an important
consideration in determining the appropriateness of a
technology.
●Feasibility and reliability – Must be easy to apply
considering the people’s natural settings – Supplies
must be constantly available
●Ecological effects – Important consideration in
choosing or rejecting a particular technology
●Potential contribute to individual and community
development – Appropriate technology promotes self-
sufficiency on the part of those using it.
Primary Health Care Vs. Primary Care

●DOH Programs to ensure equitable distribution of

manpower to the rural areas:
1.Doctor to the Barrios(DTTB) Program-
deployment of doctors to municipalities that are
without doctors. They manage Health Centers in
unserved, economically depressed municipalities.
2.Registered Nurses Health Enhancement and
Local Services(RN HEALS)- training and
development program for unemployed nurses;
deployed to unserved, economically depressed
municipalities.
Update: Nurse Deployment Project(NDP) under HRH

Appropriate Technology
●Technology- “applied science”
●Health technology- includes tools, drugs, methods,
procedures and techniques. ●Refers to the
technology that is suitable to the community that
will use it. The terms “people’s technology” and
“indigenous technology” are also used in reference to
appropriate technology

Criteria for appropriate health technology

●Safety – This means that the technology results in
minimal risk to the user and that the intended positive
outcomes of the use of technology far outweigh its
negative unintended negative effects.