PRIMARY HEALTH CARE

Course outline
Ø Background of PHC
o Definition of terms
o Goals of PHC
o Organization structure and functions of various administrative levels
Ø Elements of PHC
o Disease control
o Principles of environmental sanitation
o Maternal child health and family planning
o Community based rehabilitation
Ø Fundamentals of PHC
o Community development initiatives
o Social and economic development principles
o Equity in PHC
o Describe medical/social model of health
o Primary health delivery services
Ø Primary health care roles and training needs
o Community participation and involvement
o Health management at community level
o Rural infrastructure
o Problem identification
o Decision making
Ø Community based health care
o Role of nutritionist in PHC
Ø Nutrition and population
o Factors influencing family size
Ø Emerging issues and trends
COMPONENTS OF PHC/ELEMENTS OF PHC
· Health education about prevailing health problems and how to prevent and
control them
· Prevention and control of locally endemic diseases
· Expanded program of immunization
· Maternal child health and family planning
· Essential drugs supply
· Adequate supply of nutritional food supplements
· Treatment of common infections
· Safe water and basic sanitation
BASIC REQUIREMENTS FOR A SOUND PHC
· Appropriateness
· Availability
· Accessibility
· Acceptability
· Affordability
· Assessability
· Completeness
· Comprehensiveness
· Continuity
EXTENDED ELEMENTS OF PHC
· Expanded options of immunizations
· Reproductive health needs
· Provision of essential technologies for health
· Prevention and control of non communicable diseases
· Food safety provision of selected food supplements
· Health promotion
OBSTACLES TO IMPLEMENTATION OF PHC STRATEGY
· Misinterpretation of PHC concept
· Misconception that PHC is a second rate health care for the poor
· Selective PHC strategies
· Lack of political will
· Centralized planning and management
STRATEGIES OF PHC
Ø Reducing excess mortality of poor marginalized populations
o PHC must ensure access to health services for most disadvantaged
populations and focus on intervention which will directly impact on major
causes of mortality morbidity, and disability for those populations.
Ø Reducing the leading risk factors to human health
o PHC trough its preventive and health promotion roles must address those
known risk factors which are the major determinants of health outcomes
for local people
Ø Developing sustainable health systems
o PHC must develop ways which are financially sustainable supported by
political leaders and supported by the populations served
Ø Developing and enabling policy and institutional environment
o PHC must be integrated with other policy domains and play its part in the
pursuit of wider social economic and environment.
HOW EXPERIENCE HAS SHIFTED THE PHC MOVEMENT
· Extended access to a basic package of health interventions
· Concentration on MCH
· Focus on a small number of selected diseases
· Transformation and regulation of existing health systems aiming for universal
access
· Dealing with health of everyone
· A comprehensive response to peoples expectation
HEALTH REGULATORY AGENCIES IN KENYA
a) Clinical officers council(COC)
b) Kenya medical laboratory technicians and technologists board(KMLTTB)
c) Kenya medical practitioners and dentists board(KMPDB)
d) Public health officers and technicians council (PHOTC)
e) Nursing council of Kenya (NCK)
f) Kenya nutritionist and dieticians institute(KNDI)
g) Pharmacy and poisons board(PPB)
h) Physiotherapists council of Kenya (PCK)
i) Radiation protection board (RPB)
GOERVANCE OF PHC
Level 1/ tier 1: Community services/facilities
· Treatment of minor ailments like diarrhea
· Tb screening, home visits, contact tracing of T.B patents and tracing of T,.B
defaulters
· Screening of malnutrition
· Malaria rapid test
· Blood pressure and blood sugar testing
· Issue referral letters to other facilities
· HIV testing
· Health talks with pregnant women and observations of signs of danger
· Issuance of referral letters to other facilities
Level 2/tier 2: Dispensaries and clinics
· Outpatient services
· VCT services
· Tuberculosis services
· Laboratory services
· Well baby clinics
· Antenatal and postnatal services
· Pharmacy
· Counseling services
· Curative treatment
· Issuance of referral letters to other facilities
Level 3 /tier 2: Health centre and maternity and nursing homes
· Maternity inpatient services with a ward
· Curative services
· Laboratory services
· Dental
· Counseling
· Pharmacy
· Tb clinics diabetes and hypertensive clinics
· Comprehensive care clinics for patients living with HIV
· Well baby clinics
· Antenatal and postnatal services
· Issue referral letters to other facilities
Level 4/ tier 3: Sub county hospitals and medium sized private hospitals
· These are hospitals that offer holistic services and are ran by a director who is a
medic and at best a doctor by profession.
· Have same services as level 3 plus x-ray services.
· Issue referral letters to other facilities
Level 5/ tier 3: County referral hospitals and large private hospitals
Run by chief executive officers who are medic by profession and have over 100 beds
capacity for their inpatient.
Services include what other hospitals offer plus
Ø Ultrasound
Ø CT scan
Ø Surgery
Ø Pharmacy Physiotherapy
Ø Orthopedics
Ø Occupation therapy
Issue referral letters to other facilities
Level 6 /tier 4: National referral hospitals and large private teaching hospitals
· Services as level 5, but offer specialized treatments to patients that are not only
accessed by Kenyans but do serve east Africa and central Africa,
ü PHC services are primarily provided at levels 1-3. Public PHC facilities are
governed by health facility committees which include the facility in-charge and
community representatives.
ü For private PHC facilities government oversight is provided through regulation
implemented through the regulatory agencies
PRINCIPLES OF ENVIRONMENTAL HEALTH AND SANITATION
· Water and environmental health
o Purification of water filtration, disinfection ( use of chlorine), boiling
· Air and environmental health
o Sources of air pollution- automobiles , industries, domestic sources,
miscellaneous
o Air pollutants- carbon monoxide, sulphur dioxide, lead, carbon dioxide,
hydrocarbons
o Prevention- containment i.e. enclosure, ventilation
· Light and essentials of good lighting
o Sufficiency and uniformity in distribution. Over bright light causes eyes to
strain and sharp shadow is disturbing
· Ventilation and environmental health
o Natural ventilation- wind
o Artificial- exhaust ventilation
· Noise and environmental health
o Effects of noise- auditory effects-auditory fatigue
o Non auditory effects- annoyance, psychological changes
· Radiation exposure and environmental health
o Sources of radiations- natural sources- cosmic rays and environmental e.
g. in soils and rocks
o Man made sources- x-rays, nuclear explosions
· Environmental health and climate
o Climate e.g. heat, cold, air, rainfall, moisture dryness, sky altitude, , solar
radiltios
o Principal factors that affect health are- amount of sunlight, variations of
external temperature, humidity, atmospheric pressure, air movement,
altitude
· Residential environment (housing)and health
o Physical needs- have living rooms according to number of people.
o Free from odors and air movement
o Adequate light and water supply
o Good drainage for water
o Proper place for collection of refuse and its disposal
o Bathroom and sanitary latrines within reach
o Protected from rain sun and wild animals, rodents and snakes
· Sanitation and environmental health
· Waste and refuse
o Solid waste- ,methods of disposal- dumping, controlled tipping- material
placed in a prepared area adequately compacted and covered with earth
at end of working day
§ Incineration
§ Composting
o Human excreta disposal
§ Service type – conservancy type- bucket type of latrines
§ Non service type ( sanitary latrines, Bore hole, Dug wee or pit
latrine, Water seal type, Septic tank
§ Sewered areas- water carriage system and sewage treatment
COMMUNITY BASED HEALTH CARE
CBHC is for all people of all ages who need health care assistance at home.
Community care services include, home support, nursing, physiotherapy, nutrition
services and rehabilitation services.
Functions of community health workers
· They offer interpretation and translation services
· Provide culturally appropriate health education and information
· Help people get the care they need
· They give informal counseling and guidance on health behaviours
· Advocate for individual and community health needs
· Provide some direct services example first aid.
Components of community based health care
· Partnership between the community and the health facility staff
· Appropriate and good quality care by community based providers
· Promotion of health practices and lifestyle.
Advantages of community based development
· Spirit of empathy and high motivation in working for the community
· Community empowerment
· Use of local volunteers
· Creation of social prestige and evidence based decision making for the
community
Community based issues
· Poor self care skills
· Environmental hazards
· Need for social support and protection
· Mental health challenges and difficult with medication management.
COMMUNITY BASED ORGANIZATIONS
Ø Refers to organization aimed at making desired improvements to a community’s
social health, well being and overall functioning.
Ø It occurs geographically, psychosocially, culturally, spiritually, and/or digitally
bounded communities.
Community organization includes;
· community work
· Community projects
· Community empowerment
· Community building
· Community mobilization
Ø Community organization is a used model for organizing community within
community projects, neighborhoods, organizations, voluntary associations,
localities and social networks which may operate as ways to mobilize around
geography, shared space, shared experience, interests, need, and/or concern
Ø Its characterized by community building, community planning, direct action and
mobilization, the promotion of community change and ultimately changes within
larger social systems and power structures along with localized ones
Ø Generally functions not for profit efforts and funding, often goes directly toward
supporting organizing activities.
Functions of community based organizations
· Provide a platform for community to come together and discuss development
issues
· Analyze the causes of problems and solutions
· Communicate with decision makers to share planned action to obtain their
endorsement
· Galvanize community members to implement planned solutions
· Mobilize internal or locally available resources
Community mobilization
Ø Is the process of bringing together as many stakeholders as possible to raise
people’s awareness of and demand for a particular program to assist in the
delivery of resources and services and to strengthen community participation
for sustainability and self reliance
Ø It aims to mobilize and engage community members to address a particular
cause
Ø It contributes to giving back the affected population a sense of control over their
lives as people become more involved they are likely to become more able to
cope and more active in rebuilding their own community
Basic steps of community mobilization
· Define the problem
· Establishing a community mobilization group
· Designing strategies setting objectives and selecting target groups
· Developing an action plan with a time line
· Building capacity-involves identifying existing capacity ,resources and assessing
the gaps that exist to implement the community mobilization
· Identify partners
· Implementing the plan of activities
· Monitoring and evaluation
Community projects
Ø They are aimed at strengthening local communities. Types of community
development projects include those aimed at improving safety of its members
and enhancing social and cultural performance in the region.
Community building
Ø Is a field of practices directed toward the creation or enhancement of
community among individuals within a regional area such as neighborhood or
with a common need or interest. It is often encompassed under the fields of
community organizing, community work and community development.
Ø Community building activities are group activities that help people relax, get
comfortable, move around and become at ease with each other e.g. .potluck,
small book clubs, mass festivals, building construction projects
Community empowerment
Ø refers to the process of enabling communities to increase control over their
lives, (communities are groups of people that may or may not be spatially
connected but who share common interest concerns or identities)
Ø it is a means for community to broaden their networks and meet new and
influential people
Ø An empowered community can influence social and economic aspects of a
country to seek their rights. Moreover when working with other for a collective
cause individuals acquire a sense of witness
Ø It includes personal (psychological empowerment) organizational empowerment,
broader social and political actions
Community based rehabilitation
Ø It is a strategy within the community development for the rehabilitation ,
equalization of opportunities and social integration of all people with disabilities
Ø Its aim is to help people with disabilities by establishing community based
medical integration, equalization of opportunities and physical therapy
Ø CBR programs involves people with disabilities themselves, their families and
communities as well as appropriate professionals.
Ø CBR consists of five components( health, education, livelihood, social and
empowerment) and their associated elements
Ø CBR approach is implemented through efforts of people with disabilities,
families, communities, government, non governmental entities and other to
provide the necessary programs and services to meet the needs of people with
disabilities within a given community
Advantages of CBR
o At individual level
Ø Facilitate the training and employment of community based workers increasing
the skills income and employabilty of local community members.
o At community level
Ø The collaborative relationship between communities and health services
empowers communities and develops leadership.
Ø Major objective of CBR- are to ensure that people with disabilities are able to
maximize their physical and mental abilities to access regular services and
opportunities and to become active contributors to the community and society
at large
Community capacity building
Ø Refers to strengthening the skills of people and communities in small business
and local grassroots movement in order to achieve their goals and overcome
particular issues that may cause exclusion
Ø Capacity building is the process by which individuals and organizations obtain,
improve, retain skills and knowledge tools, equipment and other resources
needed to do their jobs competently.
Ø Community capacity building focuses on enabling all members of community
including poorest and most disadvantaged to develop skills and competencies
so as to take greater control of their own lives and also contributes to inclusive
local department
PRIMARY HEALTH CARE ROLES
Ø Provides whole person care for health needs throughout the lifespan not just for
a set of specific diseases
Ø It ensures people receive comprehensive care ranging from promotion and
prevention to treatment rehabilitative and palliative care as close as feasible to
peoples everyday environment.
· Rural infrastructure- complex of physical structures or networks within which
social and economic activities are carried out
· These structures are a means of achieving the broader goals of poverty
reduction and economic growth.
· It contributes to these goals by providing essential services such as water and
sanitation energy for cooking, heat and light and employment generating
commercial activities, transmission and communication of knowledge and
information.
Dimensions of rural development
· Economic
· Social
· Political
Components of rural development
· Education
· Entrepreneurship
· Physical infrastructure
· Social infrastructure
PROBLEM IDENTIFICATION
Ø Consists of clearly identifying the root cause of a problem.
Ø Developing a detailed problem statement that includes the problems effect on a
populations health
Problems are unique to their context it will need to talk to several different
stakeholders e.g.
· Those who are affected directly or indirectly
· Those responsible for the policy
· People whose jobs or lives might be affected by policy
· Community members and leaders
· Those with strong influence in the community e.g media, doctors, clergy
· State and local health departments
· Interest groups e.g business academics
· Funders and other resource providers
· Evaluators
· Legislators/ government officials
Steps for problem solving
· Identify issues
· Understand every ones interests
· List possible solutions
· Evaluate options
· Select an option
· Document an agreement
· Agree on contingencies monitoring and evaluation
Problem can mean
· A barrier to progress
· Need to do something
· A number of alternatives
· Needs solving
· feel frustrated
· needs to be changed
· disagree over action
· fault has occurred
· difficult to reach goal
· unexpected outcome
Characteristics of a problem
· problem identity
· location
· ownership/awareness
· importance
· time perspective
· causes
· influence
· ideas on possible solutions
· benefits to be drawn from the solution
DECISION MAKING
Is the process of making choices by identifying a decision gathering information,
assessing alternative solutions
Steps
· Identify the decision- clearly define nature of the decision you must make
· Gather relevant information
· Identify alternatives
· Weigh the evidence
· Choose among alternatives
· Take action
· Review your decision and consequences
MEDICAL MODEL OF HEALTH/ BIOMEDICAL MODEL OF HEALTH
Ø Focuses on the physical or biological aspects of disease and illness
Ø Is a model of health which suggests that disease is detected and identified
through a systematic process of observation, description, differentiation in
accordance with standard accepted procedures such as medical examinations,
tests or a set of symptom description
Ø Definition2: Medical model is a set of procedures in which all doctors are
trained includes complaint, history, physical examination, ancillary tests if
needed diagnosis treatment and prognosis with or without treatment.
SOCIAL MODEL OF HEALTH
Ø This approach attempts to address the broader influences on health(social,
cultural, environmental and economic factors) rather than disease and injury
Ø It is a community approach to prevent diseases and illnesses
Ø Focus is on policies, education and health promotion
Ø It goes beyond the focus of lifestyles and behavior and accepts the need for
social change to provide prerequisites for health.
Ø Addresses broader determinants of health(all aspects of health are addressed)
e.g gender, ethnicity, socioeconomic state, location, physical environment
influence behavioral determinants and have a strong relationship with health
and are becoming a focus of health promotion strategies.
Ø Aims to promote equity for all people and achieve these social determinants
which lead to inequality.