Primary Health Care

PHC
HEALTH FOR ALL APPROACH
 Objectives:
Students should know how to:
1-Define PHC
2-Describe the rationale and concept of PHC and how it relates
to basic health services
3. Objectives of Primary Health Care
4-List and explain the elements and principles of PHC
5-Define the promotive services
6-Define the preventive services
7-Define the curative care services
8-Explain Principles of the Ethical Practice of Public Health
 Rationale for Adopting Primary
Health Care

 Magnitude of Health Problems

 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other
development activities
 WHO-UNICEF held international conference in 1978
at Alma-Ata (USSR),the governments of 134 countries
and many voluntary agencies called for a revolutionary
approach to health care.

 The Alma-Ata conference called for acceptance of the

WHO goal for Health for All(HFA) by the year 2000
and proclaimed primary health care as a way to
achieving Health for all.
 PHC (cont.)
The Alma-Ata Conference defined PHC as
follows:-
"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 a cost the community & country
can afford to maintain at every stage of their development in the spirit of
self determination".
 All people, everywhere, have the right to achieve the highest attainable
level of health. This is the fundamental premise of primary health care
(PHC).
 Primary health care (PHC) is essential health care made universally
accessible to individuals and acceptable to them, through full
participation and at a cost the community and country can afford
 PHC (cont.)
 PHC is equally valid for all countries, although it
takes varying forms in each of them.
 The concept of PHC has been accepted by all
countries as the key to the attainment of HFA(Health
For All).
 It is accepted as an integral part of the country's
health system.
 PHC (cont.)
Primary health care is a whole-of-society approach to
effectively organize and strengthen national health systems
to bring services for health and wellbeing closer to
communities. It has 3 components:
 integrated health services to meet people’s health needs
throughout their lives
 addressing the broader determinants of health through
multisectoral policy and action
 empowering individuals, families and communities to
take charge of their own health.
 Objectives of PHC
•Improvement in the level of health care of the community
•Favorable population growth structure
•Reduction in the prevalence of preventable, communicable
and other disease.
•Reduction in morbidity and mortality rates especially
among infants and children.
•Extension of essential health services with priority given to
the underserved sectors.
•Improvement in Basic Sanitation
•Development of the capability of the community aimed at
self- reliance.
•Maximizing the contribution of the other sectors for the
social and economic development of the community.
Elements (components) of PHC

Although specific services provided will vary in different

countries & communities, the Alma-Ata Declaration has
outlined 8 essential components of PHC :-
Elements of PHC: (cont.)
 1. Health education

 It s crucial to primary health care, empowering

individuals to take charge of their health.

 It helps people to understand how to prevent and

manage illnesses, make healthy lifestyle choices, and
access health services.

 For example, the government of most countries

implement several health education programs to
promote healthy behaviors and increase awareness
about health issues.
 2. Promotion of food supply & proper
nutrition.

 It is vital for maintaining good health and preventing

diseases. Primary health care should include nutrition
education, counseling, and support to ensure that people
have access to a balanced diet.

 For instance, malnutrition is a significant health issue,

with a prevalence of 22% among children under five.
 3. Environmental Sanitation and Promotion of Safe
Water Supply
 Environmental Sanitation is defined as the study of all
factors in the man’s environment, which exercise or may
exercise deleterious effect on his well-being and survival.

 Water is a basic need for life and one factor in man’s

environment.

 Water is necessary for the maintenance of healthy

lifestyle.

 Safe Water and Sanitation is necessary for basic

promotion of health.
 4. Maternal & child health and family
planning.

 The mother and child are the most delicate members

of the community.

 So the protection of the mother and child to illness

and other risks would ensure good health for the
community.

 The goal of Family Planning includes spacing of

children and responsible parenthood.
 5. Expanded Program on Immunization.

 This program exists to control the occurrence of

preventable illnesses especially of children below 6
years old.

 Immunizations on poliomyelitis, measles, tetanus,

diphtheria and other preventable disease are given for
free by the government and ongoing program of the
MOH
6.Prevention & control of locally endemic
diseases

 The control of endemic disease focuses on the

prevention of its occurrence to reduce morbidity
rate.

 Example Malaria Control and Schistosomiasis

Control
 7. Treatment of Communicable Diseases and
Common Illness

 The diseases spread through direct contact pose a great risk to

those who can be infected.

 Tuberculosis is one of the communicable diseases continuously

occupies the top ten causes of death.

 Most communicable diseases are also preventable.

 The Government focuses on the prevention, control and treatment

of these illnesses.
 8. Provision of essential drugs.

 This focuses on the information campaign on the

utilization and acquisition of drugs.

 Some essential drugs It includes: Cotrimoxazole,

Paracetamol, Amoxycillin, Oresol, Nifedipine,
Rifampicin, isoniazid and Pyrazinamide,
Ethambutol, Streptomycin, Albendazole, Quinine
 Elements of PHC: (cont.)
The first three elements are promotive
services.
the middle three are preventive
services.
the last two services are curative care
services.
 The concept of PHC involves an effort to provide the
rural population in developing countries with at least
the basic minimum of health services.
 The list can be modified to fit local circumstances
 For example some countries have specifically
included:
-Mental health
-Physical handicaps.
-Health and social care of the elderly.
 PHC principles
The mentioned eight services indicated as elements, are to be
organized & delivered on basis of the principles of :-
1- Equity in distribution.

2- Appropriate technology.

3- Multisectoral approach.

4- Community participation.

5. 4 A’s = Accessibility, Availability, Affordability &

Acceptability, Appropriateness of health services.

6. Decentralization
Principles of PHC (cont.)
1. Equitable distribution.
The first key principle in the PHC
strategy is equity or equitable
distribution of health services.

Health services must be shared

equally by all people irrespective of
their ability to pay.
Principles of PHC (cont.)

1. Equitable distribution (cont.)

PHC aims to re-adress this imbalance by:
Shifting the centre of gravity of the health care
system from cities (where three-quarters of
the health budget is spent) to → rural areas
(where three-quarters of the people live).
Bring these services as near people's home as
possible.
Equity means:
1.Services to all
2.More services to needy &
vulnerable
i.e. while continuing to provide essential health
care for all the population irrespective of
social, economical & cultural preferences,
extended care is to be provided to the "high
risk" groups in the community either within the
health centers or by referral from the health
centers to a higher level of care (hospital).
For ensuring equity:
-The population to be served must be
known.
- The vulnerable groups are to be
identified & reached.
PHC principles (cont.)
1. Equity in distribution (cont.):
For ensuring equity (cont.) :
- The health services (not necessarily health
centers) have to be dispersed into:
- The farthest remote rural areas.
- The deepest parts of the underserved urban
population.
The failure to reach the needy & the majority is
usually due to limited geographical access.
PHC principles (cont.)
1. Equity in distribution (cont.):
Thus, to ensure equity, accessibility has to be
improved by :
- Increasing the number of health facilities.
- Improving transport conditions.
- Organizing outreach services, thus substituting
one when the other is not available.
 PHC principles (cont.)
1. Equity in distribution (cont.):
PHC aims to:
- Correct imbalance in accessibility
- Bring health services as near to people's
homes as possible.
- To achieve this, PHC is supported by
higher level of health care to which
patients can be referred for extended
care.
Principles of PHC (cont.)
2. Community participation.
Involvement of individuals,
families, & communities in
promotion of their own health &
welfare.
Principles of PHC (cont.)
2. Community participation (cont.)
There must be:
A continuing effort to secure meaningful
involvement of the community in:
Planning.
Implementation.
Maintenance of health services.
Evaluation of health services.
Maximum reliance on local resources such as:
Manpower.
Money.
Materials.
Principles of PHC (cont.)
2. Community participation (cont.)
 Participation is a critical aspect of both social
justice and equitable processes.

 People need to have some say in what is happening

to them if they have a stake in their families,
communities and societies.

 Participation is about having a voice to shape

decisions, implementations and evaluations that
influence our lives
Principles of PHC (cont.)
2. Community participation (cont.)
In terms of governance of programs relating to various
groups in a community, the following types of participation
may be:

 Inform: provide the public with balanced and objective

information to assist them in understanding the problems,
alternatives, opportunities, and/or solutions;

 Consult: obtain public feedback on analysis,

alternatives, and/or decisions;
Principles of PHC (cont.)
2. Community participation (cont.)

 Involve: work directly with the public throughout the

process to ensure that public concerns and aspirations are
consistently understood and considered.

 Collaborate: partner with the public in each aspect of the

decision including the development of alternatives and the
identification of the preferred solutions; and

 Empower: place final decision making in the hands of

citizens.
 Participation is a critical aspect of both social
justice and equitable processes.

 People need to have some say in what is happening

to them if they have a stake in their families,
communities and societies.

 Participation is about having a voice to shape

decisions, implementations and evaluations that
influence our lives
Principles of PHC (cont.)
2. Community participation (cont.)
Universal coverage by PHC cannot
be achieved without the involvement
of the local community.
In short, PHC must be built on the
principle of community
participation (or involvement).
 Principles of PHC (cont.)
3. Intersectoral coordination.
There is an increased realization of
the fact that the components of PHC
cannot be provided by the health
sector alone.
Principles of PHC (cont.)
3. Intersectoral coordination (cont.)

 The Declaration of Alma-Ata states that “PHC

involves in addition to the health sector, all
related sectors & aspects of national &
community development, in particular
agriculture, animal husbandry, food, industry,
education, housing, public works,
communication & others sectors“.
Principles of PHC (cont.)
4. Appropriate technology.

Definition:" technology that is scientifically

sound, adaptable to local needs, &
acceptable to those who apply it & those
for whom it is used, & that can be
maintained by the people themselves in
keeping with the principle of self reliance
with the resources the community &
country can afford“.
Principles of PHC (cont.)
4. Appropriate Technology (cont.):

Health technologies are required not only

for:
Diagnostic maneuvers.
Therapeutic maneuvers.
But also for:
Disease prevention.
Disease control.
Health promotion.
Principles of PHC (cont.)
4. Appropriate Technology (cont.):

Though it is commonly perceived that person who is

going to apply it is a trained health professional, in
PHC practice there are instance
where
technology may have to be applied by:
Individual.
Family.
Community.
e.g. use of tooth brush, eye glasses, domestic water
filters, domestic pest control, etc·
So, technology should be applicable for "self use".
 Principles of PHC (cont.)
4. Appropriate Technology (cont.):
So, the simplicity of the technology is always desirable;
examples of such are:
1-ORS in diarrheal disease control.
2-Breast feeding in spacing.
3-Weighing for growth monitoring… etc.
 Principles of PHC (cont.)

5. 4 A’s = Accessibility, Availability, Affordability &

Acceptability, Appropriateness of health services.

 The health services should be present where the

supposed recipients are.
 They should make use of the available resources
within the community, wherein the focus would be
more on health promotion and prevention of illness.
 Principles of PHC (cont.)

6. Decentralization
 This ensures empowerment and that
empowerment can only be facilitated if the
administrative structure provides local level
political structures with more substantive
responsibilities for development initiators.

 This also facilities proper allocation of

budgetary resources.
 Principles of the Ethical
Practice of Public Health
1. Public health should address principally the fundamental causes
of disease and requirements for health, aiming to prevent adverse
health outcomes.

2. Public health should achieve community health in a way that

respects the rights of individuals in the community.

3. Public health policies, programs, and priorities should be

developed and evaluated through processes that ensure an
opportunity for input from community members.
4. Public health should advocate and work for the
empowerment of disenfranchised community members,
aiming to ensure that the basic resources and conditions
necessary for health are accessible to all.

5. Public health should seek the information needed to

implement effective policies and programs that protect
and promote health.

6. Public health institutions should provide

communities with the information they have that is
needed for decisions on policies or programs and
should obtain the community’s consent for their
implementation.
7. Public health institutions should act in a timely
manner on the information they have within the
resources and the mandate given to them by the
public.

8. Public health programs and policies should

incorporate a variety of approaches that
anticipate and respect diverse values, beliefs, and
cultures in the community.

9. Public health programs and policies should be

implemented in a manner that most enhances the
physical and social environment.
10. Public health institutions should protect the
confidentiality of information that can bring harm to an
individual or community if made public. Exceptions
must be justified on the basis of the high likelihood of
significant harm to the individual or others.

11. Public health institutions should ensure the

professional competence of their employees.

12. Public health institutions and their employees

should engage in collaborations and affiliations in ways
that build the public’s trust and the institution’s
effectiveness.