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Primary Health Care

Nursing 105
Donna Pierrynowski Gallant PhD, RN October 1, 2008



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Explain the terms primary health care and primary care. Describe the historical significance of the Declaration of Alma Ata (1978) and the Lalonde Report (1974)‫‏‬ List and describe the five principles and eight essentials of primary health care. Describe the barriers to achieving primary health care. Discuss the contribution of nurses toward primary health care.


Primary health care is the single most important basis from which to renew the health‫‏‬care‫‏‬system… Roy Romanow



Alma Ata Conference

In 1978 at an International conference in Alma Ata, formerly in USSR, representatives from 189 countries gathered and committed themselves and their resources to the achievement of health for all by the year 2000 through primary health care.

(McMurray, pg. 30)‫‏‬



Why?  Inadequate illness management systems were not creating healthier societies Response on the part of the World Health Organization (WHO) to address the issues of unjust suffering and death that was/is occurring world wide. especially in the poorer countries. 02/04/09 5 .  (McMurray pg.30)‫‏‬   ” .

pg. Goal: Build community capacity to achieve sustainable health and well-being (McMurray. 02/04/09 6 . relationships. 2003). and environmental toxins. Addresses issues such as diet. income. housing.‫‏‬Attention‫‏‬is‫‏‬primarily‫‏‬on‫‏‬ aspects‫‏‬of‫‏‬people’s‫‏‬lives‫‏‬that‫‏‬make‫‏‬them‫‏‬sick‫‏‬ (CNA. education.Definition: Primary Health Care (PHC)‫‏‬   PHC is a philosophy and model for improving health‫‏‬that‫“‏‬focuses‫‏‬on‫‏‬promoting‫‏‬health/wellness‫‏‬ and‫‏‬preventing‫‏‬illness”. lifestyle choices.28).

LaLonde Report (1974)‫‏‬    Health is not achievable from health care services alone.. environment.‫‏‬organization‫‏‬of‫‏‬health‫‏‬care… Lifestyle‫‏‬received‫‏‬the‫‏‬most‫‏‬attention… What is wrong with this focus? (Potter & Perry. 02/04/09 7 . Must consider human biology. lifestyle. pg. 4).

31. Besner. p. J. (2004). pg. 352)‫‏‬ 8 02/04/09 .Primary health care approach conceptualizes health as a     Fundamental right Individual and collective responsibility An equal opportunity concept Essential component of socio-economic development  (McMurray.

Essentials of PHC          Health education Safe food supply and adequate nutrition Adequate supply of safe water and basic sanitation Maternal and child care Immunization against basic infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Essential drugs. (World Health Organization)‫‏‬ 02/04/09 9 .

Primary Health Care Principles      Accessibility Public Participation Intersectoral collaboration Appropriate Technology Health Promotion and Illness Prevention 02/04/09 10 .

Must supersede individual goals so that the least advantaged people in a community receive equal care and service to those who are advantaged by virtue of finances and knowledge. pg 34)‫‏‬ 02/04/09 11 . (McMurray.Social Justice (Equitable access for all)‫‏‬    Deliberate consideration of the needs and agendas of all people.

language. race. to name a few.Accessibility  Health for all people means equal access to opportunity for all people whether they differ by geography. pg. income. employment status. functional capacity. (McMurray.33)‫‏‬ 02/04/09 12 . age. gender.

Need to provide services that are responsive to the poor and help them cope and avoid the worst effects of poverty.Barriers to Accessibility  Poverty/Socioeconomic Status: Wealthy usually have better access to food and a better lifestyle. 02/04/09 13 .

02/04/09 14 .Barriers  Cultural Minorities Cultural bias can pose a barrier to accessibility and have an impact on a community’s‫‏‬health‫‏‬status‫‏‬and‫‏‬program‫‏‬ development.

02/04/09 15 . Problems revolve around limited resources inaccessible and inappropriate services.Barriers  Geography/ Rural communities: People who live in rural areas have fewer resources than those in urban environments.

Barriers   Stigma: Population groups with certain health problems. AIDS. addictions. hemophiliacs. other HP and friends (Health Canada)‫‏‬ 02/04/09 16 . prejudice. and avoidance from nurses and physicians.‫‏‬homeless‫‏‬people… In Canada people with HIV/AIDS have described insensitivity.

(p.Barriers  Lack of education or information. McMurray). Should the informed person who demands certain services from the health care system have an advantage over someone who is not aware of what is available? Internet. 02/04/09 17 .35.

and it has to be provided by methods acceptable to them.  Identify and facilitate use of health resources.  Provide health information.  02/04/09 18 .  Care should be appropriate in content and amount to satisfy the essential needs of the people.Nurses Role: Accessibility Act as an entry point for access.

Questions to ask yourself       How does the client get here? How much does parking cost and does the client have sufficient money? Are services and programs available in the needed languages? Are the hours user friendly? Is any print materials in literacy appropriate language? How much do the drugs cost and can lower priced options be suggested? Is the site wheel chair accessible? 02/04/09 19 .

Example: Community health boards.   Shift from professionally driven to people driven. 2005)‫‏‬ 02/04/09 20 . CNA. pg 42. (McMurray.Public Participation  All‫‏‬person’s‫‏‬are‫‏‬encouraged‫‏‬to‫‏‬participate‫‏‬ individually and collectively in the planning and implementation of their health care.

they can become empowered and chart their own course of action. Empowered community members enjoy broad participation in health policies. choosing priorities for health services and initiatives and in developing appropriate conditions for living and working. (McMurray.Public Participation Empowerment    Based on the premise that if people are prepared for events or circumstances with both information and community support systems. Empowerment helps build community capacity. pg 16-17)‫‏‬ 02/04/09 21 .

02/04/09 22 .Examples of Barriers to Public Participation   Client’s‫‏‬isolation‫‏‬and‫‏‬vulnerability‫‏‬when‫‏‬ confronting bureaucratic organizations. Tokenism of health boards.

2004.Nursing role: Public Participation    Promote the client as the center of care Using community development approaches. pg. (Community development is the process of empowering communities to improve their health and wellbeing). 353). 02/04/09 23 . Example Lillian Wald (Besner.

or is this a professionally defined need? Is the community working in partnership.Questions to ask yourself    How has the community been involved in determining whether this program is needed/performing as it should? Is this program reflective of a need or problem identified by the client or community. or are they just implementing what professionals tell them to? 24 02/04/09 .

(McMurray p.41)‫‏‬ The basic determinants of health cross many disciplines. housing. transportation and government). Do we need work in this area? Are human resource issues affecting the implementation of primary health care? 02/04/09 25 .Intersectoral & Interdisciplinary Collaboration     Collaboration between all disciplines within the community. (health. education.

. Ask the questions: What other professional colleagues should be involved in supporting this person? What community information.Nurses Role: Intersectoral Collaboration    Collaborating with other sectors Coordinating health services/referrals. services and referrals does this person need? What services are available in this community and how does the client access them? 02/04/09 26 .

facilities and equipment. personnel. (CNA.Appropriate Skills and Technology  A very broad definition that encompasses appropriate use of all health care resources such as funds. 2005)‫‏‬ 02/04/09 27 .

Must be affordable by the community.Technology    Technology needs to be appropriate to the community’s‫‏‬social.‫‏‬economic‫‏‬and‫‏‬cultural‫‏‬ development. 2005)‫‏‬ 02/04/09 28 . (CNA. Also means that individuals will receive appropriate care from the appropriate HCP within a time frame that is appropriate.

02/04/09 29 .Technology  Recognizes the importance of developing and testing innovative models of health care and disseminating the results of research related to health care.

Technology    Should be subordinate to the goal of improving‫‏‬people’s‫‏‬health. A question: We have the technology to keep very small birth weight babies alive. yet should we do so at the expense of others? Do we need a MRI in every hospital? 02/04/09 30 .

02/04/09 31 . Being part of developing.Nurses role: Appropriate Technology   Demonstrating cost effective. implementing and evaluating technology. evidence based (informed) care.

Questions     Is this the most cost effective way of dealing with this issue? Does the client know how to use the equipment safely? Is the most appropriate professional working with the person? Are professionals being used in the most cost effective ways? 32 02/04/09 .

02/04/09 33 . Process of enabling people to increase control over and to improve their own health (WHO. 1986). Range from local initiatives to interacting with the global community.Health Promotion & Illness Prevention    Move away from the medical model to one of prevention and health promotion.

Barriers  Canadians value expensive technology and‫‏‬quick‫‏‬fix‫‏‬cures…. 2002)‫‏‬ 02/04/09 34 . (CNA.

support clients as they strive to achieve the highest possible level of health. promote. 2002)‫‏‬ 02/04/09 35 .Nurses role  Initiate health education and other activities that assist.  (CNA.

Questions to ask yourself     What community resources are available to clients you deal with? How are clients involved in the preparation and implementation of your health education/promotion programs? Do the health education and health promotion programs include a focus on the determinants of health? Is there a focus on enabling people to increase control over and improve their health? 36 02/04/09 .

02/04/09 37 . 26). and reorient health services)‫‏‬ (McMurray. develop personal skills.Ottawa Charter  Throughout the past two decades health promotion advocates have used the Ottawa Charter for Health Promotion as a framework to encapsulate the goals of Primary Health Care….(Build‫‏‬healthy‫‏‬public‫‏‬policy.. strengthen community action. pg.‫‏‬create‫‏‬ supportive environments.

Primary care   Primary Care: Primary‫‏‬management‫‏‬of‫‏‬a‫‏‬person’s‫‏‬ condition. First level of contact an individual has with an organized health system. 02/04/09 38 .Primary health care vrs.

PC vrs PHC      Primary care individual focused emphasis on cure care provided by health professionals professional dominance      PHC community focused emphasis on promotion and prevention care provided by a wide variety of people self reliance 02/04/09 39 .

and come together as one force. 1985)‫‏‬ 02/04/09 40 . then they could become a powerhouse for change.PHC and Nursing  If the millions of nurses in a thousand different places articulate the same ideas and convictions about primary health care. (Mahler.

02/04/09 41 .PHC and Nursing  Nursing in a PHC system involves the person. family and community. It starts where the person is at and acknowledges the many factors that affect that person's health and illness.

If we want to be sure that we have a health system based on PHC principles. What can you do to ensure that the changes taking place will reflect a PHC model? 02/04/09 42 . nurses need to be sitting at the decision making tables.

Primary Health Care Research and Development. 16. Retrieved on October 2. 1-4.Additional References  Besner. 2007 from http://www.cnanurses. Canadian Nurses Association (2002).cnanurses. 2007 from C_presentation_Kirby_6602_e.pdf 02/04/09 43 . Primary health care: The time has come. Primary health care: A summary of the issues. Nursing ations/BG7_Primary_Health_Care_e. J. A New Approach to Primary Health Care. (2004). 351-358. 5. Retrieved on October 1.    Canadian Nurses Association (2005).pdf Canadian Nurses Association (2003). Nurses role in advancing primary health care: a call to action.

Case studies   Can you identify the components of primary health care in this case study? RAKKU 02/04/09 44 .

Historical significance of the Declaration of Alma Ata (1978) and the Lalonde Report (1974)‫‏‬ Five principles and eight essentials of primary health care. Contribution of nurses toward primary health care. 02/04/09 45 . Barriers to achieving primary health care.Summary      Primary health care and primary care.