PRIMARY HEALTH CARE

(PHC)
 Life Expectancy Compared with GDP per Capita for Selected
Countries

Country codes:
AG=Argentina AU=Australia BZ=Brazil CH=China CN=Canada FR=France
GE=Germany HU=Hungary IN=India IS=Israel IT=Italy JA=Japan
MA=Malaysia ME=Mexico NE=Netherlands PO=Poland RU=Russia
SA=South Africa SI=Singapore SK=South Korea SP=Spain SW=Sweden
SZ=Switzerland TK=Turkey TW=Taiwan UK=Utd Kingdom US=United States
Source: Economist Intelligence Unit. Healthcare International. 4th quarter 1999. London, UK: Economist Intelligence Unit,
1999.
 HEALTH CARE is the treatment,
prevention and management of illnesses
and the preservation of mental and
physical well being through the services
provided by the medical, nursing and
related health professions.
 WHAT IS PHC?
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 that the community and country
can afford to maintain at every stage of their development
in the spirit of self- reliance and self-determination.

It forms an integral part both of the country's health

system, of which it is the central function and main focus,
and of the overall social and economic development of the
community. It is the first level of contact of individuals, the
family and community with the national health system
bringing health care as close as possible to where people
live and work, and constitutes the first element of a
continuing health care process.
 VISION

PHC is the foundation of the health care

system which delivers quality care
according to the individual need and which
ensures a satisfying vocation for general
or family practitioners, as counselor for all
Malaysian families by 2020
 MISSION

To promote high standards of care in general

or family practice for the benefit of the
individual and his family through continuous
and comprehensive care that encompasses
promotive, preventive, curative and
rehabilitative approaches, whilst ensuring that
general/family practice is recognised as the
principal source of primary health care and is
professionally and economically viable and
satisfying.
 DECLARATION OF ALMA-ATA

Under WHO director Mahler of Denmark (1973-88) the

goal of "Health for All" was proposed and was formally put
forth in the 1978 WHO-UNICEF Alma-Ata Declaration.

The Alma-Ata Declaration affirmed health as

a fundamental human and right and called
for a transformation of conventional health
care systems and for broad intersectoral
collaboration and community organizing.
 FOUNDATION OF PHC

reflects and evolves from the economic conditions and sociocultural

and political characteristics of the country and its communities and
is based on the application of the relevant results of social,
biomedical and health services research and public health
experience;

addresses the main health problems in the community, providing

promotive, preventive, curative and rehabilitative services
accordingly;

includes at least: education concerning prevailing health problems

and the methods of preventing and controlling them; promotion of
food supply and proper nutrition; an adequate supply of safe water
and basic sanitation; maternal and child health care, including
family planning; immunization against the major infectious diseases;
prevention and control of locally endemic diseases; appropriate
treatment of common diseases and injuries; and provision of
essential drugs;
 involves, in addition to the health sector, all related sectors and aspects
of national and community development, in particular agriculture,
animal husbandry, food, industry, education, housing, public works,
communications and other sectors; and demands the coordinated
efforts of all those sectors;

requires and promotes maximum community and individual self-reliance

and participation in the planning, organization, operation and control of
primary health care, making fullest use of local, national and other
available resources; and to this end develops through appropriate
education the ability of communities to participate;

should be sustained by integrated, functional and mutually supportive

referral systems, leading to the progressive improvement of
comprehensive health care for all, and giving priority to those most in
need;

relies, at local and referral levels, on health workers, including

physicians, nurses, midwives, auxiliaries and community workers as
applicable, as well as traditional practitioners as needed, suitably
trained socially and technically to work as a health team and to respond
to the expressed health needs of the community.
 Governments should formulate national
policies, strategies and plans of action to
launch and sustain PHC

Governments have a responsibility for the

health of their people which can be
fulfilled only by the provision of adequate
health and social measures.
 DEVELOPMENT OF PHC IN MALAYSIA

Malaysia has systematically developed the

health system based on the PHC policy.

Malaysia has attained commendable health

achievements for the socioeconomic status in
which she records.

This has much to do with the policies laid and

strategies taken since independence on Rural
Health Service (RHS) which was later changed
to Primary Health Care (PHC).
 Primary Health Care 1978

The birth of Primary Health Care came just as

Malaysia was strengthening its foundations in
elements that were similarly expounded by the
Alma-Ata Declaration.

As a signatory to the declaration, the Malaysian

Rural Health Service was revamped to uphold the
principles of the Declaration affirming that health
as a fundamental human right and called for a
transformation of conventional health care systems
and for broad intersectoral collaboration and
community organizing.
 PHC concept here is based on the understanding
that health improvement results from a
reduction in both the effects of disease
(morbidity and mortality) and its incidence as
well as from a general increase in social well-
being.

The effects of disease may be modified by

successful treatment and rehabilitation and its
incidence may be reduced by preventive
measures while, well-being is promoted by
improved social environments created by the
harnessing of political will and effective
intersectoral action.
 Based on situational analysis conducted
for the second Malaysia Plan 1961-1965,
the priority social problems, as well as
their associated causes and effects, fit into
five general categories:
1) health
2) nutrition
3) education
4) environment; and
5) social development.
 The main source of financing for health
care services is from public revenues
through general taxation

Health funds are provided directly from

the federal budget. But it is based on
population size, socio-economic
conditions, burden of illness also funding
obtained from international organizations
and agencies
 An important component indicative of the quality of the
health care services is the populations access to health
care, both in the terms of geography and costs.

Strategies for comprehensively tackling health problems

can be grouped essentially under two complementary
headings:
1) promoting healthy policies and plans and
2) implementing comprehensive and decentralised
health systems.

Success of these strategies depends upon the creation of

a facilitating environment both at the central level
government level
 Structure of Primary Health Care, Malaysia
Structure Level of Service Staff Services

Three-tier system Main health centre Doctor and dental Priority outpatient
(1956-70) (1:50,000 population) officer care
and dental
Care
Health sub-centre Medical assistants Outpatient screening
(1:10,000) and and MCH Care
staff nurses

Midwife clinics Midwife Home delivery and

(1:2,000) home visiting

Two-tier system Health centre Doctor, dental officer, Outpatient, MCH care,
(1970-present) (1:20,00) medical assistants, and environment health,
public health nurses food quality
demonstration, health
education, family
planning and dispensary
Community clinics Community nurse, MCH care, home
(1:4,000) midwife, and midwives delivery, homevisiting,
minor ailments, family
Planning
 Malaysia has a dual health system of public and private
practices. The Government is the main provider of
primary care facilities.
The private practices however only began in the late
1950s and since then the main stay of their services
were almost entirely confined to medical and curative. It
is only recently that some elements of preventive care
are being provided. Referral from private to public has
been an ongoing process.
Another player in the provision of primary health care in
Malaysia is the traditional and complementary medicine
(T/CM) practitioners. T/CM has long been in existent but
is now emerging in its acceptance as an option to health
care. Hence the Ministry of Health is in the processes of
regulating T/CM so as to make it a safe alternative for
the people.
SCOPE AND CONTENT OF PHC

PROGRAMME OF IMMUNIZATION
Child immunization
E.g rubella and viral hepatitis B

PREVENTION AND CONTROL OF LOCALLY

ENDEMIC DISEASES
Heart diseases
Hypertension
Cancer
 HEALTH MANAGEMENT AND INFORMATION
SYSTEM

STREAMLINING PHC AND IMPROVING

INTEGRATION/REFERRAL SYSTEM

FINANCIAL AND BUDGETING SYSTEM

IMPROVING QUALITY

HARNESSING OTHER HEALTH PROVIDERS

Strategies in implementing PHC
Tripartite responsibility
Health in social responsibility
Privatisation and corporatisation of public hospitals and
health clinic
PHC as a driving for force to our health services, and as
gate keeper for our hospital
Training of Family Medicine Specialist (FMS) to be in
charge of clinical services at the Health Clinics
Expanded scope of the PHC programmes at the health
clinics
Strengthening the support services at the health clinic