Primary Health Care

Definition of PHC

Essential health care, based on practical, scientifically sound

& socially acceptable methods & technologies made
universally accessible to individuals & families in their
community through their full participation & at a cost that
the community & country can afford to maintain at every
stage of their development in spirit of self determination.
Levels of health care

Primary health care

 The “first” level of contact between the individual and the
health system.
 Essential health care (PHC) is provided.
 The closest to the people.
 Provided by the primary health centers
 Majority of health complaints and problems can be
satisfactory managed
 The term PHC is also used to refer to the philosophy that
underpinned the Alma Ata Declaration of 1978
(WHO/UNICEF 1978) which sets out a series of
principles for a health system.

 These principles were equity, community participation,

appropriate technology, health promotion, and multi-
sectoralism.
 Health professionals working at the PHC level have
general skills (such as community nurses, medical
assistants, or general medical practitioners).
 In some health systems, the health centers or health posts
which offer PHC also act as a ‘‘gateway’’ to secondary
levels of care.
 Secondary Health Care

 Secondary Health Care includes more specialist diagnostic facilities

and expertise, available on an out-patient and in-patient basis.
 Such facilities are usually provided at district hospitals which may
have a supervisory and support role for PHC services.
 More complex problems are dealt with.
 Comprises curative services
 Provided by the district hospitals
 The 1st referral level
Tertiary health care

 Tertiary Health Care is the most sophisticated level of health services where,
for example, treatment for infertility takes place.
 Tertiary healthcare facilities are normally located at a regional or country level.
 This is the level where narrow specialization takes place, as well as training of
health professionals.
 Tertiary health care is the most resource-intensive level of health services (both
in terms of cost of health services and human resources).
 The PHC level is supposed to take a major role in providing promotive and
preventive services, along with basic curative care.
 Secondary and tertiary levels tend to focus on curative services, but
increasingly it is recognized that secondary and tertiary levels should
provide promotive and preventive services alongside their traditional
curative services.
Initiation of PHC

Was recognized that

 Health care not equally distributed between & within countries
 Health services favored the benefits
 Fundamental right to health denied to millions of poor people
 Increasing importance to social equity
 Role of community participation
 Importance of political will/resolve
 
1977 WH O , had expressed the "health for all 2000“
1978 WHO-UNICEF called for International
Conference
Alma Ata conference declared and accepted WHO goal "Health For All
2000" & proclaimed primary health care as the way of achieving it.
 Health for all : attainment of a level of health that will enable every
individual lead a socially and economically productive life
''Health for all'' means : all for health
 Health is brought within everyone's’ reach.
 It implies removal of poverty, malnutrition, ignorance , disease,
unhygienic water supply & living conditions.
 Holistic concept to be achieved by joint efforts in agriculture, industry,
education etc
Health is the responsibility of all
Why PHC

 The first contact with people

 Provides the essential services
 PHC level/system is a system that based on the need of
population at a community level
 It is based on that secondary , tertiary and primary health
care levels are linked together with real referral system
Principles of PHC

Equitable distribution
Shift the centre of gravity of health care from urban to
rural areas

Bring health care as near to their homes as Possible

 Principles of PHC

Community participation
Types of participation:
System maintain participation: allows for increase the response of people to policies
imposed from above
System transforming participation :allows for structure changes within system itself
Other see participation in term of community financing part of the cost of their own
health care, which means to activate people to take charge of their own affairs.
Principles of PHC

In summary for health services to run well, cooperation is needed from

Governmental as well as community for:
 planning,
 implementation
 maintenance
 Manpower
 Money
 Materials
 Principles of PHC

Intersectoral coordination:
Components of health care cannot be provided by health sector alone.

It includes other sectors like, food industry, education, housing, public works,
communication etc

Cooperation needs certain legislation, allocation of resources & strong political

will
 
Principles of PHC

Appropriate technology
Defined as to be acceptable to those use it & those for
whom it is used and can be maintained by people
themselves at a cost that the country & community
can afford
 
Basic Elements of PHC

 Identifying & controlling prevailing health problems

 Health education : methods of preventing and controlling
them
 Food supply and proper nutrition
 Provision of safe water and basic sanitation
 Maternal & child health care, including family planning
 Immunization
Basic Elements of PHC

 Prevention and control of endemic disease

 Appropriate treatment of common diseases and injuries
 Promotion of mental health
 Provision of essential drugs , Basic laboratory services
 Training of health guides, health workers and health assistants.
 Referral services
The Functions of PHC

 To provide continuous and comprehensive care

 To refer to specialists and/or hospital services
 To co-ordinate health services for the patient
 To guide the patient within the network of social welfare
and public health services
 WHO strategies and PHC

 Reducing excess mortality of poor marginalized

populations: so
PHC must ensure access to health services for the most
disadvantaged populations, and focus on interventions which
will directly impact on the major causes of mortality, morbidity
and disability for those populations.
Exp :out reach program to provide immunization  
WHO strategies and PHC

 Reducing the leading risk factors to human health:

so
PHC, through its preventative and health promotion roles,
must address those known risk factors, which are the
major determinants of health outcomes for local
populations.
IMCI; integrated management of child illnesses
WHO strategies and PHC

 Developing Sustainable Health Systems:

PHC as a component of health systems must develop in ways,
which are financially sustainable, supported by political
leaders, and supported by the populations served.
WHO strategies and PHC

 Developing an enabling policy and institutional

environment:
PHC policy must be integrated with other policy domains,
and play its part in the interest of wider social, economic,
environmental and development policy
Supportive policy from others at higher level
Activities to apply PHC into practice :

 Focus and tackle the main health problems in the

community, and accordingly provide promotive,
preventive, curative and rehabilitative services.    
 Involves all related sectors
 Ensure sustainability
 All governments should formulate national policies,
strategies and plans of action to launch and sustain primary
health care as part of a comprehensive national health
system
Activities to apply PHC into practice :

 Provide education concerning common health problems and the methods of

preventing and controlling them
 Promotion of food supply and proper nutrition; maternal and child health
care, including family planning immunization …..etc
 Relies, at local and referral levels, on health workers, suitably trained socially
and technically to work as a health team and to respond to the expressed
health needs of the community.
All countries should cooperate in a spirit of partnership and service to
ensure primary health care for all people since the attainment of health by
people in any one country directly concerns and benefits every other
country.
In this context the joint WHO/UNICEF report on primary health care
constitutes a solid basis for the further development and operation of
primary health care throughout the world.