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Welcome to the Seminar on Health Care Primary

and Modes of Prevention

Primary Health Care - Definition
Primary health care is an 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

Primary Health Care - Definition
"Essential health care made universally accessible to individuals and acceptable to them through their full participation and at a cost the community and country can afford" (WHO).

clinics.THE PHC PHILOSOPHY Health is fundamentally related to availability and distribution of resources . PHC is concerned with equity to ensure that available health and social resources are distributed with justice and due consideration for those whose needs are greatest . medicines. but also other socio-economic resources such as educa-tion. Therefore. water supply and food supply. nurses.not just health resources such as doctors.

. cultural and economic as well as biological and environmental. Thus factors. which influence health are social.THE PHC PHILOSOPHY Health is an integral part of overall development.

is required to a much greater extent. Self-reliance. in taking action on their own behalf by adopting healthy behaviour and ensuring a healthy environment. families and com-munities.THE PHC PHILOSOPHY Achievement of better health requires much more involvement of people them-selves as individuals. . separate from and additional to the contributions of conventional health services.

THE PHC STRATEGY ‡ The Need for Change in the Health Care System ‡ Intersectoral Action for Health ‡ Individual and Collective Responsibility for Health ‡ PHC as a Level of Health Care .

‡ prevention and control of endemic diseases. ‡ promotion of food supply and proper nutrition. ‡ an adequate supply of safe water and basic sanitation. ‡ immunization against infectious diseases. including family planning. ‡ maternal and child health care. ‡ appropriate treatment of common diseases and injuries.The Declaration of Alma Ata stated that primary health care includes at least: ‡ education about prevailing health problems and methods of preventing and controlling them. . and ‡ provision of essential drugs.

H.PRINCIPLES OF P.C ‡ Equity ‡ Community involvement ‡ Focus on prevention ‡ Appropriate technology ‡ Multi-sectoral approach .

including family planning. ‡ immunization against major infectious diseases. ‡ appropriate treatment of common diseases and injuries. . and ‡ provision of essential drugs.ELEMENTS OF PRIMARY HEALTH CARE ‡ education concerning prevailing health problems and the methods of preventing and controlling them. ‡ maternal and child health care. ‡ an adequate supply of safe water and basic sanitation. ‡ prevention and control of locally endemic diseases. ‡ promotion of food supply and proper nutrition.

ELEMENTS OF PRIMARY HEALTH CARE E²Ensure safe water supply L²Locally endemic diseases control E²Education/Expanded Programme on Immunisation / UIP M²Maternal and child health E²Environment sanitation N²Nutritional services T²Treatment of minor ailments S²School health services .

PRIMARY HEALTH CARE IN INDIA The functions of the primary health centre in India cover all the 8 "essential" elements of primary health care as outlined in the AlmaAta Declaration .

as relevant Referral services Training of health guides. local dais and health assistants ‡ Basic laboratory services ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ . health workers.The functions of the primary health centre in India Medical care MCH including family planning Safe water supply and basic sanitation Prevention and control of locally endemic diseases Collection and reporting of vital statistics Education about health National Health Programmes .

reducing the gap between the health status of haves and havenots and ultimately contributes to the quality of life.HEALTH POLICY "A health policy generally describes fundamental principles regarding which health providers are expected to make value decisions." 'Health Policy' provides a broad framework of decisions for guiding health actions that are useful to its community in improving their health. .

.NATIONAL HEALTH POLICY (1983) ‡ Provision of universal comprehensive primary health care services with special emphasis on the preventive. ‡ To decentralise the primary health care system by restructuring the health care services to promote community partici-pation and linking it with a systematic back-up support of referral services at secondary and tertiary levels. manpower development and to ensure that personnel at all levels are socially motivated to adopt community health approach. promotive and rehabilitative aspects. ‡ To formulate a National Medical and Health Education Policy for health. ‡ Securing small family norms through voluntary efforts and moving towards the goal of population stabilisation and enunciation of a National Population Policy.

‡ Transferring simple health care knowledge. ‡ To remove the existing regional imbalances and to provide services within the reach of all. NGOs and voluntary bodies to establish curative services wherein all affluent sectors could be looked after by paying. ‡ Mobilising untapped health resources and encouraging investment by private sector. whether residing in rural or the urban areas. skills and appropriate technology to community so that majority of common health actions could be handled effectively by the community.NATIONAL HEALTH POLICY (1983) ‡ Integrally linking the health education and extension activities with primary health care services. .

within specified areas of responsibilities and functioning in the overall health care delivery system. especially with regard to the preventive. promotive and public health care aspects. ‡ The entire approach to health manpower development should ensure their functioning as a 'Health Team' ‡ To integrate the services of ISM practitioners at the appropriate levels.NATIONAL HEALTH POLICY (1983) ‡ Assist in the enlargement of the services being provided by private voluntary organisations active in the health field. especially those which seek to serve the needs of the rural areas and the urban slums. .

. auxiliaries. voluntary organisations with the govern-mental efforts in a planned and integrated manner. para-medical workers of both sexes. ‡ Improving the quality of the training of the frontline workers.NATIONAL HEALTH POLICY . and support manpower in health.APPROACHES ‡ To extend the outreach of primary health care services' through a network of health centres based on the organised support of health volunteers. ‡ Intermeshing of the efforts of NGOs.

leprosy and blindness.NATIONAL HEALTH POLICY . ‡ Fullest utilisation of domiciliary care and field health camp approach to reduce pressure on curative regarding tuber-culosis. normal deliveries and family planning measures. ‡ Provision of integrated package of services seeking to tackle entire range of poor health conditions rather than disparate health interventions. .APPROACHES ‡ Planning the optimal utilisation of specialists at the higher levels of the hierarchical structure. ‡ Creation of nationwide chain of sanitary and epidemiological units.

APPROACHES ‡ Package of services seeking to tackle entire range of poor health conditions as well as to endemic diseaseaffected populations and the vulnerable sections of the society. ‡ Reorientation of the existing health personnel towards the concepts of primary health care and goals of HFA. ‡ To move towards a meaningful phased integration of the indigenous and the modern systems of medicine. .NATIONAL HEALTH POLICY . ‡ Increasing the mobility of health personnel at all levels to enhance their accessibility and ensure availability in need.

Prevention of food adulteration and quality of drugs ‡ c. Water supply and sanitation ‡ d. Environmental protection ‡ e. Maternal and child health services ‡ g. Immunisation programmes ‡ f.The Priorities according to National Health Policy ‡ a. Nutrition ‡ b. Occupational health services . School health programme ‡ h.

Policy Formulation Identifying Policy Needs Formulating Policy Designing Policy Strategies Reviewing the Policy . Development of Managerial Information System (MIS). Medical Research. Production of Drugs and Equipments. Health Insurance and Legislation.The Priorities according to National Health Policy ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Other aspects Health Education.

c. Structural. Community Health Welfare programmes tended to be vertical programmes. . Minimal policy and organisational commitment: a.Existing Weaknesses in Implementation of Primary Health Care 1. political and economic factors were neglected. d. b. Pilot projects often very successful in small areas have tended not to be extended successfully to larger areas or into national programmes owing to the consequence dilution of resources or to difficulty in assuring supplies. Little attention to follow and integration into existing health system. Programmes were implemented with little professional interests. Lessons have not been learned from other sectors.

community leaders are not informed and motivated enough. 4.Poorly defined functions: ‡ Community Health workers have broader responsibilities often they have given numerous tasks. 2. Poor selection . Deficiencies in training and continuing education ‡ Irrelevant curricula ‡ Poorly trained teachers ‡ Poorly prepared teaching materials ‡ Too long or too short courses ‡ Unfamiliar with the conditions ... 3.Existing Weaknesses in Implementation of Primary Health Care Contd . many more than they have been trained for.

Existing Weaknesses in Implementation of Primary Health Care Contd . Uncertain working conditions ‡ pay is not sufficient ‡ no proper residential quarters 7. 5. Impossible and attempts to involve communities have been very few and generally half-hearted. Lack of monitoring and evaluation ‡ Frequent lack of well-defined objectives makes credible monitoring and eva-luation.. 6.. Undetermined cost and sources of finance. Lack of support and supervision. . 8.

. Insecurity of female staff 11. Inadequate supply of drugs and stationeries 12.Existing Weaknesses in Implementation of Primary Health Care Contd .. Lack of transport facilities 10. Medical officers are not interested to work in rural areas . 9.

and developing a global partnership for development.New concept of health care Millennium Development Goals (MDGs) ‡ eight international development goals ‡ that all 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. . fighting disease epidemics such as AIDS. ‡ They include eradicating extreme poverty. reducing child mortality rates.

The Millennium Development Goals Goal 1: Eradicate extreme poverty and hunger ‡ Target 1A: Halve the proportion of people living on less than $1 a day ‡ Target 1B: Achieve Decent Employment for Women. Men. and Young People ‡ Target 1C: Halve the proportion of people who suffer from hunger .

The Millennium Development Goals Goal 2: Achieve universal primary education ‡ Target 2A: By 2015. all children can complete a full course of primary schooling. girls and boys Goal 3: Promote gender equality and empower women ‡ Target 3A: Eliminate gender disparity in primary and secondary education preferably by 2005. and at all levels by 2015 .

The Millennium Development Goals Goal 4: Reduce child mortality rate ‡ Target 4A: Reduce by two-thirds. universal access to reproductive health . between 1990 and 2015. between 1990 and 2015. the maternal mortality ratio ‡ Target 5B: Achieve. by 2015. the under-five mortality rate Goal 5: Improve maternal health ‡ Target 5A: Reduce by three quarters.

malaria. and other diseases ‡ Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS ‡ Target 6B: Achieve.The Millennium Development Goals Goal 6: Combat HIV/AIDS. by 2010. universal access to treatment for HIV/AIDS for all those who need it ‡ Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases .

a significant reduction in the rate of loss ‡ Target 7C: Halve. by 2015. by 2010. the proportion of the population without sustainable access to safe drinking water and basic sanitation ‡ Target 7D: By 2020. reverse loss of environmental resources ‡ Target 7B: Reduce biodiversity loss. achieving.The Millennium Development Goals Goal 7: Ensure environmental sustainability ‡ Target 7A: Integrate the principles of sustainable development into country policies and programs. to have achieved a significant improvement in the lives of at least 100 million slumdwellers .

make available the benefits of new technologies.Goal 8: Develop a global partnership for development ‡ Target 8A: Develop further an open. rule-based. provide access to affordable. essential drugs in developing countries ‡ Target 8F: In co-operation with the private sector. non-discriminatory trading and financial system ‡ Target 8B: Address the Special Needs of the Least Developed Countries (LDC) ‡ Target 8C: Address the special needs of landlocked developing countries and small island developing States ‡ Target 8D: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term ‡ Target 8E: In co-operation with pharmaceutical companies. especially information and communications The Millennium Development Goals . predictable.

MODES OF PREVENTON .

.CONCEPTS OF PREVENTION The goals of medicine are ‡ to promote health ‡ to preserve health ‡ to restore health when it is impaired ‡ and to minimize suffering and distress Successful prevention depends upon ‡ knowledge of causation ‡ dynamics of transmission ‡ identification of risk factors and risk groups ‡ availability of prophylactic or early detection and treatment measures ‡ an organization for applying these measures to appropriate persons or groups ‡ and continuous evaluation of and development of procedures applied.

the concept of prevention has become broad-based.LEVELS OF PREVENTION In modern day. It has become customary to define prevention in terms of four level: ‡ primordial prevention ‡ primary prevention ‡ secondary prevention ‡ tertiary prevention .

They are: 1. Specific protection 3. Disability limitation 5. Early diagnosis and treatment 4. Rehabilitation .Health promotion 2.MODES OF INTERVENTION Intervention can be defined as any attempt to intervene or interrupt the usual sequence in the development of disease in man Five modes of intervention have been described which form a continuum corresponding to the natural history of any disease.

Thank You .