PRIMARY HEALTH CARE

By
Dr Nizam Uddin Ahmed
CEO
East West Medical Group & EATL
 Health
• Health is a fundamental human right
• State responsibility for the health of its people
• National Govt all over the world are striving to
expand and improve their health care services
• The current situation is
– Urban oriented
– Mostly curative focus & public health expanded
– Changing diseases patterns
– Emerging new infections
 Definition

Health
Health is a state of complete physical,
mental and social wellbeing and not
merely absence of disease or infirmity
(WHO Definition of Health 1948)
Eco-system which affect
this level of functioning

1. Political
2. Behavioral
3. Hereditary
4. Health care delivery system
5. Environmental Influence
6. Socio-economic influence
 Factors affecting health
parenting
gender
styles
family
age
dynamics

geographical
employability HEALTH mobility

culture social resources

family biological
finances factors
McMurray, A. (2003) pg.12
Slide 8
 Primary Health Care

• Primary Health Care is a new

approach to health care, which
integrates at the community level all
the factors required for improving
the health status of the population.
Defining primary health care

• Primary Health Care is not Primary

care alone.

• Primary, secondary and tertiary are

levels of care
 Concept of PHC
• PHC is for all specially the needy
Regardless of social and economic status every individual in the nation must have
access to good health care

• The services should be acceptable to the community and there must be active
involvement of the community

• The health services must be effective, preventive, promotive and curative

• The services should form an integral part of the country’s health system
• The programme must be efficient, multi- sectorial because health does not exit in
isolation
 Primary Health Care
Definition -

• 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
country and community can afford
Levels of Health Care

3 level of health care service

• Primary care level

• Secondary care level
• Tertiary care level
Levels of Health Care
• Primary care level
– The “First” level of contact between
individual, family and community with health
system
– Most effective and close to the people
– Essential health care (PHC) is provided.
– The closest to the people.
– Provided by the primary health centers.
– Community Clinic, RHC, THC, RMO
– General Practitioner, village doctor
Levels of Health Care

• Secondary care level

– More complex problems are dealt with.
– Comprises curative services
– Provided by the district hospitals
– The 1st referral level
– District Hospital, Upazila Hospital
– Health centers
 Levels of Health Care
• Tertiary care level
– Offers super-specialist care
– Provided by regional/central level institution.
– Provide training programs
– Specialized health care- BSMMU, Dhaka MC
– Specific private facilities- Square Hos, United
hosp, Apollo hosp, Green life etc
– Specializes hospitals-
– Children hospital
– National Heart Institute
– TB & Leprosy hospital
Primary Health Care in Bangladesh
Tertiary Level
Medical University
Medical College Hospital
Specialized Hospital

Secondary Level
District Hospital
Mother and Child Welfare Center

Primary Level
Upazila Health Complex
Union Health & Family Welfare Center
Community Clinic
 Bangladesh Health System

Internet
connected
April 2009

About 600
hospitals
About 19,000
day-care facilities
Ongoing

About 100,000
health workforce
4,000 18,000 community clinics
4,000
 PRINCIPLES OF
PRIMARY HEALTH CARE
 PRINCIPLES OF PHC

• EQUITABLE DISTRIBUTION
• COMMUNITY PARTICIPATION
• INTERSECTORAL COORDINATION
• APROPRIATE TECHNOLOGY
• DECENTRALISATION
 The Basic Requirements for
Sound PHC (the 8 A’s and the
3 C’s)
• Appropriateness • Assessability
• Availability • Accountability
• Adequacy • Completeness
• Accessibility • Comprehensiveness
• Acceptability • Continuity
• Affordability
 Essential
Component /
Elements
Essential Component/Elements
1. Education concerning prevailing health
problems and the methods of prevention
2. Promotion of food supply and
proper nutrition, an adequate supply of
safe water and basic sanitation

3. Maternal and child health care

including family planning

4. Immunization against major infectious

diseases
Essential component / Elements

5. Prevention and control of locally

endemic diseases
6. Treatment of common diseases and
injuries

7.Promotion of mental health

8.Provision of essential drugs

9.Referral services
Millennium Development Goals

• MDG,s place health at the heart of

development and represent
commitments by governments
throughout the world to reduce
poverty and hunger and to tackle ill
health
Millennium Development Goals

1. Eradicate extreme poverty and hunger

2. Achieve universal primary education
3. Promote gender equity
4. Improve maternal health
5. Reduce child mortality
6. Combat HIV/AIDS, malaria, and other
communicable diseases
7. Ensure environmental sustainability
8. Develop global partnership for development
 Determinants of Health
1. Genetic ( Biological determinants)
2. Behavior and socio-cultural conditions ( lifestyle)
3. Environment
4. Socio-economic and political conditions
5. Health and family welfare services
6. Aging of the population
7. Gender
8. Other Factors:
 Information and communication
 Science and technology
 Health-related systems
 Statistics of selected Health
Indicators of Bangladesh
• Life expectancy at birth: 70
• Neonatal Mortality Rate 24 per 1000 livebirths
• Infant Mortality Rate: 33 per 1000 livebirths
• Under-5 child mortality rate: 41
• Maternal mortality ratio (per 1000 live birth): 1.94
• Crude Death rate: 5.5 deaths/1,000 population
• Crude birth rate: 19.2
• Annual growth rate (%) : 1.37
• Total fertility rate: 2.15
• Total expenditure on health as % of GDP: 3.4 (2009)
Source: BDHS, 2013