PRIMARY HEALTH CARE

CONCEPT
HISTORY

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 HISTORICAL OVERVIEW

 The concept of primary health care emerged during the final

decades of the Cold War (the late 1960 and early 1970s).
 By then, the so- called vertical health approach used in malaria
eradication by US agencies and WHO since the late 1950s were
being criticized, thus new proposals for health and development
appeared.
 John Bryant, in his book ―Health and Developing world‖, question
the introduction of hospital- based health care system to developing
countries and lack of emphasis on prevention.
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 According to him, more than half of the world population were not
having access to health care at, and the rest who have access too,
the receive does not solve the problems.
 Kenneth W. Newell, a WHO staff member from 1967, who had a
survey on the experiences of medical auxiliaries in developing
countries.
 In health by people, he argued that ‘a strict health sectorial
approach is ineffective.
 In addition, the 1974 Canadian Lalond Report [named after the
minister of health] deemphasized the importance attributed to the
quantity of medical instructions and proposed for determinant of
health; biology, health services, environment, and lifestyles.
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 Other influential studies outside the public health
domain also challenged the assumption that, health
resulted from the transference of technology or more
doctors and other services.
 Thomas McKeown (a British historian) argued that the
overall health of the people was less related to medical
advances than to standards of living and nutrition.
 Ivan Illichsdical Nemesis contended that medicine was
not only irrelevant but even detrimental, because
medical doctors deprived health from the public.
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 Missionaries’ experiences also brought primary health
care into play. A specialized organization of the World
Council of Churches (Christian Medical Commission)
and the Lutheran World Federation, was created in the
late 1960s by medical missionaries working in
developing countries.
 This new organization stressed on the training of village
workers at the grassroots level, equipped them with
essential drugs and simple methods of treatments.
 In 1970, a journal contact was created, which used the
term primary health care, probably for the first time.
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 Another important inspiration for primary health care was the
global popularity that the massive expansion of rural medical
services in communist China experienced, especially the
‗‘barefoot doctors‘‘.
 This visibility conceded with China’s entrance into the United
Nations [UN] system [include the WHO].
 The ‘barefoot doctors whose numbers increased dramatically in
the early 1960s were a diverse array of village health workers
who lived in the community they served, stressed rural rather
than urban health care and preventive rather than curative
services, and combined Western and traditional medicines.
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Primary health care was also favored by a new
political context characterized by the
emergence of decolonized African nations and
the spread of national, anti-imperialist, and
leftist movements in many less-developed
nations.
 These changes led to new proposals on
development made by some industrialized
countries.
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In summary, the concept of Primary Health Care
[PHC] emerged during the 1970s when ideas
about health care began to change generally and
specifically in relation to the third or developing
world.
 These new Ideas about health care emerge from
many sources.
Examples of these sources include;
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Changing theories about the relationship
between health and development;
Concerns about population growth;
Question about the relevance of
implementing a western-type medical
service in a developing country;
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 The remarkable progress that was being made in improving
health in countries like China;
 The achievements of many skill, mostly community-based
health care initiatives in developing countries
 And the work of the Christian Medical Commission of the
World Council of Churches, whose church–related medical
programs in the developing World emphasized, amongst
other things, the importance of the community engagement
and the training of auxiliary health workers.
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ALMA-ATA
 The landmark event for primary health was the International Conference on
Primary Health Care that took place at Alma-Ata from September 6 to 12,
1978 and involved over 3000 delegates from 134 governments and 67
multilaterals / NGOs.
 Alma-Ata was the capital of the Soviet Republic of Kazakhstan, located in
the Asiatic region of the Soviet Union.
 When the conference took place, primary health care was to some degree
already sold to many participants. From 1976 to 1978, the WHO and
UNICEF organized a series of regional meetings to discuss alternative
approaches.
 The conferences main document, the Declaration of Alma-Ata, which was
already known by many participants, was approved by acclamation.
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Within the same conference in 1978 at Alma –Ata [USSR] all
the government of 134 countries made these declaration:
The conference confirmed that health, which is a state of
complete physical, mental and social wellbeing and not
merely the absence of disease or infirmity, is a fundamental
human right and the attainment of the highest possible level
of health is a most important.
world- wide social goal whose realization requires the action
of many other social and economic sectors in addition to the
health sector.
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The existing gross inequality in the health status of the
people particularly between developed and developing
countries as well as within countries is politically,
socially and economically unacceptable and is
therefore of common concern to all countries.
The international objective of health for all by the year
2000 as the economic and social developments, based
on a new international economic order is of basic
importance to the fullest attainment of health for all.
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The people have the right and duty to participate
individually and collectively in planning and
implementation of their own health care.
Governments have a responsibility for the health of their
people which can be fulfilled by the provision of
adequate health and social measures.
All government should formulate national policies,
strategies and plans of action to launch and sustain
primary health care .
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All countries should co-operate in a spirit
of partnership and service to ensure
primary health care [PHC] for all people.
An acceptable level of health for all the
people by the year 2000 can be attained
through a further and better use of the
world resources.
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Objectives of the Conference
To promote the concept of primary health care in all
countries.
To exchange information and experience on the development
of primary health within the framework of comprehensives
national health system and services
To evaluate the present health and health care situation
throughout the world as it relates to and can be improved by
primary health care.
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 To define the principles of primary health care as well as
the operational means of overcoming practical problems in
the development of primary health care.
 To define the role of governments, national and
international organizations in technical cooperation and
support for the development of primary health care
 To formulate recommendations for the development of
primary health care.
 WHO defined the concept primary health care as a strategy
to reach the goal of health for all by the year 2000.
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Definition Of ‘’Health for All [HFA]
 HFA is defined as the attainment by all peoples of the world by a
particular date[ kept at that time as the year 2000] of a level of
health that will permit them to lead a socially and economically
productive life.
 It does not imply that by that date, everybody in the world will
have the most state of the art health care but that by date
everybody in the world will attain a level of health so as to enable
him or her to lead physically , mentally, socially and economically
fulfilling life and contribute fully, depending on his/ her capabilities ,
towards the socio-economic development of the community and
nation.
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The global strategy for health for all by the
year 2000 [HFA200] set the following guiding
targets to be achieved by the year 2000;
Life expectancy at birth above 60 years
Infants mortality rate below 50 per 1000 live
births
Under -5 mortality rate below 70 per live
births .

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Health for All means that health is to be brought
within the reach of everyone in a given community. It
implies the removal of obstacles to health that is to
say elimination of
Malnutrition
Ignorance
Disease
Contaminated water supply
Unhygienic environment etc
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