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PRIMARY HEALTH CARE

By P.PALLAVI IV BDS

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synopsis
Definition Essential elements of health care Characteristics of primary health care Principles of primary health care Public health in india At village level Sub centre level Primary health centre level Community health centre level Urban health centre level

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Definition. Primary health care is defined asessential 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 the country can afford to maintain at every stage of their development in the sprit of self determination.

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8 essential elements of primary health care

Alma Ata declaration has outlined the essential elements 1. Education about prevailing health problems &methods of preventing and controlling them. 2.promotion of food supply and proper nutrition. 3.An adequate supply of safe water and basic sanitation. 4.Maternal and child health care , including family planning. 5.Immunization against infectious diseases. 6.Prevention and control of endemic diseases. 7.Appropriate treatment of common diseases and injuries. 8.Provision of essential drugs.

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Characteristics of Primary Health Care:

It is essential health care which is based on practical, scientifically sound and socially acceptable methods and technology. It should be rendered universally, acceptable to individuals and the families in the community through their full participation. Its availability should be at a cost which the community and country can afford to maintain at every stage of their development in a spirit of self reliance and self development. It requires joint efforts of the health sector and other health related factors, like, education, food and agriculture, social welfare, animal husbandry, housing, rural reconstruction and etc.

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Principles of PHC
1. 2. 3. 4. 5. Equitable Distribution Community Participation Inter sectoral coordination Appropriate Technology Focus on prevention

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Equitable Distribution Health Services must be shared equally by all people irrespective of their ability to pay and all rich or poor, urban or rural must have access to health services. Community Participation The involvement of individuals, families, and communities in promotion of their own health and welfare is an essential ingredients of primary health care. Inter sectoral coordination Planning with other sectors like, agriculture, animal husbandry, food, Industry, education, housing, public works and communications. In order to achieve such co-operation the administrative system of a country has to be received.

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Appropriate Technology Appropriate Technology has been Defined as technology that is scientifically sound, adaptable to local needs and acceptable to those who apply it and those for whom it is used and that can be maintained by the people themselves it keeping with the principle of self reliance with the resumes the community and country can afford. Focus on prevention treatment of illness and rehabilitation are important since community expect treatment services. Health services should not only be curative but also should promote health and healthy lifestyles with emphasis andon prevention.

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Primary Health Care in India In 1977 the Government of India launched a rural Health Scheme, based on the principle of placing peoples health in peoples hands. Based on this principle Government of India have been formed various national health committees, some of them are as follows: Bhore Committee (1946) : This committee is known as the health survey and Development committee. Suggestion of the committee was, one PHC for a population of 40,000/- And the committee also emphasized the term comprehensive Health Care Preventive, Curative and Promotional health services.

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Mudaliar Committee (1962) : This committee is known as The Health Survey and Planning Committee. Dr.A.L.Mudaliar as its chairman. This committee found the quality of services at PHC and advised to strengthening of existing centres.
. Kartar Singh Committee (1973): This committee known as the committee on multipurpose workers under health and family planning Mr.Kartar Singh was its chairman. This committee in its report recommended one health centre for a population of 50,000.

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4. Shrivatsav Committee(1975) : This committee known as, the group on Medical Education and Support Manpower Mr.Shrivatsav as its chairman. This committee recommended the creation of health workers from within the community itself. One male and one female health worker should be available for every 5,000 population. 5. Rural health scheme (1977) : This is the scheme which emerged out of the recommondation of the Shrivatsav committee is based on their system of services, at the level of, 1. Village 2. The sub centre 3. The primary health centre (PHC) 4. The community health centre. (CHC)

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At village level
a) Village health guides scheme b) training of local dais c) Anganwadi worker (ICDS)
village health guides scheme: this scheme was introduced on 2nd october, 1977,and launched in all states except kerala,karnataka,tamil nadu,arunachal pradesh,and jammu and kashmir which had alternative rural health schemes system. A village health guide is a person with an aptitude for social service and is not a government functionary.

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They serve as link between the community and Governmental Infrastructure. Their duties are, Treatment of simple ailments and activities in first aid. Mother and child health including family planning. Health Education and Sanitation. They should be, 1)be permanent residents of the local community. 2)have a minimum formal education of at least up to vi standard

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3) able to spare at least 2-3 hours every day for community health work . 4)be acceptable to all sections of the community. b.

Local Dais :
Under the Rural health scheme,this program was undertaken to train all categories They are all the local community peoples and works as a traditional birth attendants. To improve their knowledge is the elementary concepts of maternal and child health and sterilization. Training is at PHC, sub centre or at MCH(Maternal and Child Health).

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. c. Anganwadi Worker (ICDS Scheme) : The integrated child Development Services Scheme ICDS was started on 02nd October of 1975. The administrative unit for a ICDS project is a community Development Block in rural areas, tribal development block in tribal area and a group of slums in urban areas. Anganwadi covers a population of 1000 in rural areas
B. Sub-Center level : The sub-centre is the peripheral out post of the existing health delivery system in rural areas. One sub centre will cover the population of 5000 in rural and 3000 in hilly or tribal areas. Mother and child health care, family planning, and immunization are the limited functions of sub-centers.

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C.Primary Health care level : The Bhore Committee in 1946 gave the concept of primary health centre as a basic health unit to provide, as close to the people as possible, an integrated, curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. One PHC for every 30000 rural population in the plains and one PHC for every 20000 population in hilly area.

Each primary health centre covers a population of 10000 and is spread over about 100 villages. There are maintained by the state government under (MNP) Minimum Needs Program and (BSP) Basic Minimum Services Program. One PHC is a referral unit for 6 sub centres.