Unit 2: Primary Health Care

Class Session 5: Primary Health Care

Services in Oman
 Objectives
At the end of the session, students will be able to:
1. Identify the main primary health care services that are
implemented in Oman.
2. List the objectives of each primary health care services.
3. Describe the various activities that are provided by each service.
4. Specify the roles of community health nurse in providing primary
health care services.
5. Differentiate between the various types of referral system in
Oman.
6. Discuss the roles & responsibilities of health team members during
the process of referral.
Services provided at primary health care level
in the Sultanate of Oman
7. Immunization
3. 5. Child Health
1. Health 2. Promotion of 4. Maternal against
Environmental Growth 6. School Health
Education proper nutrition: Health childhood
Health monitoring
diseases

Inform, Control of
Diarrhea and Personal
motivate, help Antenatal care diarrheal EPI
malnutrition Hygiene
people diseases

Control of
Acute Immunization
Food safety Deliveries
Respiratory in Pregnancy
disease

Control of
Postnatal care Helminthic
Safe water, Infections
basic
sanitation,
waste disposal,
vector control
Services provided at primary health care level
in the Sultanate of Oman

12.Treatment 13. Adequate 14.

8.Control 11. Oral 15.Intersectoral
9. Mental 10. Eye of common supply and rational Community
of Health Cooperation
Health Health diseases and use of essential Participation
diseases
injuries drugs

a.
Detection, Referral Diagnosis, Essential Community Involve other
Communicable
referral based on treatment drugs involvement sectors
diseases
severity
b. Non Follow Management Information At wilayat
Education Screening
communicable up of drugs gathering levels
diseases
1. HEALTH EDUCATION

Meaning Who Where How Techniques

A process that Lecture

informs, Discussion
motivates, and Each individual Every hospital,
Integrate into
help people to of a health health center, Demonstration
every activity
adopt and team is a school, home
of the health Role play
maintain health and
services.
healthy educator. community.
practices and Storytelling
lifestyles. Counseling
 2. PROMOTION OF PROPER NUTRITION
Under nutrition
• High rates of infant and child mortality
• Retards the growth and development
• Lowers the resistance to infections and environment hazards.
Maternal malnutrition
• Important cause of poor health of women and their infants.
• Reduces work capacity and interferes with their personal and
professional development.
• Nutritional requirements of pregnant and lactating women
are greatly increased from those of other females .
• If a child continues to take an unbalanced diet over a period
of days, weeks or months he/she will develop malnutrition.
Diarrhea and Malnutrition
• Diarrhea leads to malnutrition.
• Children suffering from diarrhea must continue to be fed properly because withholding diet will aggravate their problem.
UNICEF report(2013) named “Improving Child
Nutrition: The achievable imperative for global
progress”
1. Stunting affects 165 million children under five
years old – one out of every four.
2. Stunting(low height for age) leads to a lifelong cycle
of poor nutrition, illness, poverty and inequity.
3. The damage to physical and cognitive development,
especially during the first two years of a child’s life,
is largely irreversible.
4. In 2012, an estimated 25 per cent of children under
five years of age were stunted globally, or 162
million children, which represents a 37 per cent
decrease from an estimated 257 million in 1990.
 2. PROMOTION OF PROPER NUTRITION

PHC objectives regarding nutrition

Role of PHC team

At family level, family should be educated on………

At individual level action must be taken to……

WORKSHEET
 3. ENVIRONMENTAL HEALTH

• Environment: All living and non-living things and conditions

in and around an individual, family, or a community which
influence them.
The main aims in PHC are:
1. To prevent diseases related to unsafe drinking
water, lack of sanitation and low standards of
personal hygiene.
2. To improve the quality of life and health of the
population by promoting personal and community
hygiene through self-reliance and community
action.
 • Hygeine
3. ENVIRONMENTAL HEALTH •
•
Water
Food
Activities related to environmental health • Vectors
• Cleanliness-excreta disposal
1. Promotion of personal and community hygiene • Training/ coordination

2. Provision of safe drinking water supply by protecting water sources and

surveillance of drinking water
3. Proper system of excreta disposal
4. Food quality control
5. Control of vectors, control of flies, mosquitoes and cockroaches
6. Participation in arranging village cleaning campaign
7. Training of local workers and health volunteers
8. Intersectoral coordination to improve environmental health
3. ENVIRONMENTAL HEALTH

• WORKSHEET
• The main aims in PHC
• Main activities
• Community Education
 4. MATERNAL HEALTH
Main Activities
Objectives:

Antenatal care
1. To promote the health of the mother by
maintaining the healthy growth of the
fetus as well as well-being of the mother
Intrapartum care
2. To reduce maternal mortality and
morbidity
Post natal care
• Worksheet
 5. CHILD HEALTH

Objectives
1. To protect and promote the health of the children by
meeting special biological and psycho-social
needs………essential for the survival of the healthy
infant and child.
2. To reduce the infant and child morbidity and mortality.
 5. CHILD HEALTH
Common problems of:
Newborn Infants and children
1. Low birth weight 1. Malnutrition
2. Difficulty in breathing 2. Diarrhea
3. Neonatal tetanus 3. Respiratory infection
4. Infection of any kind 4. Other infectious diseases
5. Head or brain injury 1. Mumps
2. Whooping cough
6. Hypoglycemia 3. Diphtheria
7. Conjunctivitis 4. Poliomyelitis
5. Measles
6. Chicken pox etc.
 5. CHILD HEALTH
Main activities of child health care
1. Promote breast feeding
2. Weaning and provision of adequate nutrition
3. Nutritional surveillance and prevention of malnutrition
4. Growth monitoring
5. Immunization against childhood diseases
6. Control of diarrheal diseases
7. Control of acute Respiratory diseases
8. Control of helminthic infections
9. Health education on personal hygiene, child rearing, healthy habits, care in
illness
6. SCHOOL HEALTH PROGRAMME

Objectives:
• To meet comprehensively the physical, mental, and
social health needs and problems of school-age
children.
 6. SCHOOL HEALTH PROGRAMME

• To help kids grow into educated, physically and

mentally healthy adults.
• By applying principles of health protection and
promotion
• Provide healthy environment to their own families.
 6. SCHOOL HEALTH PROGRAMME
Activities in School Health
Providing Health
Screening Immunization Provision of
treatment education

To detect any Sickness or Proper

Personal
disease/ injury in sanitary
hygiene
defect or school conditions
abnormality
Safe
Disease drinking
prevention water
facilities in
cooperation
Promotion of with school
health authorities
7. IMMUNIZATION AGAINST CHILDHOOD DISEASES

1.To sustain i. Diphtheria, 2. To eradicate Poliomyelitis

and consolidate ii.
iii.
Pertussis
Tetanus 3. To immunize all pregnant
high iv. Poliomyelitis women with two doses of
immunization v. Tuberculosis tetanus toxoid in order to
coverage of vi. Measles eradicate neonatal tetanus
children under vii. Mumps
one year of age viii. Viral Hepatitis 4. To further reduce the
against the ten ix. Hepatitis B incidence of the EPI target
preventable x. Hib diseases
childhood
diseases
7. IMMUNIZATION AGAINST CHILDHOOD DISEASES…..
WORKSHEET
7. IMMUNIZATION AGAINST CHILDHOOD DISEASES…..
WORKSHEET
The PHC workers must be knowledgeable and skilled about the
following:
g. Disease a. The vaccines and
surveillance. their schedule

f. Evaluating b. Correct
immunization technique of
activities giving vaccines

e. Motivating the c. Counselling

community mothers
d. Preparing and
conducting
immunization
session
PHC worker must ensure:
• Availability of
• Vaccines
• Equipment needed for vaccines

• Vaccines are kept in proper condition and maintain

cold-chain till the vaccines are actually used
 REMEMBER:
• Vaccines can be damaged and become ineffective if not maintained according
to the specifications.

• HEAT, SUNLIGHT and FREEZING can destroy the vaccines.

• Heat and sunlight damage live vaccines.
• Freezing damages killed vaccines and toxoids.

• ALL VACCINES MUST BE KEPT AT A TEMPERATURE BETWEEN + 2 to + 8 C. at

all times.
7. IMMUNIZATION AGAINST CHILDHOOD DISEASES…..
WORKSHEET

• Health education
• Follow up
• Monitoring and evaluation
8. CONTROL OF DISEASES

Objectives
• To maintain epidemiological surveillance of health
related problems, the communicable and non-
communicable diseases in the country and to institute
preventive and control action whenever required
8. CONTROL OF DISEASES
Non-
Communicable
Communicable
diseases diseases

Malaria Cardiovascular
diseases
Tuberculosis
Diabetes
Respiratory
infections Cancer

AIDS
8. CONTROL OF DISEASES
Role of PHC Workers in Communicable Disease control:

• Providing information on these diseases

• Advising the people to adopt health promotive personal
hygiene habits
• Promoting immunization
• Follow up treatment
8. CONTROL OF DISEASES
Objectives of :
8.2.1 Cardio Vascular Diseases
8.2.2 Control of Diabetes
8.2.3 Prevention and control of Cancer

SCB:Pg 60-61
8. MENTAL HEALTH
Objectives:

• 1. To promote mental health, prevent mental illness,

provide adequate treatment to mentally ill persons
and rehabilitate them as necessary
• 2. To promote mental health awareness amongst the
community
8. MENTAL HEALTH
• Functions of health workers at the PHC level
• Mental Health Education

WORKSHEET
9. EYE HEALTH CARE

Objectives

1. To prevent and control avoidable blindness, with particular

emphasis on trachoma control, so as to reduce the incidence of
blindness to the maximum.
2. To reduce blindness due to other causes e.g.: cataract, glaucoma
etc.
Clinical Activities in Primary Eye Care

All primary care providers should be able to:

• Distinguish various eye problems, treatment and follow up
• Assess visual acuity by conducting simple vision test using
Snellen Chart
• Referral system …..worksheet
11. ORAL HEALTH
Objectives:
• To reduce the oral health problems, particularly the
two major diseases namely
• dental caries
• periodontal disease,
THROUGH
• balanced diet and
• integrated curative and preventive dental health program.
11. ORAL HEALTH Role of Health Worker

Oral health Toothbrush drills Screening Referral and

education of for effective • Screening of 6-7 year Follow up
parents and plaque control old children annually • Record made for
children measures • Screening for pre- those who require
school children and referral should be set
• Emphasize on plaque • Demonstrations of mothers as part of aside and
control through regular use and MCH program. arrangements made
• Oral hygiene correct method of for them to receive
• Use of fluorides tooth brushing care either at health
• Care in use of • Parents must be center or to hospital
sugar containing encouraged to having dental care
substances. attend the sessions facility.
and reinforce the • All referred cases
habit of their should be followed
children on daily up till the treatment
basis is completed.
12. TREATMENT OF COMMON DISEASES & INJURIES

Objectives:

• Proper management of common diseases and injuries

12. TREATMENT OF COMMON DISEASES & INJURIES

The aim of PHC outlet

1. Immediate diagnosis and treatment of common diseases and
injuries
2. If required, referral to hospital for proper diagnosis and
treatment.
3. Follow up maintenance therapy when the patient is referred
back to the health center by the hospital
4. Ensure compliance with the prescribes treatment
5. Full participation in the prevention of diseases and accidents.
13. ADEQUATE SUPPLY & RATIONAL USE OF ESSENTIAL DRUGS

Objectives:
1. To ensure the regular supply to all people of safe and
effective drugs of acceptable quality with adequate
control
2. Drugs play an important role in protecting,
maintaining and restoring the health of the people.
3. Essential drugs are those drugs that achieve the widest
possible coverage of the population with proven
efficacy and safety
13. ADEQUATE SUPPLY & RATIONAL USE OF ESSENTIAL DRUGS

Criteria of Essential Drugs:

Thoroughly investigated with most favorable
pharmaceutical properties and least toxic.
Therapeutic effect is greater than the sum of the effect of
each
The cost of combination product is less than the sum of
the individual product.
Compliance is improved
13. ADEQUATE SUPPLY & RATIONAL USE OF ESSENTIAL DRUGS
Role of PHC team
1) Education of the community…..
2) Management of drugs…..
3) Dangerous drugs such as narcotics, tranquilizers and hypnotics
should be kept in a separate cabinet with a separate register
4) A small stock of life-saving drugs should be kept in a separate, easy
to reach place so as to deal with the emergencies as quickly as
possible at all times
5) General guidance for drug prescription
6) The person in charge of vaccines and toxoids should make sure
that these are kept under right storing conditions and in the right
temperatures.
14. COMMUNITY PARTICIPATION
OBJECTIVE:
Involvement of community in the process of

Health Disease
Self-care
Promotion Prevention
14. COMMUNITY PARTICIPATION

• How to stimulate community involvement?

• I-
• E-
• C-

• School teacher, a social worker or a religious leader or an

influential person……
14. COMMUNITY PARTICIPATION
Information Gathering:

Collect information such

indicating various
3. Obtain a map

landmarks
2. Get to know the
as
community
1. Establish

• Location
contact

• Communication
• Roads
• Schools
• Water resources
• Distance from nearest health
facility
• Village leaders
• Clubs, women organizations
etc.
 14. COMMUNITY PARTICIPATION

1. Collect population information: age distribution,

occupation, education, sex distribution etc.
2. When discussing with the community focus attention
on issues of importance to majority of the people.
3. Select members from the community and train them in
preventive and promotive activities
• So that they can bridge the gap between the health facility and the
community.
15. INTERSECTORAL COOPERATION

Objectives:
• To involve other sectors like education, social welfare,
women and child development, agriculture,
veterinary and addressing themselves to uplift the
quality of life of human beings.

• Encourage inter-sectoral cooperation at wilayat level.

 15. INTERSECTORAL COOPERATION

Functions of Wilayat Health Committee :

1. Suggest future expansion of health services according to the local needs

2. Plan and implement inter-sectoral activities such as environmental

health in cooperation with the municipality and local bodies.

3. Community involvement in promotion of health

4. Other health related activities

ROLE OF NURSE IN PROVIDING PHC SERVICES

1. Assessing the health status of individuals, families and

community
2. Mobilizing community involvement
3. Providing integrated health care including the treatment of
emergencies
4. Making timely appropriate referrals
5. Maintaining epidemiological surveillance
6. Training and supervising health workers
ROLE OF NURSE IN PROVIDING PHC SERVICES
7. Collaborating with other developmental workers
8. Monitoring progress in PHC
9. Monitoring records an reports of vital statistics and other
events occurring in the community.
10. Provision of PHC is a natural extension of nursing practice.
Nursing in PHC is addressed to the health needs of person at
homes, schools, health centers, places of work and other
settings of nursing care.
REFERRAL TO SECONDARY AND
TERTIARY LEVEL HOSPITALS
What is REFERRAL?

Referral is a process in which the treating physician at a lower

level of health services, who has inadequate skills by virtue of his
qualification and /or lesser facilities at his level to manage a
clinical condition, seeks the assistance of a better equipped and
specially trained person with better resources at his higher level, to
guide him in managing or take over the management of a
particular episode of clinical condition in a patient.
What is REFERRAL?

Referral is a process in which

the treating physician at a lower level of health services,
who has inadequate skills by virtue of his qualification and /or
lesser facilities at his level to manage a clinical condition,
seeks the assistance of a better equipped and specially trained
person with better resources at his higher level,
to guide him in managing or take over the management of a
particular episode of clinical condition in a patient.
Types of Referral:

Routine
• For laboratory, radiological and
other investigations

Emergency
• In case of emergencies which
cannot be totally managed at
primary health care institutions
Reasons for Seeking Referral

• -Expert opinion
• -Admission and management of a patient
• -Facilities for investigation
Referral Procedure
• Refer SCB Pg 69
Benefits of Referral

Referring PHC physician

Patient Consultant
• It would be:
• The patient would: • The consultant can: • -A learning process
• -Avoid staying from • -Devote more time • Opportunity for self-
post to pillar in the • -Plan his evaluation
referral hospital appointments • -Gaining self confidence
• -Help in organizing follow up
• -Reduce his/her • -Can gather better services
waiting time direct and indirect
• -Establishing credibility of
• -Draw faster information leading PHC institution
attention for timely to improved quality • -Improve the image of PHC
management in management. institutions
 HEALTH CARE TEAM

ROLES AND INTERRELATIONSHIP

SCB: Page 70-73

The main characteristics of a team:
• -Have common goals and objectives
• -Follow set rules and norms
• -Organize themselves to achieve their objectives
• -Cooperation between members
• -Have leaders
• -Members are considered as coequals
• -Members demonstrate a lot of sharing and caring behavior
The Health Personnel in the Health Team in PHC

• Medical officer
• Administrative officer
• Health Assistant
• Nursing staff/ health visitor
• Sanitary Inspector
• Sanitary Assistant
• Assistant Nurse
• Midwife
• Assistant Pharmacists /dispensers
• Laboratory technician and X -ray technician
• Spray man, drivers, far ashes, clerks and watchman
• The level of manpower and skill is matched with the
tasks to be carried out and the staff is adequately
distributed throughout the Wilayat Health System.
• Role of the Medical Officer
• Role of Administrator
• Role of the Senior Staff Nurse
• Role of the Staff Nurse

REFER SCB Pg 71-73

THANK YOU