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Levels of Care
Primary health care Secondary health care Tertiary health care
Primary health care The first level of contact between the individual and the health system. Essential health care (PHC is !rovided. " ma#ority of !revailing health !roblems can be satisfactorily managed. The closest to the !eo!le. Provided by the !rimary health centers.
Principles of PHC
The )*+, -eclaration of .lma".ta proposed a set of P/$'C$PL0S for primary health care# PHC should%
)# 1/eflect and evolve from the economic conditions and socio" cultural and political characteristics of the country and its communities, and be based on the application of the relevant results of social, biomedical and health services research and public health e!perience2 3# 1.ddress the main health problems in the community, providin promotive, preventive, curative and rehabilitative services accordin ly2
4# 1$nvolve, in addition to the health sector, all related sectors and aspects of national and community development, in particular a riculture, animal husbandry, food, industry, education, housin , public works,
self"reliance and participation in the plannin , or ani6ation, operation and control of primary health care, makin fullest use of local, national and other available resources7 and to this end develop throu h appropriate education the ability of communities to participate2
8# 19e sustained by inte rated, functional and mutually"supportive referral systems, leadin to the pro ressive improvement of comprehensive health care for all, and ivin priority to those most in need2 :# 1/ely, at local and referral levels, on health workers, includin physicians, nurses, midwives, au!iliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the e!pressed health needs of the community#2
There is a set of C;/0 .CT$<$T$0S, which were normally defined nationally or locally# .ccordin to the )*+, -eclaration of .lma".ta proposed that these activities should include%
)# 0ducation concernin prevailin health problems and the methods of preventin and controllin them
=ental health Physical handicaps Health and social care of the elderly
/educin e!cess mortality of poor mar inali6ed populations% PHC must ensure access to health services for the most disadvanta ed populations, and focus on interventions which will directly impact on the ma>or causes of mortality, morbidity and disability for those populations# 3# /educin the leadin risk factors to human health% PHC, throu h its preventative and health promotion roles, must address those known risk factors, which are the ma>or determinants of health outcomes for local populations#
4# -evelopin Sustainable Health Systems% PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served# 5, -evelopin an enablin policy and institutional environment% PHC policy must be inte rated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development policy#
The 9asic /e&uirements for Sound PHC @the , .(s and the 4 C(sA
.ppropriateness .vailability .de&uacy .ccessibility .cceptability .ffordability
.ppropriateness
*hether the service is needed at all in relation to essential human needs+ !riorities and !olicies. The service has to be !ro!erly selected and carried out by trained !ersonnel in the !ro!er way.
.de&uacy
The service !ro!ortionate to re,uirement. Sufficient volume of care to meet the need and demand of a community
.ffordability
The cost should be within the means and resources of the individual and the country.
.ccessibility
.cceptability
.cceptability of care depends on a variety of factors, includin satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers#
.vailability
.vailability of medical care means that care can be obtained whenever people need it#
.ssessability
.ccountability
.ccountability implies the feasibility of re ular review of financial records by certified public accountants#
Completeness
Completeness of care re&uires ade&uate attention to all aspects of a medical problem, includin prevention, early detection, dia nosis, treatment, follow up measures, and rehabilitation#
Comprehensiveness
Comprehensiveness of care means that care is provided for all types of health problems#
Continuity
Continuity of care re&uires that the mana ement of a patient(s care over time be coordinated amon providers#
To Summari6e
Primary health care is an approach that% Bocuses on the person not the disease, considers all determinants of health $nte rates care when there is more than one problem Cses resources to narrow differences
Borms the basis for other levels of health systems .ddresses most important problems in the community by providin preventive, curative, and rehabilitative services ;r ani6es deployment of resources aimin at promotin and maintainin health#
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