PRIMARY HEALTH CARE

UMMEY AIMAN
ROLL NO-95
MBBS BATCH (2014)
 A new approach to health care came to
existence in 1978 ,following an
international conference at ALMA –ATA

 This is known as primary health care .

 First proposed by the Bhore committee

in 1946.
 The ALMA-ATA international conference
gave primary health care a wider meaning
and defined as follows:

 “primary health care is essential health

made universally accessible to individuals
and acceptable to them , through their full
participation and at a cost the community
and country can afford ”.
HALLMARKS OF A PRIMARY
HEALTH CARE

AFFORDABILTY ACCESSIBILTY

ACCEPTABILITY AVAILABILITY
ELEMENTS OF PRIMARY HEALTH
CARE
Educating concerning prevailing health
problems and the methods of preventing and
controlling them.

Promotion of food supply and proper

nutrition.

An adequate supply of safe water and basic

sanitation.

Maternal and child health care , including

family planning.
Immunization against major
infectious diseases.

Prevention and control of locally

endemic diseases.

Appropriate treatment of common

diseases and injuries ,and

Provision of essential drugs .

EQUITABLE DISTRIBUTION
 The first key principle is equity or
equitable distribution of health services
i.e., health services must be shared
equally( whether rich or poor ,urban or
rural ) .

 Primary health care aims to redress the

imbalance by shifting the centre of gravity
of the health care system from cities to
rural areas.
COMMUNITY PARTICIPATION
 The involvement of individuals ,families
and communities in promotion of their
own health and welfare , is essential
ingredient.

 Their must be continuing effort to secure

,meaningful involvement in planning ,
implementation and maintenance of
health services
EXAMPLE OF COMMUNITY PARTICIPATION
IN INDIA:

 village health guides and Trained DAIs and

ASHA.
 Selected by local community and trained
locally.
Intersectoral coordination
 The declaration of Alma –Ata states that

“primary health care involves in addition

to the health sector, all related sector and
aspects of national and community
development, in particular agriculture
,animal husbandry ,food ,industry
,education ,housing ,public works
,communication and other sectors”.
 Example of intersectoral coordination at
the grass root level- anganwadi as a part
of ICDS programme.
APPROPRIATE TECHNOLOGY
 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 in
keeping with the principle of self reliance
with the resources the community and
country can afford ”
EXAMPLE OF APPROPRIATE
TECHNOLOGY
 Use of colored tapes in measuring mid
upper arm circumference.

 use of ORS.

 ITN.
HEALTH FOR ALL
 In 1977,it was decided in the world health
assembly to launch a movement known
as “Health For All by the year 2000”.

 WHO defined health for all as:

“attainment of a level of health that will
enable every individual to lead a socially
and economically productive life “
 GOALS TO BE ACHIEVED BY 2000

AD
Reduction of infant mortality from the level of 125(1978) to below
60.

 To raise the expectation of the life at birth from the level of 52 years
to 64 .

 To reduce the crude death rate from the level of 14 per 1000
population to 9 per 100.

 To reduce the crude death rate from the level of 33 per 1000
population to 21.

 To achieve net reproduction rate of one .

 To provide the portable water to the entire rural population

 HEALTH CARE SYSTEM
The health care system is intended to deliver health care
services .it constitute :
Public health sector

 primary health care

Primary health centre
sub-centre

 Hospitals/ health centre

Community health centers

Rural hospitals
District hospital/health centre
Specialist hospitals
Teaching hospitals
 Health insurance schemes

-Employees state insurance

-Central government health services

 Other agencies
-Defence services
-railways
Private sector
 Private hospitals, polyclinics , nursing
homes and dispensaries
 General practitioners and clinics
Indigenous systems of medicine
 Ayurveda and siddha
 unani and tibbi
 Homeopathy
 Unregistered practitioners

Voluntary health agencies:

Indian red cross society
Indian council for indian child welfare

National health programmes such as :

Revised national tuberculosis control programme
National vector borne disease control programme etc.
PRIMARY HEALTH CARE IN
INDIA
 In 1977 , the government of INDIA
launched a rural health scheme , based on
the principle of “ placing people’s health in
peoples hand”.
 Keeping in view the WHO goal of health
for all” by 2000 AD , the government of
INDIA evolved a national health policy
based on primary health care approach.
VILLAGE LEVEL
 To implement these policy at the village
level , the following schemes are in the
operation :

 ASHA Scheme
 ICDS Scheme
 Training of local DAIs
ASHA
 ASHA will be health activist in the community who will create
awareness on health.

 ASHA must be:-

-Resident of the village woman (married / divorced / widow) .

-Age group of 25 to 45 years.

-With formal education upto eight class .

-General norm for selection is one ASHA for 1000 population.

-In tribal ,hilly , and desert areas the norm could be relaxed to one
ASHA per habitation .-
ROLE OF ASHA
To create awareness and provide information to the
community on determinants of health such as
nutrition , basic sanitation and hygienic practices .

Counsel woman on birth preparedness importance of

safe delivery, breast-feeding and complementary
feeding , immunization , contraception and prevention
of reproductive tract infections and care of a child .

She will develop a comprehensive village health plan.

She will arrange escort /accompany pregnant women

and children requiring treatment .
Provide primary medical care for minor ailments such
as diarrhea, fevers , and first-aid for minor injuries .

Act as a depot holder for essential provisions being

made available to every habitation like oral
rehydration therapy , iron folic acid tablet ,oral pills
etc .

She will inform about the deaths and birth in her

village and any unusual problem s to the sub centers.

Promote construction of household toilets under

total sanitation.
INTEGRATION WITH
ANGANWADI
 Anganwadi worker will guide ASHA in performing :
 Organizing health day once / twice a month.
 AWWs and ANMs will act as resources persons for
the training of ASHA.
 IEC activity through display posters , folk dances etc
to sensitize on health related issues.
 Anganwadi worker will be depot holder for the drug
kits and will be issuing it to ASHA.
 AWWs will update the list of eligible couples and the
children less than 1 yr of age .
 ASHA will support the AWW in mobilizing the
pregnant and lactating women and infants for
nutrition supplements.
ROLE AND INTEGRATION WITH
ANM
 She will be guide ASHA:

 Hold weekly /fortnightly meeting with

ASHA.
 Anganwadi and ANM’s w will act as resource
person for training ASHA.
 ANM will participate in organizing health
days at anganwadi centre.
 Guide ASHA in motivating pragnant woman
for taking full course of IFA tablets and TT
injection .
Anganwadi worker
 Angan literally means a courtyard .
 Under ICDS scheme , there is an anganwadi worker
for a population of 400 -800.
 there are about 100 workers in each ICDS Project.
 Over 7,067 ICDS blocks are functioning in the
country .
 She is a part –time worker and is paid an honorarium
of Rs 1500 per month for the services .
 Along with the village health guides, the anganwadi
workers are the community’s primary link with the
health services and services for young children.
LOCAL DAIS
 A scheme for training of dais was
initiated during 2001-02.
 Scheme was implemented in 156 districts
in 18 states / UT of the country .
 At least one Dai in every village with the
objective of making deliveries safe .
THANK YOU