Primary Health Care An Introduction

Health!!!!
Worldwide, Health is defined in negative terms as:

ABSENCE OF DISEASE

negative concept of health

The negative concept of health ( = absence of disease): tended to determine decision making, planning and expenditure on health .. Services for sickness are named health services

Accordingly
Emphasis was put on building health infrastructure in the form of:

Hospitals Health Centers Dispensaries

role of health personal

Consequently the role of health personnel was primarily that of:

Providers
Whereas people (community members) were: the

Recipients

Coverage & Accessibility

Coverage:
Less than 30%

Accessibility:
Limited to those who: Could afford to pay Lived within reasonable short distance

Primary Health Care

Working together for better health

PHC history
WHO s Constitution 1946

Health for All by the year 2000 (Assembly) 1977 International Conference on Primary Health Care (Alma Ata) 1978

What is Primary Health Care ?

Primary Health Care Definition

Primary Health Care: is the first level of contact of individuals, the family and the community with the national health system, bringing health care as close as possible to where people live and work

Primary Health Care Definition

Primary Health Care: is essential care based on practical, scientifically sound, socially acceptable methods and technologies, made universally accessible to individuals and families in the community through their full participation and at a cost the community and country afford to maintain
Alma Ata declaration, 1978

Primary Health Care- Definition

Primary Health Care extends beyond the traditional health sector and includes all human services which play a part in addressing the inter-related determinants of health.

Income & Social Status

Social Environments

Employment / Working Conditions

Culture

Physical Factors

Social Support Networks

Prenatal / Early Childhood Experiences

Level of Education

Primary Health Care- Definition

Primary Health Care includes:
Primary Care (physicians, midwives & nurses); Health promotion, illness prevention; Health maintenance & home support; Community rehabilitation; Pre-hospital emergency medical services; & Coordination and referral to other areas of health care.

Primary Health Care Definition

Services are generally provided in the community Some services are also provided in hospitals

Primary Health Care Definition

Primary Health Care is different in each community depending upon:
Needs of the residents; Availability of health care providers; The communities geographic location; & Proximity to other health care services in the area.

Primary Health Care - Benefits

PHC focuses on keeping people healthy & addressing illness early so as to increase probability of cure; PHC is client focused; Individuals have access to appropriate care; Services are matched to community needs; Targeted services will have a positive impact on the utilization of health and social services; & Healthy communities with healthy people contribute to a vibrant & stable economy.

Principles of primary health care

Principled health care improvements required based on Declaration of Alma Ata: 1978

Universal access Health equity Community participation Inter-sectoral actions

International Conference on Primary Health Care, Alma-Ata, USSR, 612 17 September 1978

Principles of Primary Health Care

Accessibility

Appropriateness

Intersectoral / Interdisciplinary

Continuity of Care

Population Health

Community Participation

Efficiency

Affordable & Sustainable

Primary Health Care Reform

1. 2. 3. 4. 5. 6. 7. 8. 9. Treatment Illness Cure Episodic care Specific problem Individual practitioners Health sector alone Professional dominance Passive reception 1. 2. 3. 4. 5. 6. 7. 8. 9. Health promotion Health Prevention, care, cure Continuous care Comprehensive care Teams of practitioners Intersectoral collaboration Community participation Joint responsibility

Barbara Starfield, Johns Hopkins University

PHC Programmes
These programs include measures for: Health promotions Disease prevention Basic diagnosis, therapy and rehabilitation

Fundamental Principles for Health for All

1. 2. 3. 4. Health is fundamental human right and a worldwide social goal Health is an integral part of development The existing gross inequality in the health status of people is of common concern to all countries and must be drastically reduced. People have the right and the duty to participate individually and collectively in the planning and implementation of their health care Governments have a responsibility for the health of their people Countries must become self-reliant in health matters. Fuller and better use must be made of the world s resources to promote health and development.

5. 6. 7.

Health Education

Food Supply

Safe water

PHC
Essential drugs MCH Treatment of common Prevention of endemic Disease Immunization diseases

Main Elements of PHC

1. Health Education concerning prevailing health problems and the methods of preventing and controlling them; 2. Promotion of food supply and proper nutrition; 3. An adequate supply of safe water and basic sanitation.

Main Elements of PHC

4. Maternal and child health care, including family planning; 5. Immunization against the major infectious diseases; 6. Prevention and control of local endemic diseases; 7. Appropriate treatment of common diseases and injuries; and 8. Provision of essential drugs.

PHC is supposed to be implemented through the following

1. Assigning the responsibility for this care of the individual, the family and the community, with the national health care system undertaking a supportive role. 2. Active community participation in the process of defining needs and the development of ways to meet them.

PHC is supposed to be implemented through the following

3. Utilizing resources of each local community along with national resources Using of appropriate technology which is less sophisticated and cheaper Mobilizing other sectors (e.g. Education, Agriculture, Housing, Public Work, Information, Communications, Industry) to contribute to PHC implementation

4. 5.

Resources for unsuccessful implementation of PHC

1.- Lack of community participation 2.- Lack of intersectoral collaboration 3.- Lack or misuse of human and material resources 4.- Concentration on sophisticated technology 5.- Mismanagement 6.- Lack of intercountry collaboration 7.- Lack of operational research

A Group of Health Workers working together to achieve a common objective

How to create a health team

CLEAR OBJECTIVES Frequent meetings Allowing health workers to express their views openly Respecting different ideas Sharing agreed objectives Leadership

cont. implementation
Leadership A leader should have:
Knowledge about the objectives Vision Skill of listening Justice Decisional (say NO in a kind manner) Skills of problem-solving

Factors lead to dissatisfaction:

Inefficient administration Incompetent supervision Poor interpersonal relation Inadequate pay

Types of Evaluation
Monitoring records and reports Case Study Survey research

Steps of Evaluation
Decide what to evaluate? Collect information Compare the results with the targets Judge Decide:
To continue To change To stop

What to evaluate?
Effectiveness Efficiency (impact, quality ..) Cost-benefit Accounting

Problems of evaluation

Failure to provide information

Don t evaluate everything

Length of time
Review your resources

The end

Thank u