Primary Health Care

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FAMILY & COMMUNITY MED 1.1A PRIMARY HEALTH CARE • • • •

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CORE OBJECTIVES Explain the rationale of Primary Health Care Review the provisions of the Alma Ata Declaration Define Primary Health Care Explain the Elements, Goals and Principles of Primary Health Care RATIONALE FOR PRIMARY HEALTH CARE MAGNITUDE OF HEALTH PROBLEMS High IMR Still high incidence of communicable diseases Poor environmental sanitation Rapid population growth, ignorance, poverty

INADEQUATE & UNEQUAL DISTRIBUTION OF HEALTH RESOURCES • Problems on accessibility of HCS • Inadequate HCS • Underutilized HCS • More health facilities in the urban areas • Uneven distribution of qualified health personnel • Health care providers working abroad (“brain-drain”)

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INCREASING COST OF MEDICAL CARE Escalating cost of medicines Parallel drug importation Allocation of national budget is most spent on curative services as opposed to public health preventive services Increase in health expenditure has not brought commensurate results to improved health care ISOLATION OF HEALTH CARE SERVICES FROM OTHER DEVELOPMENTAL ACTIVITIES Lack of coordination with agriculture, education, public works ..etc. Health sector alone cannot achieve the Health for all Goal Primary causes of ill-health and misery are socio-economic (poverty, lack of education, social isolation) Must expand the responsibilities of the health sector THE ALMA ATA DECLARATION 1978, Alma Ata, USSR Defines Primary Health Care – “ Essential health care based on practical, scientific ally sound, socially acceptable methods and technology made universally acceptable 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 the their development the spirit of selfdetermination..” PRIMARY HEALTH CARE DEFINED WHO Declaration Defines Primary Health Care – “ Essential health care based on practical, scientific ally sound, socially acceptable methods and technology made universally acceptable 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 the their development the self-reliance and self- determination..” Primary health care is an approach, NOT a program

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PRIMARY HEALTH CARE APPROACH Is based on : – Social equity (Equitable distribution) – Nation-wide coverage – Self-reliance – Inter-sectoral collaboration – People (community) participation

8 MINIMUM ESSENTIAL ELEMENTS OF PRIMARY HEALTH CARE 1. Education concerning the prevailing health problems and methods to prevent and control them 2. Promotion of food supply & proper nutrition 3. The provision of safe water and basic sanitation 4. Maternal and child health care including family planning 5. Immunization against the major infectious diseases 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Provision of essential drugs

1. 2. 3. 4. 5. 6. 7. 8.

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MILLENIUM DEVELOPMENTAL GOALS 2015 Eradicate extreme poverty and hunger Achieve primary universal primary education Promote gender equality and empower women Reduce child mortality Improve the maternal health Combat HIV/AIDS, malaria, TB and other diseases Ensure environmental sustainability Develop a global partnership for development THE 2 PROLONGED GOAL OF PHC SOCIAL GOAL PHC will improve the quality of life and the extension of maximum health benefits to all particularly to the underserved population DEVELOPMENTAL GOAL Because it views the community as moving progressively towards socio-economic prosperity with the ultimate goal of self-reliance GOALS OF PRIMARY HEALTH CARE Health for all by year 2000 Health in the hands of the people by the year 2020 THE PHILOSOPHY OF PRIMARY HEALTH CARE IS BASED ON THE VALUES THAT HEALTH IS A fundamental right of every citizen An individual collective responsibility An equal opportunity Is part and essential element of the socio-economic development of any country

GENERAL OBJECTIVES OF PRIMARY HEALTH CARE Mobilize communities to make them participate fully in their own health 2. Promote good health practice and maintain optimum quality of life 3. To promote equal access to essential health services through community participation in basic health care 1.

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MAJOR THEMES OF THE STRATEGIES IN PHC Health For All (HFA) implies equity Aim is to give people a positive sense of health Page 1 of 4

FCM III • • • •

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1.1A PRIMARY HEALTH CARE

HFA will be achieved by people themselves HFA requires coordinated action of all sectors concerned The focus of health care system is to bring basic services close to where people live & work Health problems transcends national frontiers & requires international cooperation (UN, WHO, WB, UNICEF)

"Health is a means and end to development" INTER-RELATIONSHIP OF HEALTH & DEVELOPMENT

COMPONENTS OF PRIMARY HEALTH CARE Preventive health care Promotive health care Curative health care Rehabilitative health care APPROACHES TO HEALTH CARE

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PILLARS OF PRIMARY HEALTH CARE fr WHO Political will & commitment Community participation Inter-sectoral cooperation Appropriate technology/systems support

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PILLARS OF PRIMARY HEALTH CARE fr DOH Community participation Inter/intra-sectoral cooperation Appropriate technology Systems support COMMUNITY PARTICIPATION

LEVELS OF PEOPLE'S PARTICIPATION IN PRIMARY HEALTH CARE • Hospital, clinic- based • Community –oriented • Community –based • Community managed

CLINICAL MEDICINE VERSUS COMMUNITY HEALTH PROGRAMS CLINICAL MEDICINE COMMUNITY HEALTH PROGRAMS OBJECTIVE Cure patient of Improve health status disease of the community INFORMATION Clinical history, Population data, REQUIRED physical examination health problems, and labs disease patterns, availability of health services DIAGNOSIS Differential diagnosis Community diagnosis and probable and priorities for diagnosis action ACTION PLAN Treatment and Community health rehabilitation programs EVALUATION Follow-up and Evaluation of changes assessment in health status TASKS REQUIRING EPIDEMIOLOGICAL & PLANNING SKILLS District population Define population groups assess health and disease problems Collect health data produce health information assess district health status decide on priority health problems choose alternative interventions implement programs- increase access and coverage evaluate effectiveness Improvements in health status TRADITIONAL VS PRIMARY HEALTH CARE DIMENSION TRADITIONAL PRIMARY HEALTH CARE Goal Absence of disease Development and preventive health care Focus of care The sick The well and early sick Settings for services Urban based in Rural based and hospitals satellite clinics Clinics and homes Community health Accessible only to a centers, health posts few are accessible to all People Passive recipients of Active participation in health care health development Structure Health is isolated from Health is an integral other sectors part of the socioeconomic development system Process Decision- making from Decision-making from top-down bottom-up Technology Curative services Promotive &

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FCM III based on modern medicine/sophisticated technology Doctor dominated

Outcome

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Reliance on health professionals

1.1A PRIMARY HEALTH CARE preventive services blending traditional medicine with modern medicine Acceptance of indigenous practitioners Appropriate technology for frontline care Local self-reliance , socially and economically productive Self-help

INTRASECTORAL LINKAGE

FIVE BASIC PRINCIPLES OF PHC 1. EQUITABLE DISTRIBUTION Health services must be – Equally accessible – Not neglecting rural and isolated peri-urban dwellers

A 2 WAY HEALTH REFERRAL SCHEME

2. FOCUS ON PREVENTION Preventive services Promotive services Less on curative and rehabilitative 3. MULTI-SECTORAL APPROACH

4. COMMUNITY PARTICIPATION “People must want to be healthy to keep healthy” COMMUMNITY INVOLVEMENT Must share the responsibility and participate in: 1. Defining the health and health related needs and problems 2. Identifying realistic solutions 3. Organizing and mobilizing its resources for health activities 4. Evaluating the results of health actions Both inter and intra-sectoral approach, requires: 1.) Understanding of the various factors influencing the health of the community 2.) Realization by all professional and technical professional of the contribution of each on the delivery o health care 3.) Establishing a mechanism for joint planning, implementation and evaluation of community health programs 4.) Sharing of resources of the community to attain a common goal

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INTERSECTORAL LINKAGE Agriculture Education Public works Local governments Social welfare Population control Private Sectors

SOME MAJOR CONSTAINTS RELATED TO ATTITUDES OF HEALTH ADMINISTRATORS, HEALTH WORKERS AND THE COMMUNITY ADMINISTRATOR HEALTH WORKER COMMUNITY Lack of political will Poor motivation Indifference/apathy Bureaucratic set-up Indifference Dependence makes him impersonal Lack of dedication; Lack of incentives Resistance to change poorly motivated Belief system Political pressures Lack of skills in Traditional ways problem-solving , Values resistant to managerial skills in change the community

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5. APPROPRIATE TECHNOLOGY A method or technique which provides a socially and environmentally acceptable level of service or quality product at the least economic cost It is the application of appropriate technology implies the use of methods, procedures and techniques, equipment/materials that are not only scientifically sound but also suitable to the community Page 3 of 4

FCM III 1. 2. 3. 4. 5.

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1.1A PRIMARY HEALTH CARE

CRITERIA FOR SELECTING THE TECHNOLOGY Effective and safe Complexity- must be simple and easy to use Cost – Inexpensive, must not be disproportionate Acceptability – – e.g. acceptance of BHWs Scope of the technology – – related to effectiveness, safety, appropriateness and cost – E.g. DPT vaccine Feasibility – Compatible with local conditions – E.g. can be used even with out electricity

EXAMPLES OF APPROPRIATE TECHNOLOGY IN PRIMARY HEALTH CARE • Treatment of dehydration in cases of acute diarrhea with glucose containing electrolyte solution (ORS) • Herbal medicines for common ailments • Self-financing community projects – Botika sa Barangay • Use of indigenous materials – Home-made cotton pledgets

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STRATEGIES FOR IMPLEMENTATION PRINCIPLES STRATEGIES Accessibility • Health services Availability delivered where the Acceptability people are Affordability of health • Use of resident volunteer services health workers • Use of traditional herbal meds Provision of quality, • Training, design and basic and essential curriculum based on health services community needs and priorities, task analysis of community health workers (CHW and competency based • Attitudes, skills, knowledge, developed are on promotive, preventive curative and rehabilitative • Regular monitoring and periodic evaluation of BHW performance by the community and health staff Community participation • Awareness-building and consciousness raising on health and related issues • Planning, implementing, monitoring, and evaluation, done through small group meetings (10-20 household cluster) • Selection of CHW by the community • Community building and community organizing • Formation of health committees • Establishment of a CHW

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Self-reliance

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Recognition of the interrelationships between health and development

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Social mobilization

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Decentralization

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organization at the parish or municipal level Mass health campaigns and mobilizations to combat health problems Community generates support (cash, kind, labor) for the health program Use of local resources (human financial, material) Training of community in leadership and management skills Incorporation of income generating projects, cooperatives, small scale industries Convergence of health, food, nutrition, water, sanitation, and population services Integration of PHC into national, regional, provincial, municipal, and barangay development plans Coordination of activities with economic, planning, education agriculture, industry, housing, public works, communication and social services Establishment of an effective health referral system Multisectoral and interdisciplinary linkages Information education, communication support using multi-media Collaboration between government and governmental organizations Reallocation of budgetary resources Re-orientation of health professionals re: PHC Advocacy for political will and support from the national leadership down to the barangay level

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