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Health for all- primary health care- millennium development  goals
 

Health for all- primary health care- millennium development goals

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PHC is the essential care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their ...

PHC is the essential care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their full participation and at a cost they and the country can afford to maintain in the spirit of self reliance and self determination.
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    Health for all- primary health care- millennium development  goals Health for all- primary health care- millennium development goals Presentation Transcript

    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat HFA, PHC & MDG Health For All, Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat 07/12/20121 1
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Contents Alma Ata Declaration- Health for All Basic Principles of Primary Health care PHC Components of Primary Health care Comprehensive Vs. Selective PHC approaches Selective PHC "GOBI & GOBI-FFF" Millennium Development Goal -MDGs  The 8 MDG – Facts – Targets Q &A 2
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatAlma-Ata Declaration &Primary Health Care 3
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978The International Conference on Primary Health Care, meeting in Alma-Ata this twelfthday of September in the year Nineteen hundred and seventy-eight, expressing the needfor urgent action by all governments, all health and development workers, and the worldcommunity to protect and promote the health of all the people of the world, hereby makesthe following Declaration: 4
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatIThe Conference strongly reaffirms that health, which is a state ofcomplete physical, mental and social wellbeing, and not merely theabsence of disease or infirmity, is a fundamental human right and that theattainment of the highest possible level of health is a most importantworld-wide social goal whose realization requires the action of manyother social and economic sectors in addition to the health sector.IIThe existing gross inequality in the health status of the peopleparticularly between developed and developing countries as well aswithin countries is politically, socially and economically unacceptableand is, therefore, of common concern to all countries. 5
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatIIIEconomic and social development, based on a New InternationalEconomic Order, is of basic importance to the fullest attainment of healthfor all and to the reduction of the gap between the health status of thedeveloping and developed countries. The promotion and protection of thehealth of the people is essential to sustained economic and socialdevelopment and contributes to a better quality of life and to world peace. 6
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatIVThe people have the right and duty to participate individually andcollectively in the planning and implementation of their health care.VGovernments have a responsibility for the health of their people whichcan be fulfilled only by the provision of adequate health and socialmeasures. A main social target of governments, internationalorganizations and the whole world community in the coming decadesshould be the attainment by all peoples of the world by the year 2000 of alevel of health that will permit them to lead a socially and economicallyproductive life. Primary health care is the key to attaining this target aspart of development in the spirit of social justice. 7
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatVIPrimary health care is essential health care based on practical,scientifically sound and socially acceptable methods and technologymade universally accessible to individuals and families in the communitythrough their full participation and at a cost that the community andcountry can afford to maintain at every stage of their development in thespirit of self reliance and self-determination. It forms an integral part bothof the country’s health system, of which it is the central function andmain focus, and of the overall social and economic development of thecommunity. It is the first level of contact of individuals, the family andcommunity with the national health system bringing health care as closeas possible to where people live and work, and constitutes the firstelement of a continuing health care process. 8
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatVIIPrimary health care:1. reflects and evolves from the economic conditions and socio-culturaland political characteristics of the country and its communities and isbased on the application of the relevant results of social, biomedical andhealth services research and public health experience;2. addresses the main health problems in the community, providingpromotive, preventive, curative and rehabilitative services accordingly;3. includes at least: education concerning prevailing health problems andthe methods of preventing and controlling them; promotion of food 9
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatsupply and proper nutrition; an adequate supply of safe water and basicsanitation; maternal and child health care, including family planning;immunization against the major infectious diseases; prevention andcontrol of locally endemic diseases; appropriate treatment of commondiseases and injuries; and provision of essential drugs;4. involves, in addition to the health sector, all related sectors andaspects of national and community development, in particular agriculture,animal husbandry, food, industry, education, housing, public works,communications and other sectors; and demands the coordinated effortsof all those sectors; 11
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat5. requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation andcontrol of primary health care, making fullest use of local, national andother available resources; and to this end develops through appropriateeducation the ability of communities to participate;6. should be sustained by integrated, functional and mutually supportivereferral systems, leading to the progressive improvement ofcomprehensive health care for all, and giving priority to those most inneed; 11
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat7. relies, at local and referral levels, on health workers, includingphysicians, nurses, midwives, auxiliaries and community workers asapplicable, as well as traditional practitioners as needed, suitably trainedsocially and technically to work as a health team and to respond to theexpressed health needs of the community.VIIIAll governments should formulate national policies, strategies and plansof action to launch and sustain primary health care as part of acomprehensive national health system and in coordination with othersectors. To this end, it will be necessary to exercise political will, tomobilize the country’s resources and to use available external resourcesrationally. 12
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatIXAll countries should cooperate in a spirit of partnership and service toensure primary health care for all people since the attainment of health bypeople in any one country directly concerns and benefits every othercountry. In this context the joint WHO/UNICEF report on primary healthcare constitutes a solid basis for the further development and operationof primary health care throughout the world. 13
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatXAn acceptable level of health for all the people of the world by the year2000 can be attained through a fuller and better use of the world’sresources, a considerable part of which is now spent on armaments andmilitary conflicts. A genuine policy of independence, peace, détente anddisarmament could and should release additional resources that couldwell be devoted to peaceful aims and in particular to the acceleration ofsocial and economic development of which primary health care, as anessential part, should be allotted its proper share. 14
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatThe International Conference on Primary Health Care calls for urgent andeffective national and international action to develop and implementprimary health care throughout the world and particularly in developingcountries in a spirit of technical cooperation and in keeping with a NewInternational Economic Order. It urges governments, WHO and UNICEF,and other international organizations, as well as multilateral and bilateralagencies, nongovernmental organizations, funding agencies, all healthworkers and the whole world community to support national andinternational commitment to primary health care and to channelincreased technical and financial support to it, particularly in developingcountries.The Conference calls on all the aforementioned to collaborate inintroducing, developing and maintaining primary health care inaccordance with the spirit and content of this Declaration. 15
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat PRIMARY HEALTH CARE (PHC)Definition:PHC is the essential care based on practical, scientifically sound andsocially acceptable method and technology made universally accessible toindividuals and families in the community through their full participationand at a cost they and the country can afford to maintain in the spirit of selfreliance and self determination. 16
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat BASIC PRINCIPLES OF PRIMARY HEALTH CARETHE BASIC PRINCIPLES OF PRIMARY HEALTH CARE include: 1. Community participation 2. Intersectoral collaboration 3. Integration of health care programmes 4. Equity 5. Self-reliance. 17
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat1- COMMUNITY PARTICIPATIONIs the wholemark of primary health care, without which it will not succeed.Community participation is a process by which individuals and familyassume responsibility for their own health and those of the community anddevelop the capacity to contribute to their/and the community development.Participation can be in the area of identification of needs or duringimplementation. 18
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatThe community needs to participate at village, ward, district or localgovernment level. Participation is easier at the ward or village levelbecause the issue of heterogeneity is eliminated.ADVANTAGES-It addresses the felt health needs of the people-It ensures social responsibility among the community-It ensures sustainability-It ensures cost sharing-It ensures enhancement of knowledge-It encourages intersectoral collaboration 19
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat2- INTER SECTORAL COLLBORATIONThis is the coordination of health activities with other sectors; such sectorsinclude Education, Finance, Agriculture, Information etc. There should be aworking relationship these bodies and the health ministry.ADVANTAGES-Overall human development-It ensures economic development-It ensures affordability 21
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat3- INTEGRATON OF HEALTH SERVICESThis is defined as coordination of various primary health care componentsinto a whole programme and made available at all times including referrals.ADVANTAGES-It ensures efficient use of all resources and removes areas of wastage.-It ensures sustainability of programme-It ensures bye pass phenomenon-It reduces opportunity cost-It grantees clients confidentiality 21
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat4- EQUITYThe health care resources available in a given community should not be inthe handle of a few. And resources should be accessible and affordable toall. It is divided in 3 components: 1. Decentralization of health of services into federal state-local government-ward levels. 2. The essential drug services and the national drug formulae. making drugs available at all levels and at low cost. 3. National health insurance scheme-where people contribute to the health services of those who don’t have or cannot afford. 22
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat5- SELF RELIANCEThis involves the use of technological methods and scientifically soundand maintain by the community .It can be in terms of human resources,money or materials..ADVANTAGES OF SELF RELIANCE-Affordability-Sustainability-Acceptability-Authenticity 23
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat COMPONENTS OF PRIMRY HEALTH CAREThere are 8 components (elements)of primary health care. 1. Immunization: An increasing number of infectious diseases can be prevented by vaccinations example-measles, Meningitis, Pertusis, tuberculosis, yellow fever etc 2. Maternal and child care: Pregnant women and women of child bearing age (15-49 years) are the target group for special care. Children under 5yrs of age are also vulnerable to childhood killer disease. Maternal and child health clinics are established in Nigeria to take care of these groups. 24
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat COMPONENTS OF PRIMRY HEALTH CARE- conts3. Essential drugs: The most vital drugs should be available and affordable at all levels.4. Food and Nutrition: The family’s food should be adequate, affordable and balanced in nutrients.5. Education: The community should be informed of health problem and methods of prevention and control.6. Illness and injury: Adequate provision of curative services for common ailments and injuries should be made by the community.7. Water and sanitation: A safe water supply and the clean disposal of wastes are vital for health.8. Vector and reservoirs: Endemic infection diseases can be regulated through the control or eradication of vectors and animal reservoir. 25
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatThe Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s) Assessability  Appropriateness Accountability  Availability  Adequacy Completeness  Accessibility Comprehensiveness  Acceptability Continuity  Affordability 26
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Appropriateness Whether the service is needed at all in relation to essential human needs, priorities and policies.The service has to be properly selectedand carried out by trained personnel in the proper way. 27
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Adequacy The service proportionate to requirement. Sufficient volume of care to meet the need and demand of a community 28
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Affordability The cost should be within the meansand resources of the individual and the country. 29
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Accessibility Reachable, convenient services Geographic, economic, cultural accessibility 31
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Acceptability •Acceptability of care depends on a variety of factors, including 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 . • 31
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat AvailabilityAvailability of medical care means thatcare can be obtained whenever people need it. 32
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Assessability Assessebility means that medical care can be readily evaluated. Accountability• Accountability implies the feasibility of regular review of financial records by certified public accountants. 33
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat CompletenessCompleteness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation. 34
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat ComprehensivenessComprehensiveness of care means that care is provided for all types of health problems. 35
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Continuity Continuity of care requires that the management of a patient’s care over time be coordinated among providers. 36
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat 37
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Comprehensive Vs Selective PHC package Comprehensive package of PHC included at least the following:1) Education on prevailing health problems and methods forpreventing and controlling them2) Promotion of food supply and proper nutrition3) An adequate supply of safe water and basic sanitation 38
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat4) Maternal and child health care, including family planning5) Immunization against major infectious diseases6) Prevention and control of locally endemic diseases7) Appropriate treatment of common diseases and injuries8) Provision of essential drugs. 39
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatSelective Primary Health Care (1978 to Present)A “selective” approach attacks the most severe publichealth problems facing a locality in order to have thegreatest chance to improve health and medical care in lessdeveloped countries.Selective PHC, or the more frequently used term “verticalapproach”, refers to the implementation of a single disease 41
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatprogramme that may have a significant impact on reducinghigh morbidity and mortality within a short time frame.Some examples are polio eradication, making pregnancysafer, immunization programme, control of HIV/AIDS,tuberculosis and malaria. 41
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatSelective Primary Health Care (1978 to Present) GOBI & GOBI-FFFThe Alma-Ata Declaration was criticized for being toobroad and idealistic, with an unrealistic timetable. A commoncriticism was that saying Health for All by 2000 was not feasible.The term " Selective PHC meant a package of low-cost, technicalinterventions to tackle the main disease problems of poor countries. 42
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatThis interventions were known as GOBI,Meaning:growth monitoring,oral rehydration techniques,breast feeding, andimmunizations.These four interventions appeared easy to monitor and evaluate.Moreover, they were measurable and had clear targets. Fundingappeared easier to obtain because indicators of success andreporting could be produced more rapidly. 43
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat GOBI-FFFLater, some agencies added FFF to the acronym GOBI, creating GOBI-FFF. Food supplementation, Female literacy, Family Planning 44
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat The MillenniumDevelopment Goals ( MDGs ) 45
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat The Millennium Development Goals (MDGs)The Millennium Development Goals (MDGs) are eight internationaldevelopment goals that were officially established following theMillennium Summit of the United Nations in 2000, following theadoption of the United Nations Millennium Declaration. All 193United Nations member states and at least 23 internationalorganizations have agreed to achieve these goals by the year 2015.The goals are: 46
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat The 8 MDG are: 1. Eradicating extreme poverty and hunger, 2. Achieving universal primary education, 3. Promoting gender equality and empowering women 4. Reducing child mortality rates, 5. Improving maternal health, 6. Combating HIV/AIDS, malaria, and other diseases, 7. Ensuring environmental sustainability, and 8. Developing a global partnership for development.Each of the goals has specific stated targets and dates for achieving those targets. 47
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 1: Eradicate extreme poverty and hungerQuick facts  The proportion of people living on less than $1.25 a day fell from 47 per cent in 1990 to 24 per cent in 2008.  Women are far more likely than men to be engaged in vulnerable employment  The numbers of malnourished have stabilized since 1990  Progress in relieving food deprivation has slowed or stalled in many regions  Countries in sub-Saharan Africa were the hardest hit by the food and financial crises 48
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 1: Eradicate extreme poverty and hunger-conts Nearly one in five children under age five in the developing world is underweight Differences in undernutrition found between rural and urban children are largest in Latin America and the Caribbean Poverty is a major determinant of undernutrution in children in all regions The number of refugees and of the displaced remains high, even with an upturn in repatriation in 2011 49
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 1: Eradicate extreme poverty and hunger-conts Targets of this goal: Target 1A: Halve the proportion of people living on less than $1 a day  Proportion of population below $1 per day (PPP values)  Poverty gap ratio [incidence x depth of poverty]  Share of poorest quintile in national consumption Target 1B: Achieve Decent Employment for Women, Men, and Young People  GDP Growth per Employed Person  Employment Rate  Proportion of employed population below $1 per day (PPP values)  Proportion of family-based workers in employed population 51
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 1: Eradicate extreme poverty and hunger-conts Targets of this goal: Target 1C: Halve the proportion of people who suffer from hunger  Prevalence of underweight children under five years of age  Proportion of population below minimum level of dietary energy consumption[12] 51
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 2: Achieve universal primary educationQuick Facts  Progress on primary school enrolment has slowed since 2004, even as countries with the toughest challenges have made large strides.  More than half of all out-of-school children are in sub-Saharan Africa  Success at the primary level places increased demands on secondary schools  Illiteracy still holds back more than 120 million young people  52
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 2: Achieve universal primary education Targets of this goal: Target 2A: By 2015, all children can complete a full course of primary schooling, girls and boys  Enrollment in primary education  Completion of primary education  everyone will get into school 53
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 3: Promote gender equality and empower womenQuick Facts  Parity is achieved in developing world primary schools, even though some regions lag behind  Gender disparities emerge at different points through the education system  Girls from the poorest households face the highest barriers to education  Equal access to job opportunities remains a distant target for women in some regions  Women, more often than men, turn to the informal economy 54
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 3: Promote gender equality and empower women  Targets of this goal: Target 3A: Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015  Ratios of girls to boys in primary, secondary and tertiary education  Share of women in wage employment in the non-agricultural sector  Proportion of seats held by women in national parliament.  55
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 3: Promote gender equality and empower women  Targets of this goal:  For girls in some regions, education remains elusive.  Poverty is a major barrier to education, especially among older girls.  Women are largely relegated to more vulnerable forms of employment.  Women are over-represented in informal employment, with its lack of benefits and security.  Top-level jobs still go to men — to an overwhelming degree.  Women are slowly rising to political power, but mainly when boosted by quotas and other special measures. 56
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 4: Reduce child mortality ratesQuick Facts  Globally, deaths within the first month of life fell from 32 per 1,000 live births in 1990 to 23 in 2010.  Since 1990, in the developing regions, the mortality rate of under-five years old has declined by 35 percent, from 97 deaths per 1,000 births to 63.  Sub- Saharan Africa has doubled its average rate of child mortality reduction from 1.2 percent a year during 1990-2000, to 2.4 percent during 2000-2010. 57
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Sub-Saharan Africa suffers though a higher neonatal mortality rate (35 deaths per 1,000 live births in 2010) than any other region, and has recorded the least improvement over the last two decades. Children in the developing regions as a whole, are twice as likely to die before their fifth birthday as children in the richest 20 percent of households. Sub-Saharan Africa had a 85 percent drop in measles deaths between 2000 and 2010. 58
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 4: Reduce child mortality rates Targets of this goal: Target 4A: Reduce by two-thirds, between 1990 and 2060, the under- five mortality rate  Under-five mortality rate  Infant (under 1) mortality rate  Proportion of 1-year-old children immunized against measles[16] 59
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 5: Improve maternal healthQuick Facts  An estimated 287,000 maternal deaths occurred in 2010 worldwide, a decline of 47 percent from 1990.  The regions with the highest maternal mortality, sub Saharan Africa and Southern Asia, are also those with the lowest coverage of births attended by skilled health personnel—less than half.  The rural-urban gap in skilled care during childbirth has narrowed.  The number of maternal deaths per 100,000 live births is down from 440 in 1990 to 240 in 2010, for the developing regions as a whole. 61
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat hile Southern Africa reported almost universal coverage in 2010, in West Africa about one-third of women did not receive antenatal care visits. The use of contraception is lowest among the poorest women and those with no education. More than half of all women aged 15 to 49 who were married or in a union were using some form of contraception in 2010 in all regions except sub-Saharan Africa and Oceania. Fewer teens are having children in most regions, but progress has slowed. Maternal health coverage has progressively increased in developing regions from 63 percent in 1990 to 71 percent in 2000, and then to 80 percent in 2010. 61
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 5: Improve maternal health Targets of this goal: Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio  Maternal mortality ratio  Proportion of births attended by skilled health personnel Target 5B: Achieve, by 2015, universal access to reproductive health  Contraceptive prevalence rate  Adolescent birth rate  Antenatal care coverage  Unmet need for family planning. 62
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 6: Combat HIV/AIDS, malaria, and other diseasesQuick facts  In sub-Saharan Africa, annual new infections in 2011 reached 1.7 million people, including 300,000 children. This is 21 percent lower than the 1997 peak and 15 percent lower than in 2001.  The number of people dying of AIDS- related causes fell to 1.7 million in 2011, a decline of 24% since the peak in 2005.  At the end of 2011, an estimated 8 million people people were receiving antiretroviral therapy for HIV or AIDS in low- and middle- 63
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat income countries, up from 6.6 million people in 2010 and up from just 400 000 in 2003. HIV incidence and prevalence is substantially lower in Asia than in some other regions. But the absolute size of the Asia population means it has the second largest number of people living with HIV. 57% of HIV-positive pregnant women received treatment to prevent HIV transmission to their child in 2011. The estimated incidence of malaria globally has decreased by 17 percent since 2000, and malaria-specific mortality rates by 25 percent. 64
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 6: Combat HIV/AIDS, malaria, and other diseases Targets of this goal:  Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS  HIV prevalence among population aged 15–24 years  Condom use at last high-risk sex  Proportion of population aged 15–24 years with comprehensive correct knowledge of HIV/AIDS  Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it 65
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat  Proportion of population with advanced HIV infection with access to antiretroviral drugs Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases  Prevalence and death rates associated with malaria  Proportion of children under 5 sleeping under insecticide-treated bednets  Proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs  Incidence, prevalence and death rates associated with tuberculosis  Proportion of tuberculosis cases detected and cured under DOTS (Directly Observed Treatment Short Course). 66
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Goal 7: Ensure environmental sustainabilityQuick Facts  The net loss worldwide of forests decreased over the last 20 years, from -8.3 million hectares per year in the 1990s to -5.2 million hectares per year in the last decade.  Overexploitation of global fisheries has stabilized, but steep challenges remain to ensure their sustainability.  The number of people who do not use any facility and resort to open defecation has decreased by 271 million since 1990. But there remain 1.1 billion people, or 15 percent of the global people with no sanitation facilities at all. 67
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat The number of people using improved drinking water sources reached 6.1 billion in 2010, up by over 2 billion since 1990. In 2010, 89 percent of the world’s population was using improved water sources, up from 76 percent in 1990. The share of urban slum residents in the developing world declined from 39 percent in 2000 to 33 percent in 2012. More than 200 million people gained access to improved water sources , improved sanitation facilities, or durable or less crowded housing. Slum prevalence remains high in sub-Saharan Africa and increase in countries affected by conflict. 68
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Target 7A: Integrate the principles of sustainable development into country policies and programs; reverse loss of environmental resources   Targets of this goal: Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss  Proportion of land area covered by forest  CO2 emissions, total, per capita and per $1 GDP (PPP)  Consumption of ozone-depleting substances  Proportion of fish stocks within safe biological limits 69
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat  Proportion of total water resources used  Proportion of terrestrial and marine areas protected  Proportion of species threatened with extinction Target 7C: Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation (for more information see the entry on water supply)  Proportion of population with sustainable access to an improved water source, urban and rural  Proportion of urban population with access to improved sanitation Target 7D: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum-dwellers  Proportion of urban population living in slums.  71
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 8: Develop a global partnership for developmentQuick facts  Official development assistance stands at 0.31 per cent of the combined national income of developed countries, still far short of the 0.7 per cent UN target.  Aid to the African continent increased by 0.9 percent to 31.4 billion in 2011, but remains below expectations. 71
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Developing countries gain greater access to the markets of developed countries. In 2011, 75 percent of the worldwide mobile cellular subscriptions were in the developing regions, up from 59 percent in 2006. By the end of 2011, over 160 countries in the world had launched 3G mobile broadband services and 45 percent of the population worldwide was covered by a high-speed mobile broadband signal. The developing world share of the world’s Internet users rose to 63 percent in 2011, when 35 percent of the world was online. Only 1 in 6 people in the developing world has access to the Internet. 72
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatGoal 8: Develop a global partnership for development Targets of this goal: Target 8A: Develop further an open, rule-based, predictable, non- discriminatory trading and financial system  Includes a commitment to good governance, development, and poverty reduction – both nationally and internationally  Target 8B: Address the Special Needs of the Least Developed Countries (LDC) Includes: tariff and quota free access for LDC exports; enhanced programme of debt relief for HIPC and cancellation of official bilateral debt; and more generous ODA (Official Development Assistance) for countries committed to poverty reduction 73
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Target 8C: developing countries through national and international measures in order to make debt sustainable in the long term Target 8E: In co-operation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries  Proportion of population with access to affordable essential drugs on a sustainable basis Target 8F: In co-operation with the private sector, make available the benefits of new technologies, especially information and communications  Telephone lines and cellular subscribers per 100 population  Personal computers in use per 100 population  Internet users per 100 Population. http://www.un.org/millenniumgoals/ http://www.undp.org/content/undp/en/home/mdgoverview/ 74
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat 75
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Q &Ahttp://www.searo.who.int/LinkFiles/Primary_and_Community_Health_Care_SEA-HSD-338.pdf 76
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatWhat is primary health care? How is it different from primary care? 77
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatPrimary health care (PHC) is a broad and comprehensiveconcept approach to health development.It forms an integral part of both the country’s healthsystemIt is the first level of contact of individuals.Primary care refers only to the first level of contact orclose-to-client health care. 78
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatIn rural areas, this contact is usually with the healthcentre, health subcentre, health post or private practitioner(doctor, nurse or midwife).In urban areas, a majority of the middle- and upper-incomegroup visit a private practitioner, who may be a generalpractitioner or a specialist, or go directly to a hospital.In many countries, the so-called family doctor serves as thefirst point of contact. Primary care is an integral componentof primary health care. 79
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatDo developed countries also adopt PHC for health development? 81
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Yes, they do.In fact, PHC is a universal concept for health development, as articulated in its definition. 81
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat The last part of the PHC definition says that it is “a continuing health-care process”. What does this mean? 82
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatA “continuing health-care process” implies that health caredoes not stop at the primary level of care or at the firstpoint of contact. If more comprehensive or sophisticatedcare is needed, the patient will be referred to a higher levelof care – either secondary or tertiary. 83
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat How do we define equity in health? 84
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatWHO has operationally defined “equity in health” as“minimizing avoidable disparities in health and itsdeterminants – including but not limited to health care –between groups of people who have different levels ofunderlying social attributes”.WHO’s definition of “equity in health” encompasses twodifferent aspects. 85
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat means the attainment byall citizens of the highest possible level of physical,psychological and social well-being. -care resourcesare allocated according to need; health care is provided inresponse to the legitimate expectations of the people;health services are received according to need regardless ofthe prevailing social attributes, and payment for healthservices is made according to the ability to pay. 86
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatHow does PHC aim to address inequities in health? 87
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatPHC addresses inequity in health by advocating the followingapproaches:i) universal coverage,ii) intersectoral collaboration,iii) community participation, andiv) appropriate technology. 88
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatHow can we define “health system”? 89
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatA health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence the determinants of health as well as more direct health- improving activities. 91
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatWhat is the difference between health system and health care service? 91
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatHealth systems are much broader than health services.Health services refer to medical and public health servicesprovided by both the government (the health sector) and theprivate sector. They cover modern and traditional medicineas well as services provided by the community. 92
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatHow can we define “Health for All”? 93
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatHealth for All (HFA) is a social goal. HFA aims at providingthe highest possible level of health to all people so thatthey are able to live a socially and economically productivelife.HFA can be defined as: a stage of health developmentwhereby everyone has access to quality health care or willpractise self-care protected by financial security so that noindividual or family experiences catastrophic expenditurethat may bring about impoverishment.1 HFA is a process 94
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatleading to progressive improvement in the health of thepeople. It translates into the following:a. People will be enabled to use better approaches toprevent disease and alleviate unavoidable disease anddisability through the life course.b. Available resources for health will be evenly distributedamong the population. 95
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatc. Essential health care will be accessible to all individualsand families in an acceptable and affordable way, and withtheir full involvement.d. People will realize that they themselves have the powerto shape their lives and the lives of their families. They willbe free from the avoidable burden of disease, and awarethat ill-health is not inevitable. 96
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatThere are so many technical terms in the definition of health system using the PHC approach. Compare comprehensive and selective care? 97
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatIn 1978, the comprehensive package included at least thefollowing:1) Education on prevailing health problems and methods forpreventing and controlling them2) Promotion of food supply and proper nutrition3) An adequate supply of safe water and basic sanitation4) Maternal and child health care, including family planning5) Immunization against major infectious diseases 98
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat6) Prevention and control of locally endemic diseases7) Appropriate treatment of common diseases and injuries8) Provision of essential drugs.A “selective” approach attacks the most severe publichealth problems facing a locality in order to have thegreatest chance to improve health and medical care in lessdeveloped countries. 99
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatSelective PHC, or the more frequently used term “verticalapproach”, refers to the implementation of a single diseaseprogramme that may have a significant impact on reducinghigh morbidity and mortality within a short time frame.Some examples are polio eradication, making pregnancysafer, immunization programme, control of HIV/AIDS,tuberculosis and malaria. What is Equity ? is an ethical concept that eludes aprecise definition. 111
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatSynonyms are social justice and fairness, which again, couldbe taken to mean different things by people at differenttimes. Equity usually deals with a predetermined standard ornorm, which is considered “just” or “fair”.There are three dimensions of equity:Focus: Equity in health mainly focuses on the health of thevulnerable population in absolute rather than relative terms.A policy or programme aimed at improving the health of themost vulnerable would be seen as being equitable. 111
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatInclusion: No one in the community should be left out. Inthis view, a health policy that does not provide health careto certain population groups, e.g. people living in thinlysettled, remote, mountainous, island or desert areas wouldbe inequitable.Narrowing gaps: Equity measurement identifies the relativeand absolute gaps in health status. Thus, a policy thatimproves the health of the best off more than anyone elsewould not be considered equitable. 112
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatEquality: Equality does not take into account whether theexisting disparity/gap/difference is “fair or just”. Inpractice, the terms equity and equality are usedinterchangeably. 113
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatWhat is the difference between allocative inefficiency and technical inefficiency? 114
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatAllocative inefficiency occurs when more health funds areallocated towards less cost-effective interventions. Forexample, allocating an unnecessary amount of funds tomedical care as opposed to public health interventions wouldqualify as allocative inefficiency. Overall, public healthinterventions (disease prevention and health promotion) aremore cost-effective than medical care (treatment of casesand rehabilitation of disabilities). 115
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatTechnical inefficiency is said to occur when we choosesophisticated technologies that may be unnecessary insteadof available and appropriate technology. 116
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat What is it the relationship between PHC and the Millennium Development Goals? 117
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefatThe Millennium Development Goals are a commitment made by the worldsnations to improve the health and well-being of people throughout the world, including reducing poverty, infant and maternal mortality and the spread ofHIV by 2015. Within the framework of PHC as a strategy aimed at improving the living conditions of communities, reducing the burden of disease, and favoring equity in health, the principles the PHC need to be aligned, harmonized, and adjusted along these goals. Due to its capacity for strengthening health services, PHC can become a basic strategy for the achievement of these internationally agreed-upon objectives. 118
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat Cited References1. World Health Organization Regional Office for South-East Asia. Strengthening health systems based onprimary health care approach. New Delhi,WHO SEARO, 2007. Pyongyang, Democratic People Republic of Korea, 18–20 April 2007. (SEA-HSD-298).Available at: http://203.90.70.117/PDS_DOCS/B0583.pdf2. World Health Organization Regional Office for South-East Asia. The Regional six-point strategy for healthsystems strengthening based on primary health care approach. New Delhi, World Health OrganizationRegional Office for South-East Asia, 2007 (SEA-HSD-305). Available at:http://203.90.70.117/PDS_DOCS/B0684.pdf3. World Health Organization Regional Office for South-East Asia. Revisiting community-based healthworkers and community health volunteers. New Delhi, WHO SEARO, 2008 (SEA-HSD-309). Chiang Mai,Thailand, 3–5 October 2007. Available at: http://www.searo.who.int/LinkFiles/Publications_HSD - 119
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat 309.pdf 4. World Health Organization Regional Office for South-East Asia. Strategic directions for strengthening community-based health workers and community health volunteers in the South-East Asia Region. New Delhi, World Health Organization Regional Office for South-East Asia, 2008 (SEA-HSD-311). Available at: http://www.searo.who.int/LinkFiles/Publications_HSD-311-Regional_Strategy_CBHWs_CHVs.pdf 5. World Health Organization Regional Office for South-East Asia. Accelerating progress towards achieving maternal and child health Millennium Development Goals (MDGs) 4 and 5 in South-East Asia. New Delhi, WHO SEARO, 2009 (SEA-CHD-7). Ahmedabad, India, 14–17 October 2008. Available at: http://www.searo.who.int/LinkFiles/FCH_SEA-CHD-7.pdf6. World Health Organization Regional Office for South-East Asia. Revitalizing primary health care. N ew Delhi, SEARO, 2008 (SEA-HSD316). Jakarta, Indonesia, 6–8 August 2008. Available at: http://www.searo.who.int/LinkFiles/Health_System_Strengthening_SEA-HSD-316.pdf7. World Health Organization Regional Office for South-East Asia. Self-care in the context of primary health care. New Delhi, SEARO, 2009 (SEA-HSD-320). Bangkok, Thailand, 7–9 January 2009. Available at: http://www.searo.who.int/LinkFiles/Health_System_Strengthening_SEA-HSD-320.pdf 111
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat8. World Health Organization Regional Offices for South-East Asia and the Western Pacific. The application of sociocultural approaches to accelerate the achievement of MDGs 4 and 5. New Delhi/Manila, WHO SEARO/WPRO, 2009 (SEA-MCH-256). Bali, Indonesia, 11–13 August 2009.9. World Health Organization Regional Office for South-East Asia. Health care reform for the twenty-first century in the South-East Asia Region. New Delhi, WHO SEARO, 2009 (SEA-HSD-329). Bangkok, Thailand, 20– 22 October 2009. Available at: http://www.searo.who.int/LinkFiles/Reports_SEA-HSD-329.pdf10. World Health Organization Regional Office for South-East Asia. The use of herbal medicines in primary health care. New Delhi, WHO SEARO, 2009 (SEA-HSD-322). Yangon, Myanmar, 10–12 March 2009. Available at: http://203.90.70.117/PDS_DOCS/B4260.pdf11. World Health Organization Regional Office for South-East Asia. Teaching of public health in medical schools. New Delhi, WHO SEARO, 2010 (SEA-NUR-465). Bangkok, Thailand, 8–10 December 2009. Available at: http://203.90.70.117/PDS_DOCS/B4507.pdf 12. World Health Organization Regional Office for South-East Asia. Decentralization of health care services. New Delhi, WHO SEARO, (in preparation). Bandung, Indonesia, 6–8 July 2010. –http://www.undp.or.id/mdg/documents/MDG%20Indicators-UNDG.pdf 111
    • Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat 112