Primary Health Care (PHC)
Definition
Historical development
Principles
The PHC philosophy
Strategy
The level of care...
Primary Health Care
(PHC)
Definition
 PHC is essential health care based on practical, scientifically sound,
and socially...
Main terms in the definition
1. Essential – basic and indispensable
2. Scientifically sound – scientifically explainable a...
Historical development
• WHO was established in 1948.
Major objective was the attainment by all people of the highest
poss...
• In the early 1970s
– Integration of the vertical control programs
– Disease oriented based on high cost, requiring advan...
PHC…cont’d
– The health services often created in isolation neglecting other
sectors, which are relevant to health.
– Heal...
PHC Principles
1. Inter-sectoral collaboration
2. Community participation
3. Appropriate technology
4. Equity
5. Focus on ...
2. Community involvement
 The communities should be actively involved:
– In the assessment of the situation
– Problem ide...
Advantages of community participation
– Extend service/better coverage
– Programs are affordable and acceptable
– Promote ...
Skills for enhancing community participation
– Belief in community’s potential
– Skills in participatory approach (look, l...
3. Appropriate technology
Criteria for appropriateness:
• Effective
• Culturally acceptable and valuable
• Affordable, i....
4. Equity
Universal coverage of the population with care provided according
to need.
Possible definition of equity inclu...
5. Focus on prevention and promotive health services
Balanced allocation of resources to preventive and curative care
6. ...
The PHC Philosophy
A. Equity and justice
– Equitable distribution of services, resources and health care.
– Health service...
The PHC Strategy
1. Changes in the health care system
– Total coverage with essential health care
– Integrated systems
– I...
2. Individual and collective responsibility for health
– Political issue – decentralization of decision-making.
– Self rea...
PHC – The level of care
Primary level
– Primary care provided by PHCU and district hospital
– Levels of prevention – prima...
The components/elements of PHC
1. Health education
2. Provision of essential drugs
3. Immunization
4. MCH/FP
5. Treatment ...
 Additional elements incorporated after Alma-Ata
1. Oral health
2. Mental health
3. The use of traditional medicine
4. Oc...
PHC in Ethiopia
 Formally began in 1980s and includes the following:
1. Education on the prevailing health problems and m...
Major problems in the implementation of PHC in Ethiopia
– Absence of infrastructure at the district level
– Difficulty in ...
Health Delivery System
and
Health Policy in Ethiopia
• Policies are expressed in whole series of practices, statements,
re...
Historical development of health service policies in Ethiopia
– Modern medicine was introduced to Ethiopia in the 16th cen...
Health plans (The 5-year development plan)
The 1st 5 year (1958-1962)
– Did not include public health
– Priority was devel...
• Limitation of the 2nd five year plan
– Man power shortage
– Inadequate supervision mechanism
– Inadequate supply of drug...
The 3rd 5 year (1968-1973)
Major goals focused on:
1. Malaria eradication program
2. Establishing the provincial health de...
The 4th 5 years (1974-1979)
– Re-emphasized the importance of PH services
– Targeted to increase health service coverage f...
Structure and development of health care system since the
revolution of Derg era (1974GC)
• Health service distribution wa...
Structure and development of health since the derg era…cont’d
Change in health policy
Focus was:
– Primary Health Care (PH...
Structure and development of health since the derg era…cont’d
Specific aspects of policy emphasis are on:
– Community invo...
Structure and development of health since the derg era…cont’d
Development of a 6 tired health service system
Which include...
Structure and development of health since the derg era…cont’d
 On assessment it indicated that:
– The management is very ...
Structure and development of health since the derg era…cont’d
 Six annual campaign plans (1978-1984/85)
– The Gov’t throu...
Structure and development of health since the derg era…cont’d
 The ten year health sector plan (1985-1994)
– A main objec...
Structure and development of health since the derg era…cont’d
The target of 10 years plan
– Reduction of IMR from 155/1000...
Structure and development of health since the derg era…cont’d
 Number of professionals to increase as follows:
– All medi...
Structure and development of health since the derg era…cont’d
• Problems that hampered the health development
– Economic a...
Structure and development of health since the derg era…cont’d
• Major short comings were:
– Inequitable distribution
– Rec...
The Health Policy of
Transitional Government of Ethiopia
General policy
1. Democratization and decentralization of the hea...
Health policy…cont’d
6. Assurance of accessibility of health care
7. Cross boundary health issues
8. Appropriate capacity ...
Priorities of the policy
1. Information, Education and Communication (IEC).
2. Emphasis shall be given to:
– The control o...
Priorities of the policy…cont’d
3. Curative and rehabilitative components including mental
health.
4. Traditional medicine...
Priorities of the policy…cont’d
8. Special attention shall be given to the health needs of:
– Family particularly women an...
Strategies
1. Democratization
2. Decentralization
3. Inter-sectoral collaboration in addressing health problems
4. Health ...
6. Human resource development
– Team approach health care
– Community based, task oriented front line and middle level hea...
7. Assuring availability of drugs and supplies
– Develop quality control capacity
– Maintenance and repair facilities for ...
9. Health systems research, Identifying priority areas, Expanding applied
research
10. Referral system to be developed
11....
Twenty year health sector development plan (1996-2015)
HSDP – I, II, III, IV
• Give acceptable standards of comprehensive ...
Health sector development plan…cont’d
• Change of the six tire system into four tire system,
• Decentralized, democratized...
Levels of care
Level Population Staff category Function
PHCU 25,000 H.Os + others Prev, prom + curative
District H 250,000...
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Primary health care (phc) and health policy

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Primary health care (phc) and health policy

  1. 1. Primary Health Care (PHC) Definition Historical development Principles The PHC philosophy Strategy The level of care The components/elements of PHC PHC in Ethiopia
  2. 2. Primary Health Care (PHC) Definition  PHC is essential health care based on practical, scientifically sound, and socially accepted methods and technology made universally accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination. 5/19/2014 2
  3. 3. Main terms in the definition 1. Essential – basic and indispensable 2. Scientifically sound – scientifically explainable and acceptable 3. Socially acceptable methods and technology – acceptable by the community and consider the local value, culture and belief 4. Universally accessible – to bring health care as close as possible to where people live and work 5. Community involvement – individual and families assume greater responsibility for their own health. 6. Self reliance and self determination- Being independent understanding your own needs and trying to minimize problems. 5/19/2014 3
  4. 4. Historical development • WHO was established in 1948. Major objective was the attainment by all people of the highest possible level of health • Health care approaches implemented in different countries between 1948 and 1978 did not enable WHO to meet its objective • In the 1950s – Vertical health service strategy was implemented (control of malaria, TB and venereal diseases) -Was expensive and unsuccessful. – Strategy of health service – construction of health centers and health stations. 5/19/2014 4
  5. 5. • In the early 1970s – Integration of the vertical control programs – Disease oriented based on high cost, requiring advanced technology to solve health problems – Health status of hundreds of millions of people in the world is unacceptable – Tremendous strides in medicine and technology didn’t solve health problems of most people – The organized limited health institutions failed to meet the demand of most people 5/19/2014 5
  6. 6. PHC…cont’d – The health services often created in isolation neglecting other sectors, which are relevant to health. – Health institutions stressed curative services. – The community has rarely been participated. • In the late 1970s – 1977 - “Health for all by the year 2000.” – 1978 – Strategy to meet the above goal was defined • PHC in Alma-Ata USSR. 5/19/2014 6
  7. 7. PHC Principles 1. Inter-sectoral collaboration 2. Community participation 3. Appropriate technology 4. Equity 5. Focus on prevention of disease and health promotion 6. Decentralization 1. Inter-sectoral collaboration – Joint concern and responsibility of sectors in identifying problems, programs and undertaking tasks. – Health has several dimensions that can be affected by other sectors. 5/19/2014 7
  8. 8. 2. Community involvement  The communities should be actively involved: – In the assessment of the situation – Problem identification – Priority setting and making decisions – Sharing responsibility in the planning, implementing, monitoring and evaluation. 5/19/2014 8
  9. 9. Advantages of community participation – Extend service/better coverage – Programs are affordable and acceptable – Promote self reliance and confidence – Create sense of responsibility – Consider real needs and demands – Promote local community initiatives and technology – Reduce dependency on technical personnel – Build the community’s capacity to deal with problems 5/19/2014 9
  10. 10. Skills for enhancing community participation – Belief in community’s potential – Skills in participatory approach (look, listen and learn) – Ability to motivate – Awareness creation among leaders – Understanding community culture – Identify or create a mechanism for community participation. 5/19/2014 10
  11. 11. 3. Appropriate technology Criteria for appropriateness: • Effective • Culturally acceptable and valuable • Affordable, i.e., cost effective • Locally sustainable • Environmentally accountable • Measurable • Politically responsible 5/19/2014 11
  12. 12. 4. Equity Universal coverage of the population with care provided according to need. Possible definition of equity includes: Equal health Equal access to health care Equal utilization of health care . 5/19/2014 12
  13. 13. 5. Focus on prevention and promotive health services Balanced allocation of resources to preventive and curative care 6. Decentralization Taking decision making closer to the communities served and to the field providers of services. Enhance the ability to tap new sources for financing health care. 5/19/2014 13
  14. 14. The PHC Philosophy A. Equity and justice – Equitable distribution of services, resources and health care. – Health service should be accessible and affordable. B. Individual and community self-reliance – Personal responsibility for their own and their family’s health. C. Inter-relationship of health and development – Health makes a fundamental contribution to a country’s economy. 5/19/2014 14
  15. 15. The PHC Strategy 1. Changes in the health care system – Total coverage with essential health care – Integrated systems – Involvement of communities – Use and control of resources – Redistribution of existing resources – Reorientation of health human resources – Legislative changes – Design, planning and management of health system 5/19/2014 15
  16. 16. 2. Individual and collective responsibility for health – Political issue – decentralization of decision-making. – Self realization – personal responsibility for their own and their family’s health. – For both aspects it is important to have informed and motivated public. 5/19/2014 16
  17. 17. PHC – The level of care Primary level – Primary care provided by PHCU and district hospital – Levels of prevention – primary, secondary and tertiary. Intermediate level – Secondary care provided by zonal and regional hospitals. – Levels of prevention - primary, secondary and tertiary. Central level – Tertiary care provided by central referral and teaching hospital. – Levels of prevention – Tertiary prevention. 5/19/2014 17
  18. 18. The components/elements of PHC 1. Health education 2. Provision of essential drugs 3. Immunization 4. MCH/FP 5. Treatment of common diseases and injuries 6. Adequate supply of safe water and basic sanitation 7. Communicable disease control 8. Food supply and proper nutrition 5/19/2014 18
  19. 19.  Additional elements incorporated after Alma-Ata 1. Oral health 2. Mental health 3. The use of traditional medicine 4. Occupational health 5. HIV/AIDS 6. ARI 5/19/2014 19
  20. 20. PHC in Ethiopia  Formally began in 1980s and includes the following: 1. Education on the prevailing health problems and methods of preventing and controlling them 2. Locally endemic diseases prevention and control 3. EPI 4. MCH/FP 5. Essential drugs provision 6. Nutrition promotion of food supply 7. Treatment of common diseases and injuries 8. Sanitation and safe water supply 5/19/2014 20
  21. 21. Major problems in the implementation of PHC in Ethiopia – Absence of infrastructure at the district level – Difficulty in achieving inter sectoral collaboration – Inadequate health service coverage and mal-distribution for available health services – Inadequate resource allocation – Absence of clear guidelines or directives on implementation – Presence of culturally dictated HTP or unscientific beliefs – Absence of sound legal rules to support env’t health activities – Weak community involvement in health 5/19/2014 21
  22. 22. Health Delivery System and Health Policy in Ethiopia • Policies are expressed in whole series of practices, statements, regulations and even laws which are the result of decisions about how we will do things. • Health care policy may be seen as the networks of inter-related decisions which together form an approach or strategy in relation to practical issues concerning health care delivery. 5/19/2014 22
  23. 23. Historical development of health service policies in Ethiopia – Modern medicine was introduced to Ethiopia in the 16th century – 1908 an office dealing with health created in ministry of interior – World war II- Italian occupation (1935-41) no marked event has taken place during this period – 1947 the 1st health legislation established – 1948 Ministry of Health established – 1960 begun to develop basic health services – 1962 Gondar college of PH established. – 1949-1951 three nursing schools were established – 1966 the 1st medical school was opened in Addis 5/19/2014 23
  24. 24. Health plans (The 5-year development plan) The 1st 5 year (1958-1962) – Did not include public health – Priority was development of infrastructure The 2nd 5 year (1963-1967) – Contained major policies and strategies regarding health sector – Emphasis on preventive measures – Expansion of basic health services – Set long term objectives for health centers (HC) and health stations (HS) It envisioned: • 1 HC to serve 50,000 population and supervise 10 HS • 1 HS to serve 5,000 people on average 5/19/2014 24
  25. 25. • Limitation of the 2nd five year plan – Man power shortage – Inadequate supervision mechanism – Inadequate supply of drugs, medical equipment and supplies – Insufficient recurrent budget – Inadequate communication system to develop referral service – Plan implementation problem – Under utilization of capital budget 5/19/2014 25
  26. 26. The 3rd 5 year (1968-1973) Major goals focused on: 1. Malaria eradication program 2. Establishing the provincial health departments  To ensure closer supervision of health activities  To enhance preventive function 3. Emphasis to be given to training of all professionals and auxiliary personnel  Limitation was again plan implementation gap 5/19/2014 26
  27. 27. The 4th 5 years (1974-1979) – Re-emphasized the importance of PH services – Targeted to increase health service coverage from 15 to 30% – This plan was not materialized due to government change. 5/19/2014 27
  28. 28. Structure and development of health care system since the revolution of Derg era (1974GC) • Health service distribution was concentrated in a few urban centers – AA, Asmera, Harar • 43% of health budget allocated for 3 big cities • By 1974 there were – 6,474 health personnel – 650 HSs – 93 HCs – 84 hospitals with 8,624 beds 5/19/2014 28
  29. 29. Structure and development of health since the derg era…cont’d Change in health policy Focus was: – Primary Health Care (PHC) and rural health service – Prevention and control of communicable diseases – Self-reliance and community participation in health activities through its declaration of NDRP in 1976 5/19/2014 29
  30. 30. Structure and development of health since the derg era…cont’d Specific aspects of policy emphasis are on: – Community involvement – Coordinate efforts of development sectors – Gradual integration of special program and specialized health institutions – Delivery of essential health care at the cost affordable by the community 5/19/2014 30
  31. 31. Structure and development of health since the derg era…cont’d Development of a 6 tired health service system Which include: 1. Community health services (health post), 1:1000, 2. HSs (clinics), 1:10,000 3. HCs, 1:50-100,000 4. Rural hospitals, 1:50-100,000 5. Regional hospitals, 1:1.6-3 million population 6. Central referral and teaching hospitals 5/19/2014 31
  32. 32. Structure and development of health since the derg era…cont’d  On assessment it indicated that: – The management is very centralized – Minimum participation of community and the private sector – Has undesirable impact on efficiency and resource allocation – Overlapping or redundant service around a minor segment of the population. 5/19/2014 32
  33. 33. Structure and development of health since the derg era…cont’d  Six annual campaign plans (1978-1984/85) – The Gov’t through the NDRP, under took annual campaign (Development through cooperation campaigns). – Result was encouraging – Construction of thousands of wells and latrines. – Community health services introduced in more than 5000 localities. – HSs tripled from 650-1950. – HCs increased from 93-145. 5/19/2014 33
  34. 34. Structure and development of health since the derg era…cont’d  The ten year health sector plan (1985-1994) – A main objective of the plan focuses on • Full and active community involvement • Multi-sectoral collaboration and coordination • Extend health services to 80% of the population • Put under control all major communicable disease • Expand EPI services • Comprehensive health services to special population 5/19/2014 34
  35. 35. Structure and development of health since the derg era…cont’d The target of 10 years plan – Reduction of IMR from 155/1000 to 95/1000. – Reduction of CMR from 247/1000 to 95/1000. – Improvement of LE at birth from 42 years to 55 years. 5/19/2014 35
  36. 36. Structure and development of health since the derg era…cont’d  Number of professionals to increase as follows: – All medical doctors from 721-2000 – Specialists from 349-819 – Nurses from 1960-5498 – Sanitarians from 298-1962 – Lab. Tech from 425-1,209 – Health assistants from 6,991-13,500. 5/19/2014 36
  37. 37. Structure and development of health since the derg era…cont’d • Problems that hampered the health development – Economic and political problems, – Poverty, shortage of resources, – Under utilization of PHC services. • Events that took place between 1974 and 1984 – Change of Gondar P.H college to medical school. – Establishment of a third medical school in Jimma. 5/19/2014 37
  38. 38. Structure and development of health since the derg era…cont’d • Major short comings were: – Inequitable distribution – Recommended organizational and structural arrangements remained unsolved. – Unrealistic goals, – Attention shifted towards the political conflict and war. 5/19/2014 38
  39. 39. The Health Policy of Transitional Government of Ethiopia General policy 1. Democratization and decentralization of the health service system 2. Prevention and promotive components of health care 3. Equitable and acceptable standard of health service system 4. Promoting and strengthening of inter-sectoral activities 5. Strengthening of national self-reliance in health development mobilizing and maximally utilizing internal and external resources 5/19/2014 39
  40. 40. Health policy…cont’d 6. Assurance of accessibility of health care 7. Cross boundary health issues 8. Appropriate capacity building 9. Provision of health care (payment according to ability) 10. Involvement of private sector and NGOs 5/19/2014 40
  41. 41. Priorities of the policy 1. Information, Education and Communication (IEC). 2. Emphasis shall be given to: – The control of CDs, epidemics, diseases related to nutrition and poor living conditions, – The promotion of occupational health and safety, – The development of environmental health, – The rehabilitation of infrastructure and – Appropriate health service management system 5/19/2014 41
  42. 42. Priorities of the policy…cont’d 3. Curative and rehabilitative components including mental health. 4. Traditional medicine including related research and gradual integration into modern medicine 5. Applied health research 6. Provision of essential drugs and supplies shall be strengthened 7. Development of human resources 5/19/2014 42
  43. 43. Priorities of the policy…cont’d 8. Special attention shall be given to the health needs of: – Family particularly women and children. – Those in the forefront of productivity – Those most neglected regions and segments of the population – Victims of man-made and natural disasters 5/19/2014 43
  44. 44. Strategies 1. Democratization 2. Decentralization 3. Inter-sectoral collaboration in addressing health problems 4. Health education 5. Promotive and preventive activities – Control of CDs and nutritional diseases – Prevention of related affluence and aging from emerging as major health problems. – Prevention of environmental pollution 5/19/2014 44
  45. 45. 6. Human resource development – Team approach health care – Community based, task oriented front line and middle level health workers – Continuing education – Attractive career structure, remuneration and incentive for all health cadres. 5/19/2014 45 Strategies …cont’d
  46. 46. 7. Assuring availability of drugs and supplies – Develop quality control capacity – Maintenance and repair facilities for equipment 8. Encouraging the use of traditional medicine – Coordinating and encouraging research – Identifying and encouraging utilization – Developing regulation and registration for its use 5/19/2014 46 Strategies…cont’d
  47. 47. 9. Health systems research, Identifying priority areas, Expanding applied research 10. Referral system to be developed 11. Diagnostic and supportive services – prompt diagnosis and treatment. 12. Health management information system, Making the system appropriate and relevant for decision making. 13. Financing the health service 14. Health legislation shall be revised 15. Strengthening of administration and management of health system 5/19/2014 47 Strategies…cont’d
  48. 48. Twenty year health sector development plan (1996-2015) HSDP – I, II, III, IV • Give acceptable standards of comprehensive and integrated PHC through equitably distributed institutions based at the grass root level. • Focusing on preventive and promotive aspects of care: – Health education – Reproductive health care – Immunization – Environmental health and sanitation 5/19/2014 48
  49. 49. Health sector development plan…cont’d • Change of the six tire system into four tire system, • Decentralized, democratized and participatory administration. • Designed for a period of 20 years with a rolling 5 year program periods.  The main goals are: – Building basic infrastructure – Provision of standard facilities and supplies – Development and deployment of an appropriate health human power 5/19/2014 49
  50. 50. Levels of care Level Population Staff category Function PHCU 25,000 H.Os + others Prev, prom + curative District H 250,000 G.Ps + others Prev, prom + curative Regional H 1,000,000 Specialists, G.Ps + Others Most specialities Spec/tea ching H 5,000,000 High qualified Teaching + spec. ser 5/19/2014 50 Currently the health system in Ethiopia is organized in 3 level (3 tiered system)?
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