Primary Health Care


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My Lecture No. 1 for Family and Community Medicine, 3rd year medical students, USLS. July 16, 2010.

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Primary Health Care

  1. 1. Primary Health Care Looking at the Alma Ata Declaration Lectured by Bien Eli Nillos, MD
  2. 2. Objectives of the Lecture <ul><li>Define Primary Health Care </li></ul><ul><li>Discuss the points on Primary Health care as presented in the Alma Ata Declaration </li></ul><ul><li>Discuss current situations on the primary health care in the Philippines </li></ul>
  3. 3. Primary Health Care <ul><li>What is Health? </li></ul>“ a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1948) “ a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. ” (Ottawa Charter for Health Promotion , 1986) “ Without health life is not life; it is only a state of langour and suffering - an image of death. ” (Buddha)
  4. 4. What is Primary Health Care? <ul><li>“ Primary health care is essential health care based on practical , scientifically sound and socially acceptable methods and technology made universally accessible to individuals 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 .” (Alma Ata Declaration, 1978) </li></ul>
  5. 5. Levels of Health Care
  6. 6. <ul><li>The first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. </li></ul>
  7. 7. Components of Primary Health Care <ul><li>Public education and participation regarding prevention and control of health problems. </li></ul><ul><li>Promotion of food supply and proper nutrition for everyone. </li></ul><ul><li>An adequate supply of safe water and basic sanitation for everyone. </li></ul><ul><li>Comprehensive maternal and child health care, including family planning. </li></ul><ul><li>Global immunization against major infectious diseases. </li></ul><ul><li>Prevention and control of locally endemic diseases. </li></ul><ul><li>Appropriate and accessible treatment of common diseases and injuries. </li></ul><ul><li>Provision of essential drugs to all. </li></ul>
  8. 8. Public Education/Participation <ul><li>“ Primary health care starts with people. Our common humanity compels us to respect people’s universal aspiration for a better life. It compels us to respect the resilience and ingenuity of the human spirit, and the great capacity of individuals and communities to solve their own problems. This is where the unique ethic of volunteer service also counts most.” (Margaret Chan, Director-General, WHO) </li></ul>
  9. 9. Nutrition and Food Supply <ul><li>Leading Causes of Hunger in the World </li></ul><ul><li>Nature </li></ul><ul><li>War </li></ul><ul><li>Poverty </li></ul><ul><li>Lack of Agricultural Infrastructure </li></ul><ul><li>Over-exploitation of the Environment </li></ul><ul><li>(Source: World Food Program, UN http:// /hunger/causes ) </li></ul>
  10. 11. Safe Water and Sanitation <ul><li>“ Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces.” (WHO) </li></ul>
  11. 12. Maternal and Child Health Care <ul><li>Maternal death  is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. </li></ul>
  12. 13. <ul><li>The infant mortality rate (IMR) is the ratio of the number of deaths among children less than one year old during a given year to the number of live births during the same year. </li></ul>
  13. 14. Immunization <ul><li>GOAL: By 2010, ensure routine immunization of children under one year of age reaches 90 per cent nationally and at least 80 per cent coverage in every district or equivalent administrative unit. (UNICEF) </li></ul>
  14. 15. Prevention and Control of Endemic Diseases <ul><li>“ We must anticipate more new diseases, and we must accept that the speed of spread and the social and economic impact will be much greater in our globalized society. We must accept that the best defence strategy is to detect and contain emerging diseases at source. That means good local surveillance and reporting systems.” (Margaret Chan, Director-General, WHO) </li></ul>
  15. 16. Accessible Treatment 59% out of pocket 23% government 18% Shared-Risk Schemes Including National Health Insurance (PhilHealth)
  16. 17. <ul><li>No. 1 Exporter of Nurses </li></ul><ul><li>“ An estimated 85% of employed Filipino nurses (more than 150,000) are working internationally.” (Aiken et al 2004) </li></ul><ul><li>“ 70% of all Filipino nursing graduates are working overseas.” (Bach 2003) </li></ul><ul><li>No. 2 Exporter of Doctors </li></ul><ul><li>“ 68% of Filipino doctors work overseas, next to India.” (Mejia, WHO 1975) </li></ul>
  17. 18. <ul><li>200 hospitals have closed down within the past two years – no more doctors and nurses </li></ul><ul><li>800 hospitals have partially closed (with one to two wards closed) – lack of doctors and nurses </li></ul><ul><li>Nurse to patient ratios in provincial and district hospitals now 1: 40 to 1: 60 </li></ul><ul><li>Loss of highly skilled nurses in all hospitals across the country </li></ul>(Galvez-Tan, 2009)
  18. 20. … but 70% of Filipinos have no access to essential drugs. There are more than 16,000 registered medicine in the country… PROVISION OF ESSENTIAL DRUGS WHO World Medicines Situation, 2004
  19. 21. What Does Alma Ata Say? <ul><li>“ The Conference strongly reaffirms that health…is a fundamental human right ” </li></ul><ul><li>“ The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable ” </li></ul>
  20. 22. LEB over 80 years IMR less than 10 MM less than 15 LEB under 60 years IMR over 90 MM over 150
  21. 23. <ul><li>“ The people have the right and duty to participate individually and collectively in the planning and implementation of their health care” </li></ul><ul><li>“ Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures” </li></ul><ul><li>“ An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources , a considerable part of which is now spent on armaments and military conflicts.” </li></ul>
  22. 24. Aquino Ramos Estrada Arroyo Education 12.3 15.5 18.7 15.1 Health 3.1 2.6 2.4 1.8 Housing 0.1 0.6 0.8 0.4 Defense 6.1 6.7 5.6 5.0 Debt service (interest only) 40.0 25.3 19.2 25.2
  23. 25. Are the visions and mission of Alma Ata still relevant today?
  24. 26. “ Health For All” <ul><li>“ Mens sana in corpore sano.  </li></ul><ul><li>(Your prayer must be for a sound mind in a sound body . )” - Juvenal </li></ul><ul><li>“ The part can never be well unless the whole is well.”  -Plato </li></ul>
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