Primary Health Care Nursing 105 Donna Pierrynowski Gallant PhD, RN October 1, 2008

Objectives Explain the terms primary health care and primary care. Describe the historical significance of the Declaration of Alma Ata (1978) and the Lalonde Report (1974)‏ List and describe the five principles and eight essentials of primary health care. Describe the barriers to achieving primary health care. Discuss the contribution of nurses toward primary health care.

Explain the terms primary health care and primary care.

Describe the historical significance of the Declaration of Alma Ata (1978) and the Lalonde Report (1974)‏

List and describe the five principles and eight essentials of primary health care.

Describe the barriers to achieving primary health care.

Discuss the contribution of nurses toward primary health care.

Primary health care is the single most important basis from which to renew the health care system… Roy Romanow

Primary health care is the single most important basis from which to renew the health care system…

Roy Romanow

Alma Ata Conference In 1978 at an International conference in Alma Ata, formerly in USSR, representatives from 189 countries gathered and committed themselves and their resources to the achievement of health for all by the year 2000 through primary health care. (McMurray, pg. 30)‏

In 1978 at an International conference in Alma Ata, formerly in USSR, representatives from 189 countries gathered and committed themselves and their resources to the achievement of health for all by the year 2000 through primary health care.

(McMurray, pg. 30)‏

Why? Inadequate illness management systems were not creating healthier societies Response on the part of the World Health Organization (WHO) to address the issues of unjust suffering and death that was/is occurring world wide, especially in the poorer countries. (McMurray pg.30)‏ ” .

Inadequate illness management systems were not creating healthier societies

Response on the part of the World Health Organization (WHO) to address the issues of unjust suffering and death that was/is occurring world wide, especially in the poorer countries.

(McMurray pg.30)‏

”

.

Definition: Primary Health Care (PHC)‏ PHC is a philosophy and model for improving health that “focuses on promoting health/wellness and preventing illness”. Attention is primarily on aspects of people’s lives that make them sick (CNA, 2003). Addresses issues such as diet, lifestyle choices, income, housing, education, relationships, and environmental toxins. Goal: Build community capacity to achieve sustainable health and well-being (McMurray, pg.28).

PHC is a philosophy and model for improving health that “focuses on promoting health/wellness and preventing illness”. Attention is primarily on aspects of people’s lives that make them sick (CNA, 2003). Addresses issues such as diet, lifestyle choices, income, housing, education, relationships, and environmental toxins.

Goal: Build community capacity to achieve sustainable health and well-being (McMurray, pg.28).

LaLonde Report (1974)‏ Health is not achievable from health care services alone.. Must consider human biology, lifestyle, environment, organization of health care… Lifestyle received the most attention… What is wrong with this focus? (Potter & Perry, pg. 4).

Health is not achievable from health care services alone.. Must consider human biology, lifestyle, environment, organization of health care…

Lifestyle received the most attention…

What is wrong with this focus?

(Potter & Perry, pg. 4).

Primary health care approach conceptualizes health as a Fundamental right Individual and collective responsibility An equal opportunity concept Essential component of socio-economic development (McMurray, pg.31; Besner, J. (2004), p. 352)‏

Fundamental right

Individual and collective responsibility

An equal opportunity concept

Essential component of socio-economic development

(McMurray, pg.31; Besner, J. (2004), p. 352)‏

Essentials of PHC Health education Safe food supply and adequate nutrition Adequate supply of safe water and basic sanitation Maternal and child care Immunization against basic infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Essential drugs. (World Health Organization)‏

Health education

Safe food supply and adequate nutrition

Adequate supply of safe water and basic sanitation

Maternal and child care

Immunization against basic infectious diseases

Prevention and control of locally endemic diseases

Appropriate treatment of common diseases and injuries

Essential drugs.

(World Health Organization)‏

Primary Health Care Principles Accessibility Public Participation Intersectoral collaboration Appropriate Technology Health Promotion and Illness Prevention

Accessibility

Public Participation

Intersectoral collaboration

Appropriate Technology

Health Promotion and Illness Prevention

Social Justice (Equitable access for all)‏ Deliberate consideration of the needs and agendas of all people. Must supersede individual goals so that the least advantaged people in a community receive equal care and service to those who are advantaged by virtue of finances and knowledge. ( McMurray, pg 34)‏

Deliberate consideration of the needs and agendas of all people.

Must supersede individual goals so that the least advantaged people in a community receive equal care and service to those who are advantaged by virtue of finances and knowledge.

( McMurray, pg 34)‏

Accessibility Health for all people means equal access to opportunity for all people whether they differ by geography, race, age, gender, income, employment status, language, functional capacity, to name a few. (McMurray, pg.33)‏

Health for all people means equal access to opportunity for all people whether they differ by geography, race, age, gender, income, employment status, language, functional capacity, to name a few.

(McMurray, pg.33)‏

Barriers to Accessibility Poverty/Socioeconomic Status: Wealthy usually have better access to food and a better lifestyle. Need to provide services that are responsive to the poor and help them cope and avoid the worst effects of poverty.

Poverty/Socioeconomic Status:

Wealthy usually have better access to food

and a better lifestyle.

Need to provide services that are responsive to the poor and help them cope and avoid the worst effects of poverty.

Barriers Cultural Minorities Cultural bias can pose a barrier to accessibility and have an impact on a community’s health status and program development.

Cultural Minorities

Cultural bias can pose a barrier to accessibility and have an impact on a community’s health status and program development.

Barriers Geography/ Rural communities: People who live in rural areas have fewer resources than those in urban environments. Problems revolve around limited resources inaccessible and inappropriate services.

Geography/ Rural communities: People who live in rural areas have fewer resources than those in urban environments.

Problems revolve around limited resources inaccessible and inappropriate services.

Barriers Stigma: Population groups with certain health problems, AIDS, addictions, hemophiliacs, homeless people… In Canada people with HIV/AIDS have described insensitivity, prejudice, and avoidance from nurses and physicians, other HP and friends (Health Canada)‏

Stigma: Population groups with certain health problems, AIDS, addictions, hemophiliacs, homeless people…

In Canada people with HIV/AIDS have described insensitivity, prejudice, and avoidance from nurses and physicians, other HP and friends (Health Canada)‏

Barriers Lack of education or information. Should the informed person who demands certain services from the health care system have an advantage over someone who is not aware of what is available? Internet. (p.35, McMurray).

Lack of education or information. Should the informed person who demands certain services from the health care system have an advantage over someone who is not aware of what is available? Internet. (p.35, McMurray).

Nurses Role: Accessibility Act as an entry point for access. Identify and facilitate use of health resources. Provide health information. Care should be appropriate in content and amount to satisfy the essential needs of the people, and it has to be provided by methods acceptable to them.

Act as an entry point for access.

Identify and facilitate use of health resources.

Provide health information.

Care should be appropriate in content and amount to satisfy the essential needs of the people, and it has to be provided by methods acceptable to them.

Questions to ask yourself How does the client get here? How much does parking cost and does the client have sufficient money? Are services and programs available in the needed languages? Are the hours user friendly? Is any print materials in literacy appropriate language? How much do the drugs cost and can lower priced options be suggested? Is the site wheel chair accessible?

How does the client get here? How much does parking cost and does the client have sufficient money?

Are services and programs available in the needed languages?

Are the hours user friendly?

Is any print materials in literacy appropriate language?

How much do the drugs cost and can lower priced options be suggested?

Is the site wheel chair accessible?

Public Participation All person’s are encouraged to participate individually and collectively in the planning and implementation of their health care. Shift from professionally driven to people driven. Example: Community health boards. ( McMurray, pg 42; CNA, 2005)‏

All person’s are encouraged to participate individually and collectively in the planning and implementation of their health care.

Shift from professionally driven to people driven. Example: Community health boards.

( McMurray, pg 42; CNA, 2005)‏

Public Participation Empowerment Based on the premise that if people are prepared for events or circumstances with both information and community support systems, they can become empowered and chart their own course of action. Empowered community members enjoy broad participation in health policies, choosing priorities for health services and initiatives and in developing appropriate conditions for living and working. Empowerment helps build community capacity. (McMurray, pg 16-17)‏

Empowerment

Based on the premise that if people are prepared for events or circumstances with both information and community support systems, they can become empowered and chart their own course of action.

Empowered community members enjoy broad participation in health policies, choosing priorities for health services and initiatives and in developing appropriate conditions for living and working.

Empowerment helps build community capacity.

(McMurray, pg 16-17)‏

Examples of Barriers to Public Participation Client’s isolation and vulnerability when confronting bureaucratic organizations. Tokenism of health boards.

Client’s isolation and vulnerability when confronting bureaucratic organizations.

Tokenism of health boards.

Nursing role: Public Participation Promote the client as the center of care Using community development approaches. (Community development is the process of empowering communities to improve their health and wellbeing). Example Lillian Wald (Besner, 2004, pg. 353).

Promote the client as the center of care

Using community development approaches. (Community development is the process of empowering communities to improve their health and wellbeing).

Example Lillian Wald (Besner, 2004, pg. 353).

Questions to ask yourself How has the community been involved in determining whether this program is needed/performing as it should? Is this program reflective of a need or problem identified by the client or community, or is this a professionally defined need? Is the community working in partnership, or are they just implementing what professionals tell them to?

How has the community been involved in determining whether this program is needed/performing as it should?

Is this program reflective of a need or problem identified by the client or community, or is this a professionally defined need?

Is the community working in partnership, or are they just implementing what professionals tell them to?

Intersectoral & Interdisciplinary Collaboration Collaboration between all disciplines within the community. (health, education, housing, transportation and government). (McMurray p.41)‏ The basic determinants of health cross many disciplines. Do we need work in this area? Are human resource issues affecting the implementation of primary health care?

Collaboration between all disciplines within the community. (health, education, housing, transportation and government). (McMurray p.41)‏

The basic determinants of health cross many disciplines.

Do we need work in this area?

Are human resource issues affecting the implementation of primary health care?

Nurses Role: Intersectoral Collaboration Collaborating with other sectors Coordinating health services/referrals.. Ask the questions : What other professional colleagues should be involved in supporting this person? What community information, services and referrals does this person need? What services are available in this community and how does the client access them?

Collaborating with other sectors

Coordinating health services/referrals..

Ask the questions : What other professional colleagues should be involved in supporting this person? What community information, services and referrals does this person need? What services are available in this community and how does the client access them?

Appropriate Skills and Technology A very broad definition that encompasses appropriate use of all health care resources such as funds, personnel, facilities and equipment. (CNA, 2005)‏

A very broad definition that encompasses appropriate use of all health care resources such as funds, personnel, facilities and equipment.

(CNA, 2005)‏

Technology Technology needs to be appropriate to the community’s social, economic and cultural development. Must be affordable by the community. Also means that individuals will receive appropriate care from the appropriate HCP within a time frame that is appropriate. (CNA, 2005)‏

Technology needs to be appropriate to the community’s social, economic and cultural development. Must be affordable by the community.

Also means that individuals will receive appropriate care from the appropriate HCP within a time frame that is appropriate.

(CNA, 2005)‏

Technology Recognizes the importance of developing and testing innovative models of health care and disseminating the results of research related to health care.

Recognizes the importance of developing and testing innovative models of health care and disseminating the results of research related to health care.

Technology Should be subordinate to the goal of improving people’s health. A question: We have the technology to keep very small birth weight babies alive, yet should we do so at the expense of others? Do we need a MRI in every hospital?

Should be subordinate to the goal of improving people’s health.

A question: We have the technology to keep very small birth weight babies alive, yet should we do so at the expense of others?

Do we need a MRI in every hospital?

Nurses role: Appropriate Technology Demonstrating cost effective, evidence based (informed) care. Being part of developing, implementing and evaluating technology.

Demonstrating cost effective, evidence based (informed) care.

Being part of developing, implementing and evaluating technology.

Questions Is this the most cost effective way of dealing with this issue? Does the client know how to use the equipment safely? Is the most appropriate professional working with the person? Are professionals being used in the most cost effective ways?

Is this the most cost effective way of dealing with this issue?

Does the client know how to use the equipment safely?

Is the most appropriate professional working with the person?

Are professionals being used in the most cost effective ways?

Health Promotion & Illness Prevention Move away from the medical model to one of prevention and health promotion. Process of enabling people to increase control over and to improve their own health (WHO, 1986). Range from local initiatives to interacting with the global community.

Move away from the medical model to one of prevention and health promotion.

Process of enabling people to increase control over and to improve their own health (WHO, 1986).

Range from local initiatives to interacting with the global community.

Barriers Canadians value expensive technology and quick fix cures…. ( CNA, 2002)‏

Canadians value expensive technology and quick fix cures….

( CNA, 2002)‏

Nurses role Initiate health education and other activities that assist, promote, support clients as they strive to achieve the highest possible level of health. ( CNA, 2002)‏

Initiate health education and other activities that assist, promote, support clients as they strive to achieve the highest possible level of health.

( CNA, 2002)‏

Questions to ask yourself What community resources are available to clients you deal with? How are clients involved in the preparation and implementation of your health education/promotion programs? Do the health education and health promotion programs include a focus on the determinants of health? Is there a focus on enabling people to increase control over and improve their health?

What community resources are available to clients you deal with?

How are clients involved in the preparation and implementation of your health education/promotion programs?

Do the health education and health promotion programs include a focus on the determinants of health?

Is there a focus on enabling people to increase control over and improve their health?

Ottawa Charter Throughout the past two decades health promotion advocates have used the Ottawa Charter for Health Promotion as a framework to encapsulate the goals of Primary Health Care …..(Build healthy public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services)‏ (McMurray, pg. 26).

Throughout the past two decades health promotion advocates have used the Ottawa Charter for Health Promotion as a framework to encapsulate the goals of Primary Health Care …..(Build healthy public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services)‏

(McMurray, pg. 26).

Primary health care vrs. Primary care Primary Care: Primary management of a person’s condition. First level of contact an individual has with an organized health system.

Primary Care:

Primary management of a person’s condition. First level of contact an individual has with an organized health system.

PC vrs PHC Primary care individual focused emphasis on cure care provided by health professionals professional dominance PHC community focused emphasis on promotion and prevention care provided by a wide variety of people self reliance

Primary care

individual focused

emphasis on cure

care provided by health professionals

professional dominance

PHC

community focused

emphasis on promotion and prevention

care provided by a wide variety of people

self reliance

PHC and Nursing If the millions of nurses in a thousand different places articulate the same ideas and convictions about primary health care, and come together as one force, then they could become a powerhouse for change. (Mahler, 1985)‏

If the millions of nurses in a thousand different places articulate the same ideas and convictions about primary health care, and come together as one force, then they could become a powerhouse for change.

(Mahler, 1985)‏

PHC and Nursing Nursing in a PHC system involves the person, family and community. It starts where the person is at and acknowledges the many factors that affect that person's health and illness.

Nursing in a PHC system involves the person, family and community. It starts where the person is at and acknowledges the many factors that affect that person's health and illness.

If we want to be sure that we have a health system based on PHC principles, nurses need to be sitting at the decision making tables. What can you do to ensure that the changes taking place will reflect a PHC model?

If we want to be sure that we have a health system based on PHC principles, nurses need to be sitting at the decision making tables.

What can you do to ensure that the changes taking place will reflect a PHC model?

Additional References Besner, J. (2004). Nurses role in advancing primary health care: a call to action. Primary Health Care Research and Development, 5 , 351-358. Canadian Nurses Association (2005). Primary health care: A summary of the issues. Retrieved on October 1, 2007 from http:// www.cnanurses.ca/CNA/documents/pdf/public ations/BG7_Primary_Health_Care_e.pdf Canadian Nurses Association (2003). Primary health care: The time has come. Nursing Now, 16 , 1-4. Canadian Nurses Association (2002). A New Approach to Primary Health Care. Retrieved on October 2, 2007 from http://www.cnanurses.ca/CNA/documents/pdf/publications/PH C_presentation_Kirby_6602_e.pdf

Besner, J. (2004). Nurses role in advancing primary health care: a call to action. Primary Health Care Research and Development, 5 , 351-358.

Canadian Nurses Association (2005). Primary health care: A summary of the issues. Retrieved on October 1, 2007 from http:// www.cnanurses.ca/CNA/documents/pdf/public ations/BG7_Primary_Health_Care_e.pdf

Canadian Nurses Association (2003). Primary health care: The time has come. Nursing Now, 16 , 1-4.

Canadian Nurses Association (2002). A New Approach to Primary Health Care. Retrieved on October 2, 2007 from http://www.cnanurses.ca/CNA/documents/pdf/publications/PH

C_presentation_Kirby_6602_e.pdf

Case studies Can you identify the components of primary health care in this case study? RAKKU

Can you identify the components of primary health care in this case study?

RAKKU

Summary Primary health care and primary care. Historical significance of the Declaration of Alma Ata (1978) and the Lalonde Report (1974)‏ Five principles and eight essentials of primary health care. Barriers to achieving primary health care. Contribution of nurses toward primary health care.

Primary health care and primary care.

Historical significance of the Declaration of Alma Ata (1978) and the Lalonde Report (1974)‏

Five principles and eight essentials of primary health care.

Barriers to achieving primary health care.

Contribution of nurses toward primary health care.