DEFINITION OF PRIMAR HEALTH CARE, SHORTCOMING OF HEALTH SYSTEMS

1. PRIMARY HEALTH CARE
BY
AKELLO RUTH OTIM

2. Introduction
• Definitions:
1. PHC-
2. Community based health care-

3. Introduction
• Declaration of Alma-Ata, USSR on 6-12
September 1978:
• The International Conference on Primary Health
Care, expressed the need for urgent action by all
governments, all health and development
workers, and the world community to protect and
promote the health of all the people of the world.
• WHO defines Primary health care as, 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 and maintain
at every stage of their development in the spirit of self-
reliance and self-determination.

4. Introduction 2
• Summarily, PHC is essential care made universally
accessible to individuals and families within a community,
availed to them through their full participation using
scientifically sound methods and provided at a cost that the
community and country can afford (WHO, 1978).
• Full participation means that individuals within
the community help in identifying and defining
health problems affecting their well being and
developing approaches to address the
problems.
• The setting for PHC is within all communities of
a country and infiltrates all aspects of society.

5. Introduction 3
• PHC forms an integral part of the country's
health system, of which it is the central
function and main focus, and of the overall
social and economic development of the
community.
• It is 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.

6. History of PHC
• The PHC movement officially began in 1977
when the 30th World Health Organization (WHO)
Health Assembly adopted a resolution
accepting the goal of attaining a level of
health that permitted all citizens of the world
to live socially and economically productive
lives.
• At the international conference in 1978 in Alma
Ata, USSR, sponsored by WHO and UNICEF; it
was determined that this goal was to be met
through PHC.
• This resolution became known by the slogan
“Health For All (HFA) by the year 2000”.

7. History of PHC 2
• In 1981, WHO established global indicators
for monitoring and evaluating the
achievement of HFA.
• In the world Health Statistics Annual report
(1986), these indicators were grouped into
four (4) categories: Health policies; Social
and economic development; Provision of
health care and health status.
• An important part of the global indicators is
the emphasis on health as an objective of
socio-economic development (Mahler,
1981).

8. History of PHC 3
• In this context, health improvements are a
result of efforts in many areas including
agriculture, industry, education, housing,
communications and health care.
• Because PHC is as much a political
statement as a system of care, each United
Nations (UN) member country interprets
PHC in the context of its own culture, health
needs, resources and system of governance.

9. History of PHC 4
• PHC encourages self-care and self-
management in health and social welfare
aspects of daily life.
• People are sensitized to use their
knowledge, attitudes and skills in activities
that improve health for themselves, their
families and their neighbours.
• The desired outcome from the PHC
strategy is individual, family and community
self-reliance and competence.

10. Common shortcomings of
health-care delivery
• As Ugandans, what do we see as short
falls of the current health care delivery
system that have made it impossible to
attain the goal of HFA s advocated for by
WHO and partners?

11. Common shortcomings of
health-care delivery
• There are five (5) common shortcomings of
health care delivery, as outlined below:
1. Inverse care- People with the most means
whose needs for health care are often less –
consume the most care, whereas those with
the least means and greatest health problems
consume the least care.
• Public spending on health services most
often benefits the rich more than the poor in
high and low income countries alike.

12. Common shortcomings 2
2. Impoverishing care- Wherever people lack
social protection and yet payment for health
care is largely out-of-pocket at the point of
service, they can be confronted with
catastrophic expenses.
• Over 100 million people annually fall into
poverty because they have to pay for health
care.

13. Common shortcomings 3
3. Fragmented and fragmenting care- The
excessive specialization of health-care
providers and the narrow focus of many
disease control programmes discourage a
holistic approach to the individuals and the
families they deal with and do not appreciate
the need for continuity in care.
• Health services for the poor and
marginalized groups are often highly
fragmented and severely under-resourced,
while development aid often adds to the
fragmentation.

14. Common shortcomings 4
4. Unsafe care- Poor system design that is
unable to ensure safety and hygiene standards
leads to high rates of hospital-acquired
infections, along with medication errors and
other avoidable adverse effects that are an
underestimated cause of death
and ill-health.

15. Common shortcomings 5
5. Misdirected care- Resource allocation
clusters around curative services at a great
cost, neglecting the potential of primary
prevention and health promotion to prevent
up to 70% of the disease burden.
• At the same time, the health sector lacks
the expertise to mitigate the adverse effects
on health from other sectors and make the
most of what these other sectors can
contribute to health.

16. Pillars of PHC
• What are those building blocks that PHC
counts on to ensure attainment of HFA goal?

17. Pillars of PHC
• The concept of PHC as being advocated for
by WHO in all countries stands on six (6)
pillars as described below;
1. Social justice: requiring that there should
be equal distribution of the available
resources to cater for the health of all
individuals irrespective of status.
2. Preventive Health care: Prevention of
diseases in the sense of primary prevention
must be a priority in budget allocation in all
UN member states to assure public safety
& health.

18. Pillars of PHC 2
3. Participation of the inhabitants:
Participation of the intended groups in planning
and implementing issues related to people’s
health is a must.
4. Inter-sector cooperation: Health support
outside the medical services is very relevant-
requiring sectors to play their part as stake
holders and make contributions to enhance the
health of the population.

19. Pillars of PHC
5. Technology that matches with the
context: emphasizes the need for favourable
or affordable price and local technology
options for health improvement.
6. Sustainability of the measures:
Guaranteeing preventive and curative
services including supplies of medicines at all
times.
• The PHC-strategies led to the re-
organization of the health systems in the
developing countries.

20. THE END!
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