HEALTH CARE SCENARIO:   Health care has always been a problem area for India, a nation with a large population and a larger percentage of this population living in urban slums and in rural area, below the poverty line. Before independence the health structure was in dismal condition i.e. high morbidity and high mortalities, and prevalence of infectious diseases. Since independence emphasis has been put on Primary Health Care and we have made considerable progress in improving the Health Status of the country. CG:Central Government PH:Primary Health MCH:Maternal and Child Health Health is a human right, which has also been accepted in the constitution. Its accessibility and affordability has to be insured. While the well-to-do segment of the population both in rural & urban areas have acceptability and affordability to wards medical care, at the same time cannot be said about the people who belong to poor segment of the society. It is well known that more then 75% of the population utilizes private sectors for medical care unfortunately medical care becoming costlier day by day and it has become almost out of reach of the poor people. Today there is need for injection of substantial resources in the health sectors to ensure affordability of medical care to all. Health insurance is an important option, which needs to be considered by the policy makers and planners.

1. CM17.3 Primary Health Care-
Definition, Principles, and
Components
Dr Anjali Mall

2. Specific Learning Objectives
At the end of lecture 1st year MBBS
students must-know-(60mts)
1. Introduction to Health care in India(5mts)
2. Health Care Scenario in India(10mts)
3. Evolution of Primary Health care (10mts)
4. Definition of Primary Health care(10mts)
5. Components of Primary Health care(10mts)
6. Principles of Primary Health Care (10mts)
7. Challenges (5mts)

3. 1. INTRODUCTION TO HEALTH CARE
HEALTH IS A FUNDAMENTAL HUMAN
RIGHT(Article 21)
ITS AFFORDABILITY & ACCEPTABILITY
HAS TO BE ASSURED FOR URBAN/
RURAL, WELL TO DO AND THE POORER
SECTION OF THE SOCIETY.

4. 2. Health Care scenario
After independence - dismal condition.
• High morbidity, -Infectious diseases.
Problems
• High mortality, negligible MCH care.
• Urban-Rural divide:70:30.
• Population Size of the country.
• Declining funds to HealthCare Sector-
CG/State.
• After independence - emphasis on Primary
Health care

5. Health Care scenario
5

6. Health Care Scenario……contd.
6

7. Recognizing the crisis in India

8. Recognizing the crisis in India

9. 3. EVOLUTION OF PRIMARY HEALTH CARE
ALMA ATA Declaration on 6-12th September 1978
at Alma Ata(USSR )
• Promote the concept of PHC
• Evaluation of the situation of health
• Defining the principals
• Define the role of Government and international
org.
• Formulating recommendation

10. EVOLUTION OF PRIMARY HEALTH
CARE(Cont.)
• Integrated care comprising preventive,
promotive, curative &rehabilitation
services.
• Extending from “womb to tomb”.
• Key to socio economic development and
progress of the country.
• Organized in three levels.

12. 4. Definition of Primary Health Care
Primary health care -“an essential health care
made universally accessible to individuals and
acceptable to them, through their full
participation and at a cost the community and
country can afford to maintain at every stage of
their development in the spirit of self reliance
and self determination”.

13. ATTRIBUTES OF PRIMARY HEALTH CARE
• Essential health care
• Universally accessible
• Acceptable
• Community based
• First point of contact
• Affordability

14. 5. Elements of Primary health care
• Education concerning prevailing health problems
and the methods of preventing and controlling
them.
• Promotion of food supply and proper nutrition.
• Adequate supply of safe water and basic sanitation.
• Maternal and child health care and family planning
• Prevention and control of endemic diseases.
• Immunization against major infectious diseases.
• Appropriate treatment of common diseases and
injuries.
• Provision of essential drugs.

15. 6. PRINCIPLES OF PRIMARY HEALTH
CARE
A. Equitable distribution
B. Community participation
C. Intersectoral coordination
D. Appropriate technology

16. A. EQUITABLE DISTRIBUTION
Inequity in the availability of health services - major
concern
• First key principle in the primary health care.
• Ensures that individuals with more compromised
health conditions will receive more health services.
• Commitment to health equity focuses not only on
ensuring program inputs but also reducing
differences in health outcomes.

17. A.
Equitable
Distribution

18. Who are we talking about?

19. Dr Aaron Momin, Medical Officer of Jorhat Boat Clinic
shared this experience.
An elderly villager from Majuli came to one of the
camps and just observed the team’s work. He smiled
when Dr Momin asked him if he needed treatment. No,
he was fine. Then why did he come? “To see a doctor- I
have never seen what a doctor looks like”

22. EQUITABLE DISTRIBUTION
• Equal resources
• Equal access to health care
• Equal utilization of health services
• Equal health

27. Examples of equitable distribution in access to health
care in India:
 Tripura- helicopter service to reach the remote set
of tribal hamlets .
 Andhra Pradesh- free bus passes to pregnant
women for the antenatal visits.
 Assam -Akha-ship to provide primary care services
in riverine Island through boat clinics.
 Tamil Nadu – concept of birth resorts is introduced
in remote and hilly areas for institutional deliveries.

28. B. COMMUNITY PARTICIPATION
• Involvement of the individuals, families and
community.
• Determines both collective needs and
priorities.
• Important role in formulating a health problem.
• Universal coverage cannot be achieved without
the involvement of the local community.

29. Examples of Community Participation
in India:
• Village health guides, trained dais, ASHA
• Selected by the local community and trained
locally.
• Essential feature of health care in India.

30. • Village Health and Sanitation Committee:
Play multiple roles including IEC, household
surveys, preparation of health registers,
organisation of meetings , promoting
household toilet, sanitation programme.
• Rogi Kalyan Samitis/ patient welfare society.
• Jan Swasthya Abhiyan Initiative- People
Rural Health watch.

31. C. INTERSECTORAL CO-ORDINATION
“Primary care involves in addition to the health
sector, all related sectors and aspects of national
and community development”
• Includes sustainable participation that combine
inter-organizational cooperative working
alliances.
• Possibly, but not necessarily, in collaboration with
the health sector.

32. Intersectoral Coordination

34. D. Appropriate
technology

35. D. APPROPRIATE TECHNOLOGY
“Technology that is scientifically sound,
adaptable to local needs and acceptable to
those who apply it and those for whom it is
used and is maintained by the people
themselves in keeping with the principle of
self reliance with the resources the country
and the community can afford.”

36. An appropriate technology should be:
(WHO-1989)
• Scientifically valid
• Adapted to local needs
• Acceptable to users and recipients
• Maintainable with local resources

37. Examples of the appropriate technology
• Use of coloured tapes for measuring mid-upper
arm circumference.
• Use of ORS.
• Growth chart maintenance for under-five children.
• Insecticide Treated Bed nets.
• Low-cost mosquito repellent creams.
• Simple water purification.

38. 7. Challenges faced in implementation
• lack of political commitment and vision.
• Too idealistic, expensive, and unachievable.
• Focussed more on MCH care.
• Community participation could not be realized.
• Lack of availability of resources.
• Civil war, disasters, political instability, changing
demography, and epidemiology.

39. Comment

40. References
1. Park K .Textbook of preventive and social medicine. 26th
ed. Jabalpul: M/S Banarsidas bhanot publications; 2021.
2. Primary health care [Internet]. Who.int. 2022 [cited 3
August 2022]. Available from: https://www.who.int/news-
room/fact-sheets/detail/primary-health-care
3. Primary health care [Internet]. Who.int. 2022 [cited 3
August 2022]. Available from: https://www.who.int/news-
room/fact-sheets/detail/primary-health-care
4. Baris E, Silverman R, Wang H, Ali Pate M. Walk The
Talk: Reimagining Primary Health care after Covid-19.
World Bank Group; 2022.