HEALTH PROMOTION AND PRIMARY HEALTH CARE

1. HEALTH PROMOTION AND
PRIMARY HEALTH CARE
PRESENTEDBY ,
DEEPIKAR,
M. SC .,(NURSING) I - YEAR ,
COLLEGE OF NURSING,
MADRAS MEDICALCOLLEGE.

3. •CONCEPT:
•THE ROLE OF PERSON ,GROUPS AND
ORGANIZATIONS AS ACTIVE AGENTS IN SHAPING
HEALTH PRACTICES AND POLICES TO OPTIMIZE
BOTH INDIVIDUAL WELLNESS AND COLLECTIVE
WELL BEING.
-
STOKOLS,1996.

4. PRINCIPLES:
FIVE KEY PRINCIPLES:
 HEALTH PROMOTION INVOLVES THE POPULATION AS
A WHOLE IN THE CONTEXT OF THEIR EVERYDAY LIFE ,
RATHER THAN FOCUSING ON PEOPLE AT RISK FROM
SPECIFIC DISEASE.
HEALTH PROMOTION IS DIRECTED TOWARDS ACTION
ON THE DETERMINANTS OR CAUSE OF HEALTH

5. CONT…….
HEALTH PROMOTION COMBINES DIVERSE ,BUT
COMPLEMENTARY METHODS OR APPROACHES
INCLUDING COMMUNICATION ,EDUCATION
,LEGISLATION , FISCAL MEASURES
ORGANIZATIONAL CHANGE , COMMUNITY
CHANGE , COMMUNITY DEVELOPMENT AND
SPONTANEOUS LOCAL ACTIVITIES AGAINST
HEALTH HAZARDS.

6. • EFFECTIVE AND CONCRETE PUBLIC PARTICIPATION , FURTHER
DEVELOPMENT OF PROBLEM-DEFINING AND DECISION MAKING
LIKE SKILLS , BOTH INDIVIDUALLY AND COLLECTIVELY ,
PROMOTION OF EFFECTIVE PARTICIPATION MECHANISMS.
• HEALTH PROFESSIONALS HAVE AN IMPORTANT ROLE IN
ADVOCATING AND ENABLING HEALTH PROMOTION.
• PROMOTION OF HEALTHFUL LIVING:
 HEALTH EDUCATION:
• IT INCLUDES EDUCATIONAL
MODIFICATION ACTIVITIES ,ENHANCE
WELL-BEING.

7. • ENVIRONMENTAL MODIFICATION:

8. NUTRITIONAL INTERVENTION:

9. •LIFESTYLE AND BEHAVIOURAL CHANGES:

10. • VARIOUS SERVICES FOR HEALTH PROMOTION:
• PREVENTIVE HEALTH SERVICES

11. •FAMILY PLANNING:

12. •IMMUNIZATION:

13. •STD PREVENTION:

15. • SOME NON –HEALTH SECTORS WITH AN INPUT INTO HEALTH
PROMOTION:
• EDUCATIONAL SCHOOLS.
• AGRICULTURE
• COMMUNITY SERVICES
• SPORTS
• MEDIA
• NON- GOVERNMENTAL ORGANIZATION(NGO’S)
• COMMUNITY GROUPS
• YOUTH

16. • CONT …..
• PRIVATE SECTOR
• HOUSING
• PUBLIC WORKS
• LEGAL
• WATER AUTHORITY
• RELIGION(MOSQUES , CHURCHES ETC)
• ALTERNATIVE MEDICINE.

17. • HEALTH SECTORS WITH AN INPUT INTO HEALTH
PROMOTION:
• ENVIRONMENTAL HEALTH
• NUTRITION
• COMMUNITY NURSING
• MENTAL HEALTH
• DENTAL
• EPIDEMIOLOGY
• HOSPITAL(SECONDARY) CARE
• SCHOOL OF NURSING
• OCCUPATIONAL THERAPY

18. • HEALTH PROTECTION:

22. •HEALTH PROMOTION THROUGHOUT LIFE SPAN:
• CHILD CAN BE AFFECTED EITHER POSITIVELY OR
NEGATIVELY BY THE HEALTH PRACTICES OF MOTHER
DURING PRENATAL PERIOD.
• HEALTH PROMOTION STARTS FROM BIRTH AND
EXTENDS THROUGH CHILDHOOD, ADULTHOOD AND
OLD AGE.
• IT INCLUDES HEALTH SCREENING.
• CHILDREN AND ADOLESCENT:
• HEALTH SCREENING IS IMPORTANT FOR CHILDHOOD

23. • THE GOAL HAS BEEN TO DETECT HEALTH PROBLEMS AT AN EARLY AGE SO
THAT CAN BE TREATED EARLY IN A CHILD’S LIFE.

24. • CHILDREN SHOULD BE ENCOURAGED TO DEVELOP POSITIVE HEALTH
ATTITUDES , FOR THIS REASON MORE AND MORE PROGRAMS ARE BEING
OFFERED.
• TO SCHOOL AGE CHILDREN AND TO ADOLESCENTS TO HELP THEM
DEVELOP GOOD HEALTH HABITS

25. •YOUNGAND MIDDLE AGE ADULTS:

26.  GENERAL WELLNESS
 SMOKING CESSATION, EXERCISE.
 PHYSICAL CONDITIONING
 WEIGHT CONTROL
 CONFLICT RESOLUTION AND
 STRESS MANAGEMENT

27. • CONT…..
• PROGRAMS THAT PROVIDE HEALTH SCREENING SUCH AS
THOSE SCREEN FOR HIGH CHOLESTEROL
,HYPERTENSION , DIABETES AND HEARING IMPAIRMENTS
ARE QUITE POPULAR AGE GROUP PROGRAMS THAT
COVER HEALTH PROMOTION FOR PEOPLE WITH SPECIFIC
CHRONIC ILLNESSES SUCH AS
• CANCERS
• DIABETES
• HEART DISEASE AND PULMONARY DISEASE ARE ALSO

29. HEALTH PROMOTION PROGRAMS CAN BE OFFERED ALMOST
ANYWHERE IN THE COMMUNITY COMMON SITES INCLUDE LOCAL
CLINICS.
• ELEMENTARY SCHOOLS
• HIGH SCHOOLS
• COMMUNITY COLLEGES
• RECREATION CENTERS
• WORK PLACES HAS BECOME CENTER FOR HEALTH PROMOTION
ACTIVITY.
• EMPLOYERS BECOME INCREASINGLY CONCERNED ABOUT THE
RISING COSTS OF HEALTHCARE INSURANCE TO TREAT THAT IS
RELATED TO LIFESTYLE AND BEHAVIOR.

30. • ELDERLY ADULTS :

31. • ELDERLY ADULTS :
• 80% OF PEOPLE OLDER THAN 65 YEARS OF AGE HAVE ONE
• OR MORE CHRONIC ILLNESS AND ABOUT 50% ARE LINKED IN THEIR
ACTIVITY ELDERLY AS A GROUP EXPERIENCES SIGNIFICANT GAINS FROM
HEALTH PROMOTION.
• BOTH PUBLIC AND PRIVATE ORGANIZATION CONTINUES TO BE RESPONSIVE
TO HEALTH PROMOTION AND MORE PROGRAMS THAT SERVE ELDERLY AS
EMERGING’.
• OFFERED BY HEALTHCARE AGENCIES , SENIOR CITIZENS RESIDENCE AND
VARIETY OF OTHER ORGANIZATION.
• PHYSICAL FITNESS
• EXERCISE
• NUTRITION

32. This Photo by Unknown Author is licensed under CC BY-SA

36. • PRIMARY HEALTH CARE

37. • DEFINITION:
• PRIMARY HEALTH CARE IS ESSENTIAL HEALTHCARE AND
TECHNOLOGY BASED ON PRACTICAL , SCIENTIFICALLY SOUND
AND SOCIALLY ACCEPTABLE METHODS AND TECHNOLOGY
,MADE UNIVERSALLY ACCESSIBLE TO INDIVIDUALS AND FAMILIES
IN THE COMMUNITY BY MEAN ,ACCEPTABLE TO THEM ,THROUGH
THEIR FULL PARTICIPATION AND AT A COST THAT THE
COMMUNITY AND COUNTRY CAN AFFORD
-WORLD HEALTH
ORGANISATION.

38. • PRINCIPLES:
• EQUITABLE DISTRIBUTION:
• SERVICE MUST BE SHARED EQUALLY BY ALL
THE PEOPLE IRRESPECTIVE OF THEIR ABILITY TO
PAY BELONGING TO URBAN AND RURAL AREAS.
• TO ANY SEGMENT OF THE COMMUNITY BUT GIVING
PRIORITY TO THE UNPRIVILEGED AREAS OF THE
SOCIETY.

39. • COVERAGE AND ACCESSIBILITY:
• TO PROVIDE ESSENTIAL HEALTHCARE TO
WHOLE POPULATION
• PROVIDING HEALTH CARE SERVICES TO ALL
WHICH ARE REQUIRED BY THEM.
• EXAMPLE: TO CHILDREN , TO MOTHER , ADULTS
• ELDERS AND ALSO WHICH ARE REACHABLE TO
THEM., THAT IS GEOGRAPHICALLY, FINANCIALLY,CULTURALLY
AND FUNCTIONALLY.

40. • COMMUNITY PARTICIPATION:
• INDIVIDUAL AND FAMILIES ASSUME
RESPONSIBILITIES FOR THEIR OWN
HEALTH AND WELFARE.
• CREATES AWARENESS AMONG
PEOPLE ABOUT THEIR SITUATION AND RESOURCES AND
MOTIVATE THEM TO SOLVE THEIR COMMON PROBLEMS

41. • CONT ….
• ASSESSMENT OF THE HEALTH SITUATION DEFINING OF HEALTH
PROBLEMS, HEALTH NEEDS, SETTING OF PRACTICES ,
PLANNING OF ALTERNATIVE ACTION , IMPLEMENTATION OF
ACTIONS BY THE PEOPLE , MONITORING AND EVALUATION
AND FEEDBACK.
• MULTISECTORAL APPROACH:
• NO SECTOR INVOLVED IN SOCIOECONOMIC DEVELOPMENT
CAN FUNCTION PROPERLY IN ISOLATION.
• ACTIVITIES OF ANY ONE SECTOR HAVE IMPACT ON GOAL OF
ANY SECTOR.

42. • CONT……
• THERE IS NEED FOR CONSULTATION
AND COORDINATION OF THE
INTERSECTORAL ACTIVITY.SO,
IS TRUE WITH HEALTH
SECTOR.

43. • MULTISECTORAL APPROACH:
• THE OTHER SECTORS INCLUDE
• AGRICULTURE
• ANIMAL HUSBANDRY
• HOUSING
• WATER SUPPLY
• SANITATION
• PUBLIC WORKS
• COMMUNICATION EDUCATION AND MASS
MEDIA PANCHAYATS.

44. APPROPRIATE HEALTH TECHNOLOGY:

45. • APPROPRIATE HEALTH TECHNOLOGY:
• IT IS AN VERY IMPORTANT FACTOR FOR SUCCESSFUL
PRIMARY HEALTHCARE.
• IT IMPLES USE OF METHOD , TECHNOLOGIES AND
EQUIPMENT WHICH ARE SCIENTIFICALLY SOUND BUT
SIMPLE IN ACCORDANCE TO LOCAL CULTURE.
• SO THAT THESE ARE UNDERSTAND AND ACCEPTABLE
TO THOSE WHO USE AND THOSE FOR WHOM THESE ARE
USED.

47. • HUMAN RESOURCES:
• IT IS AN VERY IMPORTANT FACTOR FOR THE SUCCESS OF
PRIMARY HEALTHCARE.
• OFTEN THIS RESOURCE IS NOT USED EFFECTIVELY AND
SUFFICIENTLY.
• FOR EFFECTIVE IMPLEMENTATION OF PHC , IT IS VERY ESSENTIAL
TO MAKE FULL USE OF ALL AVAILABLE RESOURCE INCLUDING
THE HUMAN POTENTIAL OF THE ENTIRE COMMUNITY.
• IT IS IMPORTANT TO ENSURE AVAILABILITY OF ADEQUATE
NUMBER OF APPROPRIATE HEALTH PERSONNEL IN PHC.

48. • COMMUNITY HEALTH WORKERS AND HEALTH CARE PRACTITIONERS:

49. • SERVICES BY COMMUNITY HEALTH WORKERS AND
TRADITIONAL HEALTH PRACTITIONERS:
• PRIMARY HEALTHCARE IS THE FIRST LEVEL CARE WHICH IS
PROVIDED BY COMMUNITY HEALTH WORKER.
• THEY ARE THE LINK BETWEEN COMMUNITY AND HEALTH
SYSTEM.
• THEY ARE GIVEN SHORT AND SIMPLE TRAINING TO BE ABLE TO
TAKE CARE OF SOME OF THE SIMPLE AND BASIC HEALTH
NEEDS OF PEOPLE

50. •REFERRAL SYSTEM:

51. • REFFERAL SYSTEM:
• IT IS ESSENTIAL , THAT IS GIVEN SUPPORT OF HIGHER
LEVEL HEALTH PERSONNEL WHICH HAS SPECIALIZED
TECHNICAL KNOWLEDGE AND TECHNOLOGY WHICH IS
USEFUL TO SERVICE THE LIFE OF THE CLIENT.
• THE TRANSPORTATION OF PATIENT TO AND FROM
REFERRAL SERVICE HAS TO BE PROPERLY ORGANISED
MAKING MOST OF AVAILABLE FACILITIES.

52. LOGISTIC OF SUPPLY:
• PLANNING AND BUDGETING FOR SUPPLIES REQUIRED
,STORAGE, DISTINCTION AND CONTROL SUPPLIES OF THE
RIGHT QUALITY AND QUANTITY HAVE TO BE DELIVERED TO
PRIMARY HEALTH FACILITIES.
• PROVIDE SERVICES ON A CONTINUING BASIS.
• IT IS ADVISABLE TO HAVE A STANDARD LIST OF DRUG AND
EQUIPMENT WHICH CAN BE ADJUSTED ACCORDING TO LOCAL
VARIATION ,SUCH AS SEASONAL FLUCTUATION AND THE
INCIDENCE AND OF CERTAIN DISEASE.

53. • PHYSICAL FACILITIES:
• PRIMARY HEALTH CARE TO BE SIMPLE AND CLEAN ,ALREADY
EXISTING FACILITIES CAN BE USED FOR PURPOSE.
• SPECIALLY BUILT,THE COMMUNITY PEOPLE CAN BE INVOLVRD
TO CONTRIBUTE THEIR OWN LABOR AND MATERIALS.
• CONTROL AND EVALUATION:
• SUPPORTING SERVICE HAS TO BE CONTROLLED AND
EVALUATED TO ENSURE THAT IS FUNCTIONING IN
ACCORDANCE WITH NATIONAL POLICY AND STRATEGY.

54. • CONT….
• COMMUNITY CAN BE INVOLVED IN MANAGERIAL CONTROL OF
PRIMARY HEALTHCARE
• A PROCESS OF EVALUATION HAS TO BE BUILT IN A ASSESS THE
RELEVANCE,PROGRESS,EFFICIENCY AND EFFECTIVENESS AND
IMPACT OF SERVICES.

55. • ELEMENTS OF PRIMARY HEALTH CARE:
• IN 1987 ,THE WORLD HEALTH ORGANIZATION (WHO)ADOPTED
THE DECLARATION OF ALMA-ATA
• THE DECLARATION ALSO DEFINED EIGHT ESSENTIAL
COMPONENTS OF PRIMARY HEALTH CARE ,WHICH HELPED
OUTLINED A MEANS OF PROVIDING HEALTHCARE GLOBALLY.
• IN THE ALMA ATA DECLARATION IT WAS STARTED TO INCLUDE
THE FOLLOWING ESSENTIAL ELEMENTS IN PRIMARY
HEALTHCARE.

56. EDUCATION OF
THE PEOPLE
ABOUT HEALTH
PROMOTION OF
FOOD SUPPLY AND
PROPER
NUTRITION
ADEQUATE SUPPLY
OF SAFE WATER
AND BASIC
SANITATION
MATERNAL AND
CHILD HEALTH
CARE
FAMIL PLANNING

57. PREVENTION AND CONTROL
OF LOCALLY ENDEMIC
DISEASE
APPROPRIATE TREATMENT
OF COMMON DISEASE AND
INJURIES
PROVISION OF ESSENTIAL
DRUGS
PROVISION OF COMMUNITY
HEALTH
IMMUNIZATION AGAINST
MAJOR INFECTIOUS
DISEASES

58. • PUBLIC HEALTH:
• FIRST AND ONE OF THE MOST ESSENTIAL,COMPONENT OF
PRIMARY HEALTH CARE,BY EDUCATING THE PUBLIC ON THE
PREVENTION AND CONTROL OF HEALTH PROBLEMS.

59. • PROPER NUTRITION:
• NUTRITION IS ANOTHER ESSENTIAL COMPONENT OF
HEALTH CARE WORKS TO PREVENT MALNUTRITION
AND STARVATION .
• TO PREVENT MANY DISEASES AND AFFLICTIONS.

60. • CLEAN WATER AND SANITATION:

61. • TO SUPPLY OF CLEAN, SAFE DRINKING WATER AND BASIC SANITATION
MEASURES
• REGARDING TRASH SEWAGE AND WATER CLEANLINESS CAN
SIGNIFICANTLY IMPROVE THE HEALTH OF A POPULATION
• REDUCING AND EVEN ELIMINATING MANY PREVENTABLE DISEASES.

62. • MATERNAL AND CHILD HEALTH CARE:

63. • CONT …..
•ADEQUATE HEALTH CARE TO THE PATIENT.
•CARE OF THESE INDIVIDUALS INVOLVES
ADEQUATE COUNSELING ON FAMILY PLANNING
AND SAFE SEX.
•IMMUNIZATION:
•WHO WIPES OUT THE MAJOR INFECTIOUS
DISEASE ,GEARTLY IMPROVING CRUCIAL HEALTH
GLOBALLY.

64. •ACCESSIBLE TREATMENT:
•ACCESS APPROPRIATE MEDICAL CARE FOR
TEATMENT OF DISEASES AND INJURES.
•DRUG PROVISION:
•PROVIDING ANTIBIOTICS.

65. • INFRASTRUCTURE OF PRIMARY HEALTH CARE SERVICES:

66. • VILLAGE LEVEL:
• VILLAGE HEALTH GUIDE(VHG)
• TRAINED BIRTH ATTENDANT(TBA)
• ANGANWADI WORKERS(AWW)

67. •VILLAGE :
•VILLAGE HEALTH GUIDE
•STARTED ON 2ND OCTOBER,1977.
•PURPOSE:
•VILLAGE SANITATION
•SAFE WATER AND PROMOTION OF NUTRITION
•ACCEPTANCE OF CONTRACEPTION,MEDICINE
FOR MINOR AILMENTS AND FIRST AID.

68. • TRAINED BIRTH ATTENDANT(TBA)
• ANGANWADI WORKERS(AWW)
• SUBCENTERS:
• CONTACT POINT BETWEEN THE PRIMARY HEALTH CARE AND
THE COMMUNITY.
• LADDER OF PRIMARY HEALTH CARE.
• POPULATION-5000.
• DELIVERY HUTS PROVIDED.
• TWO KITS ARE PROVIDED.(SAFE DELIVERY, IUD INSERTION)

69. • SUBCENTERS TEAMS:
• HEALTH WORKERS (MALE /FEMALE).
• TRAINED BIRTH ATTENDANTS.(TBA)
• ANGANWADI WORKER.(AWW)
• VOLUNTARY WORKER
• ONE FEMALE LINK WORKER ( ASHA ).
• VILLAGE CHOWKIDAR COLLECTS EVENTS OF BIRTH , DEATHS IS
ALSO HELPFUL TO SUBCENTER TEAM.

70. This
Photo

71. • MATERNAL AND CHILD HEALTH SERVICES:
EARLY REGISTRATION
IDENTIFICATION OF CASES FOR REFFERAL
IMMUNIZATION

72. • CONT…..
IRON AND FOLIC ACID SUPPLIMENTATION
FOR TREATMENT OF ANEMIA IN
PREGNANT/CHILDREN AND SCHOOL AGE
VITAMIN A PROPHYLAXIS
RECORD
KEEPING
DAIS
TRAINING
ESSENTIAL
NEWBORN
CARE
PULSE POLIO
IMMUNIZATI
ON

73. TREATMEN
T AND
CONTROL
OF
DIARROHE
AL
DISEASES,
HEALTH
,NUTRITIO
N,
EDUCATIO
PREPARATION OF MONTHLY PROGRESS REPORTS
AND HOLDINGS
TNTERSECTORAL COORINDATION OF SCHOOL
TEACHER,ANGANWADI
WORKERS,GRAMSEVIKAS,PANJAYATI RAJS
INSTITUTION
REGISTRATION OF BIRTH,DEATH AND
MARRIAGES.

74. • PRIMARY HEALTH CENTER(PHC):
• COVERS 3000 POPULATION.
• QUALIFIED MEDICAL OFFICER ARE AVAILABLE.
• 1 PHC ACT AS A REFFERAL UNIT FOR 6 SUBCENTERS.
• UNDER MINIMUM NEED PROGRAM AND BASIC
MINIMUM SERVICE PROGRAM.

75. •STAFFING PATTERN:
• MEDICAL OFFICER 1-2
• HEALTH ASSISTANT(MALE) 1
• HEALTH ASSISTANT(FEMALE) 1
• HEALTH EDUCATOR 1
• HEALTH WORKER (FEMALE) 1
• STAFF NURSE 1
• PHARMACIST 1
• LAB TECHNICIAN 1

76. • CONT……
• UPPER DIVISION CLERK 1
• LOWER DIVISION CLERK 1
• DRIVER 1
• CLASS IV 4
• TOTAL STAFF 15
• STRENGTHENING OF PHCS UNDER NRHM:
• FUNCTIONS OF PHCS

77. • COMMUNITY HEALTH CENTER(CHC):
• STAFFING PATTERN:
• MEDICAL OFFICERS 4
• NURSE MIDWIVES 7
• DRESSER 1
• PHARMACIST 1
• LAB TECHNICIAN 1
• RADIOGRAPHERS 2
• WARD BOYS 2

78. • CONT…..
• DHOBI 1
• SWEEPERS 3
• MAID 1
• CHOWKIDAR 1
• AYA 1
• PEON 1
• STRENGTHENING OF CHCS UNDER NRHM:
• FUNCTIONS:

79. This Photo by Unknown Author is licensed under CC BY

80. • ROLE OF NURSE IN PRIMARY HEALTH CARE:
• ASSESSMENT
• MOBILIZING COMMUNITY INVOLVEMENT.
• INTRGRATED HEALTH CARE
• EPIDEMIOLOGICAL SURVEILLANCE
• TRAINING THE HEALTH WORKER.
• COLLABORATION
• MONITORING