1. PRIMARY HEALTH
CARE
Written by Michael Mutisya Msc,Bsc public health jkuat,Diploma in
clinical medicine and surgery-Kmtc Nrb
2. Definition:
'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.
3. From the definition, you need to note the following key statements which identify PHC as
essential health care. These are:
• PHC is universally accessible to individuals and families in the community.
• PHC is socially acceptable to all, meaning that the health care is appropriate and adequate in
quality to satisfy the health needs of people, and is provided by methods acceptable to them
within their social cultural norms.
• PHC is affordable, that is, whatever methods of payment used, the services should be at a
price the community can afford.
• PHC promotes full participation of individual, families and communities.
• PHC is appropriate technology that is, the use of methods and technology which use locally
available supplies and equipments.
4. ELEMENTS OF PRIMARY HEALTH CARE
The PHC elements listed at the Alma Ata Declaration were as follows:
1. Education concerning prevailing health problems and the methods
of preventing and controlling them
2. Local disease control
3. Expanded programme of immunization
4. Maternal and child health care and family planning
5. Essential drug supply
6. Nutrition and adequate food supply
5. 7. Treatment and prevention of common diseases and injuries
8. Safe water supply and good sanitation.
Use the acronym 'ELEMENTS' to help you remember these eight
elements.
The Kenyan government has added additional PHC elements to the ones
identified at the Alma Ata conference These are:
• Mental health
• Dental health
• Community based rehabilitation
• Malaria control
• STI and HIV/AIDS prevention and control
6. PRINCIPLES OF PRIMARY HEALTH CARE
1. CARE SHOULD BE AIMED AT THE MOST NEEDY GROUPS
This principle puts forward the need for EQUITY – resources should be distributed
justly, according to need, with more going to the more needy. Who are the needy?
• Some population groups are below the poverty line, such as the landless and
jobless, refugees and squatters. They, the rural dwellers and the squatters in the
urban shanty towns, are not only poor but live with few or no services, including
health services.
• Some groups are more vulnerable to disease, especially children under five and
pregnant and nursing women.
• Some are "invisible" to planners, for example, the nomadic minorities in settled
countries.
WHENEVER WE LOOK AT A PROGRAMME, WE HAVE TO ASK WHICH
GROUPS ARE NOT BEING REACHED – WE CHECK THE SEX OR AGE
GROUPS AT RISK, WE CHECK WHAT CLASSES OR CASTES ARE
IDENTIFIABLE, WHETHER THERE ARE MINORITY GROUPS OR LIFESTYLES,
AND WE LOOK TO SEE IF THEY ARE USING THE SERVICES AS OFTEN AND
AS WELL AS THE "NORMALS".
7. 2. PHC SHOULD INCLUDE A RANGE OF ESSENTIAL,
APPROPRIATE ACTIVITIES
A number of vertical programmes have tried to combat diarrhoea, or
malaria, or measles or malnutrition, usually in children under five. The
sad fact is that tackling one problem may stop children dying of that
problem – but they then die of something else and in the same
numbers. A RANGE of services is necessary
Integration of these services is also important, or the Village Had
health Worker can end up trying to carry out the plans of twelve
different programmes each with its own land rover, twice-yearly
supervision, records, etc. Here, funders need to co-ordinate.
8. 3. CARE SHOULD BE ACCESSIBLE AND ACCEPTABLE TO EVERYBODY
Think of a woman who has a smelly vaginal discharge which worries her.
What might discourage her from consulting a health worker?
Distance to the clinic and time lost from work? Inconvenient hours? A male
worker? A language barrier? No privacy? Carelessness or rudeness from the
staff?
Being sent to the Clinic for Sexually Transmitted Diseases?
All these, and others, are factors that affect accessibility and acceptability.
Definitions: distance to a clinic is a problem of accessibility (whether the
patient can get to use a service); vaginal examination by a man is a
problem of acceptability (whether a patient can bear to accept a service);
in between, the two concepts overlap. Many problems in these areas have
been quickly solved when local staff see how important it is.
9. 4. PRIMARY HEALTH CARE SHOULD BE AFFORDABLE
Some countries have free first-line health care as part of the constitution.
However, the experience of the last twenty years suggests that free health
care is not sustainable. A number of PHC projects sell medicines to people
who are sick. This enables the health workers to renew his stock and in
some projects the profit pays for basic preventive activities such as
immunizations. There is some cost-recovery, as planned in the Bamako
Initiative, and some self-reliance. However, people in rural communities still
pay taxes, and their cousins in the cities get first-line health care for free,
paid out of taxes. PHC may be making poorer people pay twice. Most
African countries have GNPs which are falling. Initial investments to set up
PHC projects often amount to about $25 per head and will continue to cost
yearly for the preventive activities..
10. 5.THERE SHOULD BE FULL COMMUNITY PARTICIPATION, AND PHC
SHOULD BE CONTRIBUTING TO THE SELF-RELIANCE AND SELF-
DETERMINATION OF COMMUNITIES.
Most programmes intend that the communities will participate and
most create some kind of structure to make it possible, usually
village PHC committees. However, there are problems.
First, a programme of community education and mobilization, to
give people the information and skills they need to make good
choices, can take up to three months per village, and few
programmes will budget for this time and investment. Few funders
are prepared to wait. When they are, the results are impressive as
they were in the villages trained by the GRAPPE method in
French-speaking West Africa.
11. Cont……
Second, most programmes are not prepared to delegate any serious
power or decision- making. For example, most PHC programmes invite
the community to join in the identification of priority problems, but,
since the programmes are funded from health budgets, they usually can
do little if the community sees the need for a road as a priority. Honesty
from the beginning is essential The priorities of women can be buried at
several stages of the consultation process or they can be brought
forward through conscious effort.
Where the community involvement is poor, the PHC activities which are
most successful are the ones such as immunizations. Here the
community does not need to have active, organized involvement – it
only has to turn up and stand still for a few minutes. The activities
which do much less well are those in which active, co-ordinated
participation over time is essential. Think of what the community would
need to do in order to tackle malnutrition in the small children or raise
the age of arranged marriages for their daughters.
12. 6. PHC SHOULD BE INTEGRATED BOTH WITH OTHER PARTS
OF THE HEALTH PROGRAMME AND WITH OTHER
DEVELOPMENT SECTORS
Think of the different Ministries, each with its own structure and
policies. Suppose there is a real need for an integrated programme
to improve malnutrition, including Vitamin A deficiency. You would
want to work with the Ministry of Agriculture, promoting vegetables
(nearest office the District Town) and also with the Ministry of Water
and Forests, to get fruit trees planted (nearest office the Regional
Capital 80 km away). Neither have petrol for their vehicles so that
you can meet. And your budget comes from the Health budget of a
Western
13. country, and is meant for health activities which do not include tree-
planting. In practice, agriculture is the easiest section to work with,
because it tends to have workers at village level. Even so, in reality,
active working together is rare. It has to be fought for. But it is
possible, and the first step to finding funding for integrated projects.
14. Disability act Kenya persons with
disability 2003
Defination of disability:
In life, anything that stops a part of your body from functioning duly is known
as impairment. There are different types of impairment such as
motor,sensory, and emotional or intellectual impairment.
Disability is a physical, emotional, or ,mental injury or illness that is severe or
permanent,that interferes with an individual's normal growth and
development or ability to work
Most disabilities start later in life or childhood. Those that at art in life are
often as a result of accidental injuries
15. In most cases ,the loss of a function due to disability need not make a
person useless. Often disabled people have other facilities which they can
be able to put in good use and therefore be able to earn a living for
themselves.
Causes of disability:
Chronic diseases: DM,HPT,cancer
Injuries due to RTA,conflicts falls and land minds
Mental health problems
Birth defects
Malnutrition
HIV/AIDS
16. Persons with disabilities are increasingly in number due to:
Population growth
Increasing in chronic health condition
Agreeing
Prolonged life
Persons with disabilities
Need to be registered
Not be discriminated
Exemption from tax
Special facilities
Retirement 65
Education
18. MDGs,VISION 2030 AND SDGs
MDGs: Millennium development goals.
Vision 2030
SDGs: Sustainable development goals
19. MILLENNIUM DEVELOPMENT GOALS
1.Eradicate extreme poverty and hunger
- Prevalence of underweight children under 5 years of age
2. Achieve universal primary education
-Net attendance ratio in primary education1 2.3 Literacy rate of 15-24 year-
olds2
3. Promote gender equality and empower women
- Ratio of girls to boys in primary, secondary and tertiary education
4. Reduce child mortality
- Under five mortality rate4
- Infant mortality rate4
- Percentage of 1 year old children immunized against measles
20. MDGs
5. Improve maternal health
- Maternal mortality ratio
- Percentage of births attended by skilled health personnel
- Contraceptive prevalence rate7
- Adolescent birth rate8
- Antenatal care coverage
- At least one visit
- Four or more visits
- Unmet need for family planning
21. MDGs
6. Combat HIV/AIDS, malaria and other diseases
6.2 Condom use at last higher-risk sex
6.3 Percentage of the population age 15-24 years with comprehensive correct
knowledge of HIV/AIDS12
6.4 Ratio of school attendance of orphans to school attendance of non-orphans
age 10-14 years
6.7 Percentage of children under 5 sleeping under insecticide-treated bed nets
6.8 Percentage of children under 5 with fever who are treated with appropriate
antimalarial drugs14
22. Sustainable development goals
GOAL 1:END POVERTY IN ALL ITS FORMS EVERYWHERE
GOAL 2: ZERO HUNGER
GOAL 3:GOOD HEALTH AND WELL-BEING
GOAL 4: QUALITY EDUCATION
GOAL 5: GENDER EQUALITY
GAOL 6: CLAEAN WATER AND SANITATION
GOAL 7: AFFORDABLE CLEAN ENERGY
GOAL 8: DECENT WORK AND ECONOMIC GROWTH
GOAL 9:BUILD RESILIENT INFRASTRUCTURE, PROMOTE SUSTAINABLE
INDUSTRIALIZATION AND FASTER GROWTH
23. SDGs….cont
GOAL 10: REDUCE INEQUALITIES
GOAL 11: SUSTAINABLE CITIES AND COMMUNITIES
GOAL 12: RESPONSIBLE CONSUMPTION AND PRODUCTION
GOAL 13: CLIMATE ACTION
GOAL 14: LIFE BELOW WATER
GOAL 15: LIFE ON LAND
GOAL 16: PEACE, JUSTICE AND STRONG INSTITUTIONS
GOAL 17: PARTNERSHIP FOR LIFE GOALS
24. VISION 2030- KENYA
Kenya vision 2030 is the country's new developments blue print covering the
period 2008 to 2030. It aims to transform Kenya into a newly industrializing,"
middle-income country providing a high quality life to all citizens by the year
2030"
Development of the vision:
Was through consultative forum involving all citizens -through workshops with
all stake holders in public and private sectors,civil society,the media, and
NGOs.
Suggestions from leading and international experts-researchers,
25. Vision 2030- Kenya
The vision is based on three pillars
1. Economic : TO maintain a sustained economic growth of 10% p.a over next 25
years.
2. Social: a just and cohesive society enjoying equitable social development in a
clean and secure environment
3. Political: TO realize a democratic political system founded on issue-based
politics that respects the rule of law,and protects the rights and freedoms of every
individual in Kenya society.
26. 1. Economic pillar
Macroeconomics stability for long term development .
Continuity in government reforms:-anti corruption programs,better
investigations,public education and judicial reforms.
Enhanced equity and wealth creation opportunities for the poor:-investment in
ASALS, youth employment women and all vulnerable groups.
Infrastructure:-railway's ports,water and sanitation facilities and
telecommunication.
Energy:-encouraging more sources of energy sources and commenting Kenya to
energy- surplus .
Science,technology and innovation:-research and development so as to accelerating
economic development in all new industrialized areas.
27. 2. SOCIAL PILLAR
Kenya's journey towards prosperity also involves the building of a just and cohesive
society that enjoys equitable social development in a clean and secure
environment. This quest is the basis of transformation of our society in seven key
sectors.this are:
Education and training:- fund research,reduce illiteracy levels, increase enrollment
of students in public and private universities.
Healthy sector:- TO improve the overall livelihoods of Kenyan,the country's aims to
provide an efficient and high quality health care system with best standards. This
will be done thorough a two prolonged approach.
28. Social pillar….cont
1).Devolution of funds and management of healthy the communities; living
the ministry to deal with policies and research.
2).Shifting the bias of the national health bill from curative to preventive
care
Special attention will be paid to lowering the incidences of HIV/AIDS, Malaria
and TB and lowering infant mortality ratio.
All this will reduce equalities in access to health care and improve key Areas
where Kenya is lagging behind especially lowering mortality and infant
mortality. Specific strategies will involve:
- Provisions of robust health infrastructure network
29. POLITICAL PILLAR
The political pillar envisions a countywide with a democratic system
reflecting the aspirations and expectations of its people. Kenya will be a state
in which equality is entrenched,irrespective of ones race, ethnicity,religion
,gender or social Economic status; a nation that not only respects but also
harnesses the diversity of its people values,aspirations and traditions for the
benefit of its people.
* Rule of law:- increase service availability and access to justice.
* Electoral and political process
* Democracy and public service delivery
* Transparency and accountability
* Security,peace-building and conflict management
