7. SIGNIFICANCE OF HEALTH Fundamental human right. Central to quality of life and human development Essence of a productive life An intersectoral issue and an integral part of socioeconomic system Involves individuals, community, state and international responsibilities A major social investment Worldwide a social goal
8. DIMENSIONS OF HEALTH PHYSICAL Functioning of body organs Ability to do daily tasks MENTAL Balance with surroundings Self- esteem Know problems and goals Self control Faces problems. SOCIAL Harmony with society Involvement with community Social skills
15. CultureBiological and cognitive Genetics, race, sex, age Diabetes, breast cancer are genetic in nature Diarrhoea more common in children Psychological and spiritual Life stress causes mental disorders, hypertension, heart attack, diabetes, gastric ulcer
17. HEALTH FOR ALL Attainment byall people of the world of a level of health that can permit them to lead a socially and economically productivelife. “30th World health assembly, Alma Ata, 1977”
18. PRIMARY HEALTH CARE “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 the country can afford to maintain at every stage of their development in the spirit of self-determination. ” “WHO, 1978”
57. Introduction and Overview Responding to the challenges of a changing world Growing expectations for better performance From the packages of the past to the reforms of the future Four sets of PHC reforms Seizing opportunities
58. The PHC reforms necessary to refocushealth systems towards health for all
59. The challenges of a changing world Unequal growth, unequal outcomes Longer lives and better health, but not everywhere Growth and stagnation Adapting to new health challenges A globalized, urbanized and ageing world Little anticipation and slow reactions Trends that undermine the health systems’ response Hospital-centrism: health systems built around hospitals and specialists Fragmentation: health systems built around priority programmes Health systems left to drift towards unregulated commercialization Changing values and rising expectations Health equity Care that puts people first Securing the health of communities Reliable, responsive health authorities Participation PHC reforms: driven by demand
60. The shift towards noncommunicable diseases and accidents as causes of death*
61. Five common shortcomings ofhealth-care delivery 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. Public spending on health services most often benefits the rich more than the poor in high- and low income countries alike. Impoverishing care. Wherever people lack social protection and payment for 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. 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 poor and marginalized groups are often highly fragmented and severely under-resourced, while development aid often adds to the fragmentation. 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. Misdirected care. Resource allocation clusters around curative services at 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.
62. Primary care: putting people first Good care is about people The distinctive features of primary care Effectiveness and safety are not just technical matters Understanding people: person-centred care Comprehensive and integrated responses Continuity of care A regular and trusted provider as entry point Organizing primary-care networks Bringing care closer to the people Responsibility for a well-identified population The primary-care team as a hub of coordination Monitoring progress
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