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111111111111111111111-Phc-Lecture-Note.pdf

The document outlines the objectives and principles of Primary Health Care (PHC), emphasizing its role in achieving health for all through equitable access, community participation, and integrated health services. It describes eight essential components of PHC, including health education, nutrition, sanitation, maternal and child health, immunization, disease control, and drug provision. The framework advocates for a whole-of-society approach to improve public health outcomes while considering ethical practices in public health management.

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Primary Health Care PHC HEALTH FOR ALL APPROACH
Objectives: Students should know how to: 1-Define PHC 2-Describe the rationale and concept of PHC and how it relates to basic health services 3. Objectives of Primary Health Care 4-List and explain the elements and principles of PHC 5-Define the promotive services 6-Define the preventive services 7-Define the curative care services 8-Explain Principles of the Ethical Practice of Public Health
Rationale for Adopting Primary Health Care  Magnitude of Health Problems  Inadequate and unequal distribution of health resources  Increasing cost of medical care  Isolation of health care activities from other development activities
 WHO-UNICEF held international conference in 1978 at Alma-Ata (USSR),the governments of 134 countries and many voluntary agencies called for a revolutionary approach to health care.  The Alma-Ata conference called for acceptance of the WHO goal for Health for All(HFA) by the year 2000 and proclaimed primary health care as a way to achieving Health for all.
PHC (cont.) The Alma-Ata Conference defined PHC as follows:- "Primary health care is 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 the community & country can afford to maintain at every stage of their development in the spirit of self determination".  All people, everywhere, have the right to achieve the highest attainable level of health. This is the fundamental premise of primary health care (PHC).  Primary health care (PHC) is essential health care made universally accessible to individuals and acceptable to them, through full participation and at a cost the community and country can afford
PHC (cont.)  PHC is equally valid for all countries, although it takes varying forms in each of them.  The concept of PHC has been accepted by all countries as the key to the attainment of HFA(Health For All).  It is accepted as an integral part of the country's health system.
PHC (cont.) Primary health care is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. It has 3 components:  integrated health services to meet people’s health needs throughout their lives  addressing the broader determinants of health through multisectoral policy and action  empowering individuals, families and communities to take charge of their own health.
Objectives of PHC •Improvement in the level of health care of the community •Favorable population growth structure •Reduction in the prevalence of preventable, communicable and other disease. •Reduction in morbidity and mortality rates especially among infants and children. •Extension of essential health services with priority given to the underserved sectors. •Improvement in Basic Sanitation •Development of the capability of the community aimed at self- reliance. •Maximizing the contribution of the other sectors for the social and economic development of the community.
Elements (components) of PHC Although specific services provided will vary in different countries & communities, the Alma-Ata Declaration has outlined 8 essential components of PHC :-
Elements of PHC: (cont.)
1. Health education  It s crucial to primary health care, empowering individuals to take charge of their health.  It helps people to understand how to prevent and manage illnesses, make healthy lifestyle choices, and access health services.  For example, the government of most countries implement several health education programs to promote healthy behaviors and increase awareness about health issues.
2. Promotion of food supply & proper nutrition.  It is vital for maintaining good health and preventing diseases. Primary health care should include nutrition education, counseling, and support to ensure that people have access to a balanced diet.  For instance, malnutrition is a significant health issue, with a prevalence of 22% among children under five.
3. Environmental Sanitation and Promotion of Safe Water Supply  Environmental Sanitation is defined as the study of all factors in the man’s environment, which exercise or may exercise deleterious effect on his well-being and survival.  Water is a basic need for life and one factor in man’s environment.  Water is necessary for the maintenance of healthy lifestyle.  Safe Water and Sanitation is necessary for basic promotion of health.
4. Maternal & child health and family planning.  The mother and child are the most delicate members of the community.  So the protection of the mother and child to illness and other risks would ensure good health for the community.  The goal of Family Planning includes spacing of children and responsible parenthood.
5. Expanded Program on Immunization.  This program exists to control the occurrence of preventable illnesses especially of children below 6 years old.  Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing program of the MOH
6.Prevention & control of locally endemic diseases  The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate.  Example Malaria Control and Schistosomiasis Control
7. Treatment of Communicable Diseases and Common Illness  The diseases spread through direct contact pose a great risk to those who can be infected.  Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death.  Most communicable diseases are also preventable.  The Government focuses on the prevention, control and treatment of these illnesses.
8. Provision of essential drugs.  This focuses on the information campaign on the utilization and acquisition of drugs.  Some essential drugs It includes: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, isoniazid and Pyrazinamide, Ethambutol, Streptomycin, Albendazole, Quinine
Elements of PHC: (cont.) The first three elements are promotive services. the middle three are preventive services. the last two services are curative care services.
 The concept of PHC involves an effort to provide the rural population in developing countries with at least the basic minimum of health services.  The list can be modified to fit local circumstances  For example some countries have specifically included: -Mental health -Physical handicaps. -Health and social care of the elderly.
PHC principles The mentioned eight services indicated as elements, are to be organized & delivered on basis of the principles of :- 1- Equity in distribution. 2- Appropriate technology. 3- Multisectoral approach. 4- Community participation. 5. 4 A’s = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health services. 6. Decentralization
Principles of PHC (cont.) 1. Equitable distribution. The first key principle in the PHC strategy is equity or equitable distribution of health services. Health services must be shared equally by all people irrespective of their ability to pay.
Principles of PHC (cont.) 1. Equitable distribution (cont.) PHC aims to re-adress this imbalance by: Shifting the centre of gravity of the health care system from cities (where three-quarters of the health budget is spent) to → rural areas (where three-quarters of the people live). Bring these services as near people's home as possible.
Equity means: 1.Services to all 2.More services to needy & vulnerable
i.e. while continuing to provide essential health care for all the population irrespective of social, economical & cultural preferences, extended care is to be provided to the "high risk" groups in the community either within the health centers or by referral from the health centers to a higher level of care (hospital).
For ensuring equity: -The population to be served must be known. - The vulnerable groups are to be identified & reached.
PHC principles (cont.) 1. Equity in distribution (cont.): For ensuring equity (cont.) : - The health services (not necessarily health centers) have to be dispersed into: - The farthest remote rural areas. - The deepest parts of the underserved urban population. The failure to reach the needy & the majority is usually due to limited geographical access.
PHC principles (cont.) 1. Equity in distribution (cont.): Thus, to ensure equity, accessibility has to be improved by : - Increasing the number of health facilities. - Improving transport conditions. - Organizing outreach services, thus substituting one when the other is not available.
PHC principles (cont.) 1. Equity in distribution (cont.): PHC aims to: - Correct imbalance in accessibility - Bring health services as near to people's homes as possible. - To achieve this, PHC is supported by higher level of health care to which patients can be referred for extended care.
Principles of PHC (cont.) 2. Community participation. Involvement of individuals, families, & communities in promotion of their own health & welfare.
Principles of PHC (cont.) 2. Community participation (cont.) There must be: A continuing effort to secure meaningful involvement of the community in: Planning. Implementation. Maintenance of health services. Evaluation of health services. Maximum reliance on local resources such as: Manpower. Money. Materials.
Principles of PHC (cont.) 2. Community participation (cont.)  Participation is a critical aspect of both social justice and equitable processes.  People need to have some say in what is happening to them if they have a stake in their families, communities and societies.  Participation is about having a voice to shape decisions, implementations and evaluations that influence our lives
Principles of PHC (cont.) 2. Community participation (cont.) In terms of governance of programs relating to various groups in a community, the following types of participation may be:  Inform: provide the public with balanced and objective information to assist them in understanding the problems, alternatives, opportunities, and/or solutions;  Consult: obtain public feedback on analysis, alternatives, and/or decisions;
Principles of PHC (cont.) 2. Community participation (cont.)  Involve: work directly with the public throughout the process to ensure that public concerns and aspirations are consistently understood and considered.  Collaborate: partner with the public in each aspect of the decision including the development of alternatives and the identification of the preferred solutions; and  Empower: place final decision making in the hands of citizens.
 Participation is a critical aspect of both social justice and equitable processes.  People need to have some say in what is happening to them if they have a stake in their families, communities and societies.  Participation is about having a voice to shape decisions, implementations and evaluations that influence our lives
Principles of PHC (cont.) 2. Community participation (cont.) Universal coverage by PHC cannot be achieved without the involvement of the local community. In short, PHC must be built on the principle of community participation (or involvement).
Principles of PHC (cont.) 3. Intersectoral coordination. There is an increased realization of the fact that the components of PHC cannot be provided by the health sector alone.
Principles of PHC (cont.) 3. Intersectoral coordination (cont.)  The Declaration of Alma-Ata states that “PHC involves in addition to the health sector, all related sectors & aspects of national & community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication & others sectors“.
Principles of PHC (cont.) 4. Appropriate technology. Definition:" technology that is scientifically sound, adaptable to local needs, & acceptable to those who apply it & those for whom it is used, & that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community & country can afford“.
Principles of PHC (cont.) 4. Appropriate Technology (cont.): Health technologies are required not only for: Diagnostic maneuvers. Therapeutic maneuvers. But also for: Disease prevention. Disease control. Health promotion.
Principles of PHC (cont.) 4. Appropriate Technology (cont.): Though it is commonly perceived that person who is going to apply it is a trained health professional, in PHC practice there are instance where technology may have to be applied by: Individual. Family. Community. e.g. use of tooth brush, eye glasses, domestic water filters, domestic pest control, etc· So, technology should be applicable for "self use".
Principles of PHC (cont.) 4. Appropriate Technology (cont.): So, the simplicity of the technology is always desirable; examples of such are: 1-ORS in diarrheal disease control. 2-Breast feeding in spacing. 3-Weighing for growth monitoring… etc.
Principles of PHC (cont.) 5. 4 A’s = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health services.  The health services should be present where the supposed recipients are.  They should make use of the available resources within the community, wherein the focus would be more on health promotion and prevention of illness.
Principles of PHC (cont.) 6. Decentralization This ensures empowerment and that empowerment can only be facilitated if the administrative structure provides local level political structures with more substantive responsibilities for development initiators.  This also facilities proper allocation of budgetary resources.
Principles of the Ethical Practice of Public Health 1. Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes. 2. Public health should achieve community health in a way that respects the rights of individuals in the community. 3. Public health policies, programs, and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members.
4. Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all. 5. Public health should seek the information needed to implement effective policies and programs that protect and promote health. 6. Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community’s consent for their implementation.
7. Public health institutions should act in a timely manner on the information they have within the resources and the mandate given to them by the public. 8. Public health programs and policies should incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community. 9. Public health programs and policies should be implemented in a manner that most enhances the physical and social environment.
10. Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public. Exceptions must be justified on the basis of the high likelihood of significant harm to the individual or others. 11. Public health institutions should ensure the professional competence of their employees. 12. Public health institutions and their employees should engage in collaborations and affiliations in ways that build the public’s trust and the institution’s effectiveness.