The document introduces the concept of Primary Health Care (PHC) as essential healthcare accessible to all, outlining its principles, objectives, and roles of community health nurses. It emphasizes equitable distribution, community participation, and intersectoral coordination as core components, addressing challenges in implementing PHC in healthcare systems, particularly in rural areas. It also highlights the pivotal role of nurses in delivering primary health care services and discusses various elements and global goals associated with health care improvement.

1. UNIT : INTRODUCTION TO
COMMUNITY HEALTH
The concepts and principles of primary
health care

3. OBJECTIVES
The student will be able to,
 define primary health care
 list out the elements of primary health care
 explain the principles of primary health care
 detail the roles and responsibility of community health nurse in
primary health care

4. PRIMARY HEALTH CARE

5. HEALTH CARE
 Health is a fundamental human right.
It is the responsibility of the government.
Current criticism
- predominantly urban oriented
- mostly curative
- accessible mainly to small part of the population

6. PRIMARY HEALTHCARE
“Primary Health Care is essential
health care made universally accessible
to individuals & acceptable to them,
through their full participation & at a
cost the community & country can
afford”.

7. LEVELS OF HEALTH CARE

8. HEALTH CARE SYSTEM IN RWANDA

9. PRIMARY HEALTH CARE (PHC)
Primary – first level of contact….essential health care
PHC, HP
 Secondary – complex problems are dealt…
district hospitals, Zonal/Hospitals
Tertiary – specialized level ….medical colleges,
specialized hospitals

10. CHARACTERISTICS OF PHC
COST EFFECTIVE HEALTH
CARE

11. NATURE OF PHC

12. PRIMARY HEALTH CARE (PHC)/CONCEPT
In the year 1946 Sir Joseph
Bhore recommended in
his report
A PHC for every 30,000 pop in
Terai & 20,000 pop in hilly areas

13. WHAT IS PRIMARY HEALTH CARE (PHC)
Primary Health Care (PHC) is the health care that is available
to all the people at the first level of health care.
According to World Health Organization (WHO), ‘Primary
Health Care is a basic health care and is a whole of society
approach to healthy wellbeing, focused on needs and
priorities of individuals, families and communities.’

14. What is Primary Health Care (PHC) Conti…
• Primary Health Care (PHC) is a new approach to health
care which integrates at the community level all the factors
required for improving the health status of the population.
• Primary health care is both a philosophy of health care and
an approach to providing health services.
• It is developed with the concept that the people of the
country receive at least the basic minimum health services
that are essential for their good health and care.

15. CONCEPT OF PHC
Before 1978, globally, existing health services were failing to
provide quality health care to the people.
Different alternatives and ideas failed to establish a well-
functioning health care system.
Considering these issues, a joint WHO-UNICEF international
conference was held in 1978 in Alma Ata (USSR), commonly
known as Alma-Ata conference.

16. CONCEPTS OF PHC
Primary health care approach had its inception in the year
1978 following an international conference at Alma –ATA in
USSR.
Primary health care is equally applicable for all the
countries from most to the least developed countries have
accepted primary health care as the vital part of the health
system.

17. CONCEPTS OF PHC CONTI…..
• The conference included participation from government
from 134 countries and other different agencies.
• The conference jointly called for a revolutionary
approach to the health care.

18. CONCEPT OF PHC CONTI…
• The conference declared ‘The existing gross inequality in
the health status of people particularly between developed
and developing countries as well as within countries is
politically, socially and economically unacceptable’.
• Thus, the Alma-Ata conference called for acceptance of
WHO goal of ‘Health for All’ by 2000 AD.
• Furthermore, it proclaimed Primary Health Care (PHC)
as a way to achieve ‘Health for All’.
• In this way, the concept of Primary Health Care (PHC)
came into existence globally in 1978 from the Alma-Ata
Conference.

19. DEFINITION OF PHC
Definition:
 In 1978 the alma-Ata conference( USSR)
“Is the 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.

20. ELEMENTS OF PHC
There are eight (8) elements of Primary Health Care.
These 8 elements are also known as ‘essential health care’.
They are:
1. Education concerning prevailing health problem & the
methods of preventing & controlling them.
2. Promotion of food supply and proper nutrition.
3. An adequate supply of safe water & basic sanitation.
4. Maternal & child health care, including family planning.
5. Immunization against major infectious diseases.
6. Prevention & control of locally endemic diseases.
7. Appropriate treatment of common diseases & injuries.

21. ELEMENTS OF PRIMARY HEALTH CARE
1.Education concerning prevailing health problem & the
methods of preventing & controlling them.
2.Promotion of food supply & proper nutrition.
3.An adequate supply of safe water & basic sanitation.
4.Maternal & child health care, including family planning.

22. ELEMENTS OF PRIMARY HEALTH CARE
5.Immunization against
major infectious
diseases.
6.Prevention & control of
locally endemic diseases.

23. ELEMENTS OF PRIMARY HEALTH
CARE
7.Appropriate treatment of
common diseases & injuries.
8.Provision of essential drugs.

24. PRINCIPLES OF
PRIMARY HEALTH CARE
1.Equitable distribution.
2.Community participation.
3.Intersectoral coordination.
4.Appropriate technology.
5. Prevention

25. PRINCIPLE OF PHC
Equitable distribution of health services.
This means that health services must be shared by all people
irrespective of their ability to pay, and all (rich or poor, urban or
rural) must have access to health.
Community Participation: active involvement of individuals,
families, and communities in promotion of their own health.
Multisectorial approach : Coordinated action between health
sector and other related sectors. An important element of
multispectral approach is planning with other sectors to avoid
unnecessary duplication of activities.

26. EQUITABLE DISTRIBUTION
Health services must be shared equally by all people
irrespective of their ability to pay.
Rich or poor / rural or urban must have access to
health services.
80% percentage of people live in rural areas & only
20% live in the urban areas,
but the proportion of the health services is grossly
inversely propotionate.ie, 80% of people are catered
by only 20% & 20% are catered by 80% of health
services.

27. This has been termed as social injustice.
Primary Health Care aims to readdress this
imbalance by shifting the centre of gravity of the
health care system from cities to the rural areas, &
bring these services as near people’s home as
possible.

28. COMMUNITY PARTICIPATION
Involvement of the individuals & community in promotion of their
own health & welfare, is an essential ingredient of primary health
care.
There must be a continuing effort to secure meaningful
involvement of the community in planning, implementing &
maintenance of health services, besides maximum reliance on
local resources such as manpower, money & materials.
There must be a continuing effort to secure meaningful
involvement of the community in planning, implementing &
maintenance of health services, besides maximum reliance
on local resources such as manpower, money & materials.

29. INTERSECTORAL CO - ORDINATION
There is an increasing realization that HFA cannot be provided
by the health sector alone.
The declaration of Alma Ata states that primary health care
involves in addition to health sector, all related sectors &
aspects of national & community development, in particular
agriculture, animal husbandry, food, industry, education,
housing, public works, communication & other sectors.

30. To achieve such cooperation, countries may have to review
their administrative system, reallocate their resources &
introduce suitable legislation to ensure that coordination can
take place.
This requires a strong political will to translate values into
action.
An important approach is the inter sectoral approach.

31. APPROPRIATE TECHNONOLOGY
Appropriate technology has been defined as “technology that is
scientifically sound, adaptable to local needs, & acceptable to
those who apply it & for those whom it is used & that cab be
maintained by the people themselves in keeping with the
principles of self reliance with the resources the community &
country can afford”.
The term appropriate is emphasized because in some countries
luxurious hospitals that are totally inappropriate to the local
needs, are built, which absorb a major part of the national health
budget, effectively blocking many improvement in general
health services.

32. This also implies use of costly equipments, procedures &
techniques when cheaper, scientifically valid & acceptable ones
are available. (ORS packets over house to house sand pipe
connections)

33. SERVICES UNDER PHC

34. SERVICES IN PRIMARY HEALTH
CARE
Education concerning
prevailing health problems
and the methods of
preventing and controlling
them.

35. Promotion of
food supply and
proper
nutrition.

36. An adequate supply
of safe water and
basic sanitation.

37. Maternal and
child health
care, including
family planning.

38. Immunization against
major infectious
diseases.

39. Prevention and control of
locally endemic
diseases.
Appropriate treatment of
common diseases and
injuries.

40. Provisio
n of
essential
drugs

41. PRINCIPLE OF PHC
Appropriate technology : appropriate technology is the
technology that is scientifically sound, adaptable to local
needs, and acceptable to those who apply it and for whom
it is used, and that can be maintained by the people
themselves in keeping with the principle of self reliance
with the resources the community and counter can afford.

42. CHALLENGES FOR IMPLEMENTATION OF PHC
 Poor staffing and shortage of health personnel
 Inadequate technology and equipment
 Poor condition of infrastructure/infrastructure gap, especially in the
rural areas
 Concentrated focus on curative health services rather than preventive
and promotive health care services.
 Challenging geographic distribution
 Poor quality of health care services
 Lack of financial support in health care programs
 Lack of community participation
 Poor distribution of health workers/health workers concentrated on the
urban areas.
 Lack of intersectoral collaboration

43. ROLE OF A NURSE
The role of a nurse to deal health
needs and health problems of
people at community level was
realized byWHO in 1970s.

44. ROLE OF A NURSE
The same was recognized in 1977
during 30th
WHO Assembly and also
during International Conference on
Primary Health care in 1978 at Alma
Ata.

45. ROLE OF A NURSE
The participants at the meeting
suggested to change/ modify basic,
post basic and continuing
education so that nurses are
prepared to fit into national health
care system and meet health care
needs of people in the context of

46. ROLE OF A NURSE
In 1970, the International
Council of Nurses affirmed its
commitment to primary health
care.

47. ROLE OF A NURSE
It felt since nurses provide and
continue to provide large part of
health care in most countries,
their training should and role in
health care must be enlarged and
enriched to fit into the changing

48. ROLE OF A NURSE
It suggested changes in nursing
curriculum, nursing practice
and nursing administration so
that nurses can participate from
decision making level to grass
root level and contribute to
primary health care approach
effectively.

49. ROLE OF A NURSE
The Trained Nurses Association
of India (TNAI) affirmed its
commitment to HFA through
primary Health Care in its
conference on Nursing Education
in 1979.

50. ROLE OF A NURSE
It recommended to prepare
nurses to work in the community,
to re-orient nurses to primary
health care, to have nurses at
decision making position at the
centre and state level and have
more nurses in the district and
primary health centres.

51. WHO study group in 1985
highlighted the following roles
and functions of nurses in
primary health care.

52. 1.DIRECT CARE PROVIDER
The nurse provide direct care to
individual, families and
community with reference to 8
elements of primary health care.

53. E.G.,
For MCH care the nurse has to
identify pregnant mothers,
register them, conduct
complete physical and
obstetrical examination,
identify high risk factors, give
TT injection, IFA tablets, and
health educate them about
diet, rest and sleep, exercise
etc.

54. 2. HEALTH EDUCATOR &
TEACHER
In order to promote health,
prevent disease, regain and
maintain health, the nurse
educates individuals, families
and community at large about
healthful behaviour, sanitary
environment, prevention of
diseases etc.,

55. Whatever she does, even the
care of the sick at home, she
educates family members to
take are of the sick in her
absence and also other
preventive measures.

56. 3. PLANNER & CARE MANAGER
The nurse working for primary
health care makes assessment of
health needs, health problems of
individuals, families and
community.

57. The nurse plans care
accordingly for them and
implements the planned care.
The nurses involves individuals,
families and community in
planning and implementing of

58. The nurses makes use of the
community resources and guides
them in giving care.
The nurse listens to and
communicates with them and
advise them accordingly.

59. She makes referrals when
required.
She maintains the record of care
given and evaluates the
effectiveness of the same.

60. 4. GUIDE & SUPERVISOR
As a nurse engaged in providing
primary health care, she is
expected to supervise, guide and
help other personnel in providing
care, planning health services for
families and for the community.

61. SPECIFIED FUNCTIONS
Assessment of health needs and
health problems of individuals
and community.

62. Provide integrated comprehensive
primary health care service
related to 8 essential elements.
Mobilize involvement of
individuals, families and
community in providing primary
health care.

63. Surveillance of locally endemic
diseases.
Training and supervision of
health workers.

64. Working in collaboration with
other socioeconomic sectors.
Maintenance of accurate,
complete and up-to-date records
of health care services rendered.

65. Monitoring and analysis of
health condition to
determine the progress in
primary health care.

66. ROLE OF PUBLIC HEALTH NURSE IN PHC
Assessing the health status of individuals and communities.
Health Education
Food Supply And Proper Nutrition
Water supply and basic sanitation.
Maternal and Child Health Care including Family Planning.

67. ROLE OF PUBLIC HEALTH NURSE IN PHC
CONTI…
 Immunization
 Treatments of Minor ailments.
 Mobilizing community involvement.
 Providing integrated health care including the treatment of emergencies and making referrals

68. BASIC HEALTH NEEDS
 Basic needs refer to those things that are necessary to sustain life.
 It is the minimum requirements of a community for
a decent standard of life.
 Basic needs consists of adequate food, shelter, and
clothing plus some household equipment and furniture.
 Food, water and environment are personal and
 immediate matters.
 Nutritious food maintains health, promotes growth in
children, and prevents blindness. Safe drinking water
nurtures and restores; unsafe water, even when it looks clean, is harmful.

69. FOOD, AIR ,WATER
 Like light, air (oxygen in particular) can be good and bad for you. Oxygen is essential for life.
Without oxygen we would only survive for a few minutes at the most.
 Oxygen is our most important nutrient. It is fundamental to all animal and plant life. Oxygen is
needed constantly by every cell because it releases the energy in food that the cells need to
function.
 Physical and mental well-being starts with access to fresh air and water, nutritious food, and the
security of a stable home. People also need healthy relationships—with freedom to express
gender and sexuality—and a life free from violence, injury, and toxic stress.

70. FOOD, AIR ,WATER
 Water is the stuff of life. We cannot survive for long without it.
 Water comprises about 60 percent of solid tissue by weight in the human body. Besides oxygen, it is the
most important nutrient in the body, functioning as a physiological “jack of all trades.”
 Water has an important role in nearly every major function in the body, regulating body temperature,
carrying nutrients and oxygen to cells, removing waste, cushioning joints and protecting organs and
tissues.
 The rest of our body is made from the nutrients we get from food that are reliant on water for their
existence.
 Many things are soluble in water so it makes it an ideal medium
 It is liquid at temperatures organisms survive in
 It has a neutral ph
 Make sure you drink plenty of water. At least 3 liters a day.

71. CLOTHING
 Wearing clothes satisfy three basic human needs; physical,
psychological, social.
 These needs are satisfied through protection, adornment,
identification, modesty, and status.
 A traditional list of immediate "basic needs"is food (including water),
shelter and clothing

72. SHELTER/HOUSING
 Adequate housing is universally viewed as one of the most basic human
needs.
 The United Nations identifies adequate housing as a fundamental
human right, defining it as “the right to live somewhere in security,
peace and dignity.
 For many low-income families a house is more than just a shelter.
Their home has turned into a valuable asset. It has given them the
opportunity to work out of the comfort of their space and change
their lives for the better.

73. EDUCATION
 Education is a basic human right and is necessary for sustainable
social and economic development.The education of girls is one of
the most important determinants of development.
 Education is crucial for poverty reduction, because it is an
empowering tool that cannot be restricted to the power-holding classes.

74. HEALTH SECURITY
 According to the World Health Organization (WHO), health
security encompasses the “activities required to minimize the danger and
impact of acute public health events that endanger the collective health of
populations living across geographical regions and international boundaries”.
 Health security is essential to achieving human security.
 Health security focuses on pandemics, epidemics, and the spread of
infectious disease. Infectious diseases are the most significant threat to
public health.

75. THANK YOU

77. PHC RELATED SDGS

78. DEVELOPMENT
GOALS
GOAL 3
 The goals within a goal: Health targets for SDG 3
 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births.
 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all
countries aiming to reduce neonatal
 mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25
per 1000 live births.
 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and
combat hepatitis, water-borne
 diseases and other communicable diseases.

79. GOAL 3
3.4 By 2030, reduce by one third premature mortality from non-
communicable diseases through prevention and treatment and
promote mental health and well-being.
3.5 Strengthen the prevention and treatment of substance abuse,
including narcotic drug abuse and harmful use of alcohol.
3.6 By 2020, halve the number of global deaths and injuries from road
traffic accidents.
3.7 By 2030, ensure universal access to sexual and reproductive
health-care services, including for family planning, information and
education, and the integration of reproductive health into national
strategies and programmes

80. Goal 3
 3.8 Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential
medicines and vaccines for all.
 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals
and air, water and soil pollution and contamination.
3.a Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all
countries, as appropriate.

81. Goal 3
3.b Support the research and development of vaccines and medicines for the
communicable and non-communicable diseases that primarily affect developing
countries, provide access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement and Public Health,
which affirms the right of developing countries to use to the full the provisions in the
Agreement on Trade-Related Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide access to medicines for
all

82. Goal 3
• 3.c Substantially increase health financing and the recruitment, development, training and
retention of the health workforce
in developing countries, especially in least developed countries and small island developing
States.
• 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning,
risk reduction and management of national and global health risks.

83. * Multiple targets in SDG 3 and refer to reproductive, maternal,
newborn and child health.
These include targets for mortality, service coverage, risk factors and
health determinants (Table 6.1). The Global Strategy for
* Women’s, Children’s and Adolescents’ Health, 2016–2030 is fully
aligned with the SDG targets, and is organized.
Goal 3 Targets

84. SDG 3

85. SDG 3

86. SDG 3
* SDGs are founded on the principle that they are“ integrated and
indivisible” progress in one area is dependent upon progress in many
others.
* The health of people is not solely a health-sector responsibility;
it is also impacted by issues such as transport, agriculture, housing,
trade and foreign policy.
* To address the multisector nature of health determinants, the health
sector should promote “Health in All Policies”.

87. CONTI….
 Health implications of decisions, seeks synergies and avoids harmful health
impacts in order to improve population health and health equity, and
address the social determinants of health.1,2 Well over a dozen targets in
other goals can be considered to be health related
should be given special attention in strategies, policies and plans to achieve
the health goal, and in monitoring progress. Examples include targets related
to nutrition, environmental risk factors and violence

88. SDG 3
the current situation, a brief discussion of what is needed to
achieve the 2030 target, the equity dimension and the data gaps.

89. Conti…

90. INFECTIOUS DISEASES

91. FURTHER READING
 WHO. Declaration from the website of the World Health Organization
 Chotchoungchatchai S, et al. (2020). Primary health care and sustainable development
goals. Bull World Health Organ. ;98(11):792-800. doi: 10.2471/BLT.19.245613. Epub 2020
Sep 3. PMID: 33177776; PMCID: PMC7607463.