The document provides information on primary health care (PHC), including its definition, important terms, historical development, principles, components, approaches, characteristics, essential elements, obstacles to implementation, and the nursing process as applied to community health. Some key points: - PHC is based on practical, scientifically sound methods that are universally accessible and affordable. - Its goal is to provide the highest level of health for all people. - Principles include equity, intersectoral collaboration, community involvement, and decentralization. - Approaches include selective PHC focusing on a few diseases and comprehensive PHC addressing all health elements. - The nursing process—assessment, diagnosis, planning, implementation, and

1. Ahmad Guelleh
BScN

2. PRIMARY HEALTH CARE (PHC)
PHC is an essential health care based on practical, scientifically
sound and socially acceptable methods and technologically
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 confidence and self
development.

3. Important terms in the definition
Primary: First in order of its importance
Essential: basic and necessary and vital.
Practical: Applicable or Appropriate
Scientifically sound: The strategy we use in
implementing PHC should be scientifically
explainable and understood.

4. Socially acceptable methods: Should be accepted by the
local community.
Universally accessible: To bring health care as close as
possible to where people live and work
 Mawel1233A
 Berberashop2017

5. Historical Development of PHC
The World Health organisation (WHO), which was
established in 1948, has always had as a major objective
the achievement or ability by all people of the highest
possible level of health." WHO definition”

6. However due to political and socio-economic factors the
various health care approaches implemented in different
countries between 1948 and 1978 did not enable WHO to
meet the stated objective.

7.  Thus -the magnitude of health problems and inadequate
distribution of health resources called for a new approach
and the concept of PHC was born.

8.  In 1977 the WHO set a goal of providing "Health for All
by the year 2000" which aims at achieving a level of
health that enables every citizen of the world to lead a
socially and economically productive life.

9.  The strategy to meet this goal was later defined in the
1978 WHO/UNICEF joint meeting at Alma-Ata USSR.
In this meeting it was declared that the primary health care
strategy (PHC) is the key to meet the goal of "health for
all by the year 2000".

10. Principles of primary health care
Equity
Intersectoral collaboration
Community involvement
Appropriate technology
Emphasis to promotion and prevention
Decentralization

11. I. Equity
Providing equal health care to all groups of people
according to their needs
giving highest priority to those with greatest health needs
Services should be physically, socially, and financially
accessible to everyone

12. II. Intersectoral collaboration
 It means a joint concern and responsibility of sectors
(Organizations)
 It is important to:-
 Save resources (effective use of resources)
 Identify community needs together
 It can be promoted through
 Forming bodies from relevant agencies and elders at different
levels, starting from the community

13. III. Community involvement
The communities should be actively involved in:
The assessment of the situation
Definition of the problems
Setting of priorities

14. Planning,
Implementation
Monitoring
Evaluation
Management of development programs

15. Advantages of community involvement
Extended service (coverage)
Programs are affordable and acceptable
Promote self-reliance and confidence
Success has a multiplying effect
Create sense of responsibility

16. Consideration of real needs
Promote local community’s initiatives and technologies
Reduce dependency on technical personnel
Builds the community’s capacity to deal with problems.
Helps to choose correct strategy

17. IV. Appropriate Technology
Methods- procedures - techniques, equipments are
Scientifically valid
Adapted to local needs
Acceptable by the professional
Acceptable by the community

18. Criteria of Appropriateness
Effective
Culturally acceptable and valuable
Affordable
Sustainable Locally
Evolutionary capacity

19. Environmentally Accountable
Measurable
Politically Responsible

20. V. Emphasis on health promotion and prevention
 Promotive: addresses basic causes of ill health at the level
of society.
 Preventive: reduces the incidence of disease by
addressing the immediate and underlying causes at the
individual level.

21.  Curative: reduces the prevalence of disease by stopping
the progression of disease.
 Rehabilitative: reduces the long-term effects or
complications of a health problem.

22. VI. Decentralization
Bringing decision making away from the national or
central level closer to the local communities served and to
field level providers of services.

23. The components of PHC at alma-ata declaration
Health education
Promotion of food supply and proper nutrition
adequate supply of safe water and basic sanitation
Maternal and child health care, including family planning

24. Immunization
Prevention and control of locally endemic diseases
treatment of common diseases and injuries
Provision of essential drugs

25. Components added after Alma Ata Declaration
 Mental health
 Dental health (oral health)
 Control of ARI (Acute respiratory tract infections)
 Control of HIV/AIDS and other STDS
 Occupational health
 The use of traditional medicine

26. Approaches to PHC
The two main approaches are:-
Selective PHC (sPHC)
Comprehensive PHC (cPHC)

27. Selective PHC (sPHC)
It is the low cost strategy to treat and prevent few selected
diseases which have great impact to mortality

28. Advantage of sPHC approach
 Easy to plan and implement
 Decision making is easier
 Results are achieved faster
 It gives more satisfaction
 Requires limited resources

29. Disadvantages of sPHC
Limited scope of activities
The approach is disease oriented.
The approach doesn't address the general health problems
of the community

30. It doesn't address priorities of the community
Top to down decision making
It doesn't recognize contribution and co-operation by other
sectors

31. Comprehensive PHC (cPHC)
It defines Health in its holistic sense, in its complete form.

32. Advantage of the cPHC approach
It looks at health holistically
Development oriented
It promotes equity
It advocates multi- sectoral collaborations
It deals with priorities of the community
Covers all elements of PHC

33. Disadvantages of the cPHC approach
It is expensive initially to set up an infrastructure
Requires conscious planning
Results are gradual
It is a long process
It is a complex process

34. Characteristics of primary health care from
Alma Ata declaration
 Evolves from the economic conditions and sociocultural
and political characteristics of a country and its
communities
 Is based on the application of social, biomedical, and
health services research and public health experience
 Involves all related sectors and aspects of national and
community development, in particular agriculture, animal
husbandry, food, and industry

35.  Requires maximum community and individual self-
reliance and participation in the planning, organization,
operation, and control of services
 Develops the ability of communities to participate through
education

36.  Should be sustained by integrated, functional, and
mutually supportive referral systems, leading to better
comprehensive health care for all, giving priority to those
most in need
 Relies on health workers, including physicians, nurses,
midwives, auxiliaries, and community workers as well as
traditional practitioners, trained to work as a team and
respond to community’s expressed health needs

37. Essential components of effective
primary health care
o Well trained, multidisciplinary workforce
o Properly equipped and maintained premises or buildings
o Appropriate technology, including essential drugs
o Capacity to offer comprehensive preventive and curative
services at community level

38. o Sound management and governance systems
o Sustainable funding streams aiming at universal coverage
o Functional information management and technology
o Community participation in the planning and evaluation of
services provided

39. o Collaboration across different sectors—for example,
education, agriculture
o Continuity of care
o Equitable or fair distribution of resources

40. Obstacles to implementation of PHC
strategies
 Misconception of PHC
 Selective PHC strategy
 Resistance to change
 Lack of political

41.  Centralized planning and management Of
infrastructure
 Inequitable and insufficient recourse allocation
 Poor organization of health services and ineffective
referral system
 Inequitable distribution of health professionals

42. o Unsatisfactory working conditions of health workers: low
salaries, poor living conditions and inadequate career
structures.
o Inappropriate use of medical technology
o Limited intersectoral cooperation for health development
o Weakness of health information systems to measure
performance and make decisions

43. THE NURSING PROCESS IN COMMUNITY HEALTH
NURSING
 A community usually is defined by boundaries which may be
geographic, such as those defined as city, state or nation.
 The nursing process is a systematic, purposeful act of nursing
actions that includes assessment, diagnoses, planning,
implementation and evaluation.
 Nursing process can be applied to community as it is applied to
individual patients.

44. Establish Rapport:
Nurse - client interaction (rapport) is often an implied or
indirect element in the process.
Rapport is called the act of respectful informality that
helps build client trust in the nurse.

45. Important elements in establishing rapport:
Respect fullness
 Courtesy or politeness
 Objectivity
 Caring and warmth
 Concern for client's welfare
 Interest and attention

46. Nursing Assessment
The first step in the nursing process is
assessment which involves collection of data.

47. Sources of data
1. Primary data is the data that are directly obtained from
clients. It offers the most accurate insights and
comprehensive information.
2. Secondary sources of data are data obtained from
people who know the client: family, friends, neighbors,
and workmates pending clients' permission.

48. Additional secondary sources include:-
o Clients' records
o Community health statistics
o Census bureau data
o Research report
o Police
o Insurance records
However, secondary data may need augmentation or further
validation.

49. Data collection Techniques
 Observation
 Interviewing
 Listening
 Measuring
 Survey study
 Record review

50. Nursing Diagnosis
It is a statement describing client's healthy and unhealthy
responses that can be influenced or changed by nursing
intervention.
A nursing diagnosis is often called a problem statement
when writing nursing diagnosis for wellness response or
deficit response.

51. Planning
 The purpose of the planning phase is to determine how to
satisfy clients' needs. Planning is a logical, decision
making, designing an orderly, detailed program of action
to accomplish specific goals and objectives.

52. Planning involves:
 Establishing priority
 Establishing goals and objectives
 Identifying intervention activities that will
accomplish objectives

53. Criteria for priority:
Severity
 Feasibility
 Magnitude
 Community concern
 Political concern

54. Establishing goals and objective:
 Specific
 Measurable
 Achievable
 Reliable
 Time targeted

55. Implementation
Implementation is putting the plan into action.
Implementation is often referred to as the action phase of the
nursing process.
In community health nursing implementation is not nursing
action or intervention but it is a collaborative
implementation by the clients.

56. The nurse and clients should have a clear idea of who, what,
why, when, where and how.
Example: What are each person's responsibilities?
Do they know when and where activities will occur?

57. Evaluation
It is the final component of the nursing process. The nursing
process is not complete until evaluation takes place.
Evaluation is an act of appraisal in which one judges value
in relation to a standard and a set of criteria.

58.  Ask how effective the service was?
 Whether client's needs truly met?
 If not, why not?

59. Community Assessment
Community assessment is a key element in the nursing
process. When the community is thought of as the client,
the goal is to identify groups of people who are at
increased risk for health problems.

60. The community assessment process
1. Define the community that is the focus of the
assessment process.
2. Describe the people socio- demographic elements that
help describe the population of the community, e.g.
Sex
 Age
Income
Education, etc.

61. 3. Describe the structures that organize the community:
Family structures
Voluntary structures
Informal power structures
4. Identify health risk factors

62. 5. Risk factors in the community can be made using vital
statistics, clinic records, and reports of communicable
diseases.
6. Identify resources for dealing with risk factors,
Resources include the health department, NGOs,
social organizations, and other voluntary agencies.

63. Community Nursing Diagnosis
The community nursing diagnosis has a different
starting point. It uses the list of health risk factors and
converts them to a nursing diagnosis.

64. Some of the community nursing diagnosis include:-
High rate of infants with low birth weights and related
factors
Low levels of participation in prenatal clinics, etc.
High teenage pregnancy rates related to poor sex
education programs in the community.

65. Poor prenatal nutrition related to cultural practices
High school dropout among school girls related to
unplanned pregnancy
Poor nutritional status of under five children
Knowledge deficits regarding weaning diet.

66. Planning
Planning involves thinking on what will be done to
prevent and manage the health problems.
In all phases of Community activities we should involve
community.

67.  The process includes a survey of the resources identified
in the assessment phase, a discussion of the actual
availability of the resources and a plan to gain access to
them.

68. Implementation: -
Implementation is put the planning into action, monitoring
the activities.

69. Evaluation
Evaluation is the process by which the impact of the
program is assessed.
 Process evaluation: The way in which the various
processes of a program are carried and evaluated by
comparing with a predetermined standard.
 Outcome evaluation - This is concerned with the end
results.

70. There are many benefits to conducting a
community assessment.
The following are ways an assessment can benefit your
community; you can work with other organizations in your
community to identify additional benefits.
There is increased understanding within the community about
its needs, why they exist, and why it is important for the needs
to be addressed.
Community members have the opportunity to share how the
needs impact the quality of life for the larger community.

71. Community appointment is increased because members
from different parts of the community are included in
discussions about needs, assets, and the community’s
response.
The community’s strengths and weaknesses are identified.
There is a record of the resources currently available
within the community that can be leveraged to improve
the quality of life for community members.

72. Communities identify the asset gaps that exist in their
communities.
Community members have an increased awareness of how
they can contribute to their community’s assets.
Community organizations can use the information about
community needs to assess their service delivery
priorities.

73. There is data for making decisions about the actions that
can be taken to address community needs and how to use
the available assets.
Data can be used to inform strategic planning, priority
setting, program outcomes, and program improvements.

74. There are six steps to conducting a
community assessment.
The six recommended steps in the process of planning and
conducting a community assessment are:
1. Step 1: Define the Scope
2. Step 2: Go Solo or Collaborate
3. Step 3: Collect Data
4. Step 4: Determine Key Findings
5. Step 5: Set Priorities and Create an Action Plan
6. Step 6: Share your Findings

75. Needs and Assets
Before you can begin the six steps of conducting a
community assessment, it is important to understand the
terms "community needs" and "community assets.
“The Work Group for Community Health and Development
defines community needs as "the gap between what a
situation is and what it should be."

76. They define community assets as "those things that can be
used to improve quality of life." Understanding these
terms will help you get started on your quest to assess
what your community needs and what its assets are.

77. Community needs are the gaps between
what a situation is and what it should be.
One goal of a community assessment is to develop an
informed understanding of the gaps or needs that exist
within a community and their impacts upon the
community’s members.
Low high school graduation rates mean that there is need
to find effective ways to keep kids in school.

78. Community needs can affect a large or small number of a
community’s members. This may include families,
individuals, youth, seniors, parents, businesses,
community organizations, and faith-based organizations –
essentially, anyone who claims membership in the
community.
.

79. If community needs affect a large number of community
members, there will likely be more support for addressing
the needs.
Sometimes community needs are referred to as “community
problems.”

80. Community assets are those things that
can be used to improve quality of life.
Another goal of a community assessment is to develop a
detailed analysis of community assets, or resources, that
currently exist in the community and can be used to help
meet community needs.

81. Community assets include organizations, people,
partnerships, facilities, funding, policies, regulations, and
a community’s collective experience.
Any positive aspect of the community is an asset that can
be leveraged to develop effective solutions.

82. Two approaches can be used to identify
community assets:
1. Identify the assets that are already known for supporting
the community need.
This includes community organizations and individuals that
currently provide services to community members or have
provided financial support to address the need.
Organizations that provide after-school programs to help youth
graduate on time would be included in a community
assessment focused on keeping kids in school.

83. Clinics that offer free medical services to low-income
seniors should be identified in a community assessment of
seniors who need medical financial assistance.

84. 2. Build upon the experiences of other communities to
highlight resources that may be available.
The community assessment can identify communities with
similar demographics that have successfully addressed
similar needs and can be used as a blueprint (first
planning) for identifying assets.