CPHC, primary health care and its details

CPHC, primary health care and its details

• 2.
  Comprehensive Primary Health
• 3.
  Introduction  In thelast few decades, concerted efforts have been made towards improvement in provision of quality healthcare in the country. India has adopted a holistic approach towards healthcare to realize the mantra of: “May All be Happy, May All be Free from Illness”
• 4.
  Government has launchedambitious Ayushman Bharat Programme in 2018. The component of Ayushman Bharat - Health and Wellness Centers (AB-HWCs) is the platform to deliver Preventive, Promotive and Comprehensive Primary Health Care (CPHC). The Primary Health Care approach is a priority for ensuring accessible, affordable and quality health care.
• 5.
  Primary health care Primary Health Care as defined by the World Health Organization (WHO) in 1978 is…  Essential health care; based on  practical,  scientifically sound, and  socially acceptable method and technology….  …….made universally accessible to individuals and families of the community through their full participation….  ……at a cost that community and country can afford to maintain every stage of their development in the spirit of self determination.
• 6.
  Cont… Definition Primary health careis 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
• 7.
  What is therein Primary Health Care..????? Primary Health Care includes:  Primary Care (physicians, midwives & nurses);  Health promotion, illness prevention;  Health maintenance & home support;  Community rehabilitation;  Pre-hospital emergency medical services… and…  Coordination and referral to other areas of health care.
• 8.
  Cont.…  It isthe first level of contact with the health system to promote health, prevent illness, care for common illnesses, and manage ongoing health problems.  Primary Health Care involves concerted effort to provide rural population of developing countries with least bare minimum of health services.  Some services are also provided community and hospitals  Primary Health Care is different in each community depending upon:  Needs of the residents;  Availability of health care providers;  The communities geographic location; &  Proximity to other health care services in the area.
• 9.
  Elements of primaryhealth care 1. Education about prevailing health conditions and methods to prevent and control them 2. Promotion of food supply and proper nutrition 3. Adequate water supply and basic sanitation 4. Maternal and child health care with family planning 5. Immunization against major infectious diseases 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Provision of essential drugs
• 10.
  Principles of primaryhealth care Equitable distribution Community participation Intersectoral coordination Appropriate technology
• 11.
  Primary Health Careto CPHC Primary care has been very selective in the past, covering less than 20% of primary health care needs. This has made primary care less responsive to felt health care needs and created the image of the under-performing system. Primary Health Care is necessarily comprehensive- addressing primary care for all of reproductive and child health, communicable, and non-communicable diseases and accidents and injuries through appropriate health communication, technologies and care provision.  Comprehensive primary health care package will also include nutrition, geriatric health care, palliative care and rehabilitative care services. To denote this important policy change, facilities which start providing the larger package of comprehensive primary health care will be called Health and Wellness centers.
• 12.
  Current Scenario ofHealth in India  The Under-five Mortality has come down to 39/1000 live births in 2016 in comparison to 74.3 in 2005.  Infant Mortality Rate is 33/1000 live births in 2016 and used to be 58/1000 live births in 2005.  Similar reduction is visible in Maternal Mortality Ratio that has declined from 234/one lakh live births in 2004-06 (SRS 2008) to 130/one lakh live births in 2014- 16 (SRS, 2018).  This decrease is visible on account of various initiatives by the government such as- the universal immunization program, several initiatives for improving maternal, child and reproductive health under the National Health Mission etc.
• 14.
   Ten tofifteen years ago communicable diseases along with maternal and nutritional disorders contributed to the major disease burden. We are now seeing a change in this disease pattern.  Death from the four major NCDs–Cancer, Cardio Vascular Diseases (CVD), Diabetes, and Respiratory Diseases accounts for nearly 62% of all mortality among men and 52% among women – of which 56% is premature.  However, high levels of maternal and child mortality continue to exists in many states.
• 15.
   Despite thechanging disease pattern, the public health care delivery system focussed only on provision of care related to reproductive, maternal, new born and child health and few communicable diseases under the disease control programmes. These conditions together represent merely 15% of all morbidities.  Majority health care is sought at the level of District Hospitals as primary health centres and sub-centres are not providing a wider range of services.  For the rest of the services people are availing care from the private sector that leads to high Out of Pocket Expenditure (OOPE) on healthcare.
• 17.
  Why is PrimaryHealth Care (PHC) Important?
• 18.
  Need For ComprehensivePrimary Health Care  To completely address the morbidity burden,  Reduce OOPE,  Improving the utilization of government health facilities and for ensuring continuum of care  The Government of India has recently implemented the holistic programme of the “Ayushman Bharat".
• 19.
  Cont...  It comprisesof two inter-related components.  The first component involves upgrading of 1.5 lakh Sub Health Centres (SHCs) and Primary Health Centres (PHCs) to Ayushman Bharat Health and Wellness Centres for the delivery of CPHC.  The second component comprises of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) which aims to provide financial protection of up to Rs. 5.0 lakh per annum for secondary and tertiary care to about 40% of India’s socially vulnerable and low-income households.
• 20.
  Comprehensive Primary HealthCare Triangle
• 23.
  PRINCIPLES of CPHC Principlesof CPHC-  Equity  Accessibility  Community participation  Holistic care  Intersectoral Collaboration  Cultural Sensitivity  Primary care focus
• 24.
  Cont..  Preventive care Health promotion and Education  Quality and accountability  Sustainability  Multi-sectional approach  Universal health coverage
• 25.
  Elements of CPHC Continuum of care  Telehealth / Referral systems  Expanded service delivery  Expanding human resources  Medicines and diagnostics  Community mobilization and health promotion  Infrastructure development  Financing and provider payment reforms  Robust IT systems  Partnerships  Knowledge sharing
• 26.
  CPHC TROUGH SC/HWC  Expanded service range  Preventive and Health promotion services  Non – communicable disease management  Mental health services  Technology integration  Community engagement  Health workforce development  Medicine dispensation  Health and wellness camp  Emergency and referral services  Quality assurance
• 27.
  Health team  Midlevel provider (Team leader) -Practitioner from the ayurvedic system or - a Nurse  1st ANM  2nd ANM OR MPW (Male)  ASHAs of the area
• 28.
  SERVICES  Preventive ,Promotive, Rehabilitative and Curative care  RMNCH+A  Communicable disease  Non – Communicable disease  Ophthalmology  ENT  Dental  Mental and geriatric care  Palliative care  Treatment for acute simple medical conditions  Emergency and trauma services