The document discusses the concept of primary health care (PHC). It defines PHC as essential care based on scientifically sound and socially acceptable methods that is universally accessible to communities through their participation and at a cost they can afford. The key elements of PHC include education on health problems, nutrition, water and sanitation, maternal and child health services, immunizations, treatment of common diseases and injuries, and essential drugs. Factors that contributed to the development of PHC in Tanzania include policies of self-reliance and rural development as well as diseases being largely preventable. The document outlines indicators for evaluating PHC programs and provides the current status of some PHC indicators in Tanzania based on DHS data from 2010.

1. Concept of Primary Health
care
DR MALIMU -MUHAS/KIU

2. Learning objectives:
At the end of the session the participants will be able to:
1. Define what is primary health care (PHC)
2. Describe the Elements, principles and strategy of PHC
3. Outline the factors that contributed to evolvement of PHC
4. Describe the indicators for evaluating PHC
Find out the current status of PHC in Tanzania
6. .Describe the linkage between PHC and HFA 2020

3. Definition of PHC
“Is essential care that is based on scientifically sound and
socially acceptable methods and technology that is made
universally accessible to individuals and families in the
community through their full participation and at a cost they can
afford at every stage of development and spirit of self reliance”.

4. Differentiate
 Primary Health Care
 Primary Medical Care

5. Context- Primary health care
Elements
1. Education on prevailing health problems and methods of
preventing and controlling them
2. Provision of food supplies and promotion of proper nutrition
3. Adequate supply of safe water and provision of basic
sanitation
4. Maternal and child health care, including family planning
5. Immunization against the major infections diseases
6. Prevention and control of locally endemic and epidemic
diseases
7. Appropriate treatment of common disease and injuries
8. Provision of essential drugs and supplies
Tanzania add:
9. Provision of Mental Health
10. Provision of Oral Health

6. Factors that contributed to evolvement of PHC
in Tanzania
1. Policy of socialism and Self reliance, emphasizes
rural development; equity in distribution of basic
human needs (BHN)
2. Pattern of diseases are preventable
3. Increase in health infrastructures not synchronous
with population increase
:. PHC for every village instead of a dispensary for each
village

7. Factors which contributed to evolvement of PHC at
At Global level
1. Failure of the trickle down theory of economic
development
2. Maurice King's ideology of accessibility of
facilities
3. Success of barefoot doctors in China, Cuba,
and Tanzania
4. Pressure from Donors
5. Population growth not synchronizing with
increase in basic services

8. Strategies for implementation of
PHC
1. Training and use community members as health
workers
2. Community participation in planning and
implementing health programmes
3. Inter-sectoral coordination, particularly between
agriculture, education, housing, sanitation and water
supplies
4. Collaboration between health organizations,
particularly governmental and NGO , traditional and
private practitioners.
5. Decentralization of MOH planning and the
strengthening of district health system

9. Milestones of PHC in
Tanzania
 1967- Started with Arusha
Declaration emphasizing rural
development and distribution of
basic human Needs (BHN)
 1972 – Villagization &
Decentralization policy
 1974- Mtu ni Afya Campaign
 1977- Universal Primary education
(UPE)

10. Milestones of PHC in
Tanzania
 1974 & 1977 MCH and T.B and Leprosy
programs started country wide
 Private Practice banned in Tanzania
 1978- Alma Ata Declaration of PHC
 1980 – Long-term Health policy
established
 1983 – Formulation of Guidelines for
implementation of PHC
 1992-New PHC strategy
 1993- Health Sector Reform and Cost
sharing

11. Principles underlying PHC
1. Equity
2. Community involvement
3. Focus on prevention
4. Appropriate technology
5. Multi-sectoral approach

12. INDICATORS FOR EVALUATING PHC
 HEALTH POLICY INDICATORS (1)
 SOCIAL AND ECONOMIC INDICATORS(2)

INDICATOR OF PROVISION OF HEALTH CARE (3.)
 INDICATOR OF COVERAGE (4)
 HEALTH STATUS INDICATORS(5)
Nutritional status

13. HEALTH POLICY INDICATORS (1)
1. Political commitment
2. Allocation of Resources
3. Degree of Equity in distribution of Resources
4. Level of community Involvement
5. Establishment of suitable managerial & National
Strategy for HFA
6. Political Manifestations of International Political
commitment to HFA, 2020.

14. SOCIAL AND ECONOMIC INDICATORS(2)
1. Rate of population increase
2. Gross National product (GNP) and Gross
Domestic Product (GDP)
3. Income distribution
4. Work availability
5. Adult literacy rate
6. Adequacy of housing expressed as the No. of
people per room
7. Per capita energy availability.

15. INDICATORS FOR EVALUATING PHC
INDICATOR OF PROVISION OF HEALTH CARE (3.)
1. Availability
2. Physical accessibility
3 Economic and cultural accessibility
4 Utilization of services
5 Indicators of assessing quality of care

16. INDICATOR OF COVERAGE (4)
1. Level of "healthy literacy"
2. Availability of safe water in the home or within short
distance
3. Adequate sanitary facilities in the home or immediate
vicinity
4. Access of mothers and children to local health care
5. Birth attendance by trained staff
6. Percentage of immunized children
7. Availability of essential drugs throughout the year
8. Accessibility of Referral Institutions
9. Ratio of population to different kinds of health worker in
PHC and referral level
s.

17. HEALTH STATUS INDICATORS(5)
1. % Newborns with Birth weight <2500g
2. % Children with Weight/Age according to norms
3. Indicators of psychosocial development in
children
4. Infant Mortality Rate
5. Child mortality rate
6. Under five year mortality Rate
7. Life expectancy at a given age
8. Maternal mortality rates
9. Disease specific mortality rates
10. Disease specific morbidity Rates
11. Disability Rates
12. Indicators of social & mental pathology (suicide, drug
addiction, juvenile delinquency, alcohol, smoking)

18.  What is the Current status of PHC Indicators in
Tanzania 2010?
 Ref; DHS/2010 and other MOHSW documents.

19. Status of PHC
Nutritional status
1. % Newborns with BWT <2500g …..
2. % Children underweight (Wt/Age) <2SDs …..
% Children (stunted) (ht/Age <2SDs …..
% Children (wasted) wt/ht <2SDs ……
Mortality
3. Infant Mortality Rate …/1000 live births
5. Child mortality rate
6. Underfive year mortality Rate ……/1000
7. Life expectancy at birth …… years
8. Maternal mortality rate ……./100000 live births

20. Current Status of PHC
Basic Education
1. % of women with completed Primary education ……..
% of men with completed Primary education ……..
% of girls 6-12 years attending school ……..
%of boys 6-12 years attending school ……..
% of women who are 15-49 who are literate ………..
Child Health
% mothers who received TT during pregnancy ………
% Children 12-23 with measles vaccination ………
% of Children 12-23 fully vaccinated ……..

21. Recent Status of PHC
Women’s health
% of births with medical prenatal care ………
% of births with prenatal care in 1st trimester ……..
% of births with medical assistance at delivery ……..
% of births in a health facility ……..
% of births at high risk ………
Contraceptive prevalence rate(any method) ………
Child Health
% children with diarrhea who received ORS ……….
% Children with ARI seen by a medical person ……….

22. What is the linkage between PHC
and Health for All 2020?
 Began in 1977 when WHA passed
resolution No. 30.43 of HFA by 2000
 Endorsed at the Alma Ata Conference
of 1978 that PHC will be the strategy
for attainment of HFA 2000,
 In 1995 WHO reviewed HFA
achievements and passed Resolution
No. 48.16 for renewed policy of HFA
2020

23. What is Health for All
2020?
 HFA is a social goal
 Health is a human right
 Emphasizes equity in health
 Health is part and parcel of socio-economic
development
 Individuals, families and communities must
take a leading role in changing their life
style and behavior so as to be in a good
state of health ultimately contribute towards
Socioeconomic development

24. EPIDEMOLOGY
 The END
 Thank you

25.  What are Non communicable disease
 Causes
 Prevention and control