Primary health care (PHC) is based on five principles: accessibility of health services to all people, full community participation, emphasis on preventive rather than curative services, use of appropriate technology, and integration with social and economic development. The nurse plays many roles in PHC, including healthcare provider, educator, manager, researcher, evaluator, coordinator, and change agent. As an educator and change agent, the nurse teaches communities about health and promotes behavioral changes.

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2. PRIMARY HEALTH CARE
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3. Definition of PHC
“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 that the community and country can
afford to maintain at every stage of their
development in the spirit of self reliance and
self determination.”
Alma Ata Declaration (1978)
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4. Principles of PHC
PHC is based on five major principles
• Accessibility of health services
• Full individual, family and community participation
• Emphasis on preventive rather than curative services
only.
• Appropriate methods and technology.
• Integration of health development with social and
economic development.
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5. Accessibility of health services
• The term “accessibility” refers to the health
care system that can be reached and used by
all people. This means that health post must
be located in places where people can go
easily.
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6. Accessibility of health services
• It also means that health care must be
available to all people regardless of their age,
sex, religion, caste, level of income, level of
education, or place of residence.
• People living in rural areas have as much the
same right to health care as the people living
in cities.
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7. Accessibility of health services
• The health post and hospitals should be
located in convenient and appropriate places
as well as have trained health care worker.
• But the problem in Nepal is a shortage of
trained health care workers throughout the
country. As a result, health care is not yet
available to all people in Nepal.
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8. Full individual, family and community
participation
Community participation is “the process by
which individuals and families assume
responsibility for their own health and welfare
and for those of the community, and develop
the capacity to contribute to their and the
community’s development.”
(WHO and UNICEF)
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9. Full individual, family and community
participation
• To have full community participation, the
community must be involved in all aspects of
the project.
• This means the community has to determine
what its problems are and decide which
problem is to work on.
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10. Full individual, family and community
participation
• Then, using its own power, money and
resources, implement the project, and
evaluate its effectiveness.
• Such a project succeeds only when the
community takes full responsibility for every
part of the process.
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11. Emphasis on preventive and promotional
rather than curative services.
• Preventive and promotional health services
teach people to remain clean and prevent
diseases from occurring.
• Diseases can result from drinking
contaminated water, poor hygiene and
sanitation, many people living together in a
small house, inhaling smoke from cigarettes of
chulos and many other cause.
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12. Emphasis on preventive and
promotional rather than curative
services.
• In the USA and Britain, after preventive health
measures were taken, the morbidity and
mortality rates decreased enormously. This
was long before drugs were invented to
prevent or treat the diseases.
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13. Emphasis on preventive and
promotional rather than curative
services.
• Preventive and promotional services include
providing clean water to communities,
sanitation facilities, such as latrines and
sewers; adequate housing; the isolation of ill
people from other family members; the
availability of adequate amount of nutritious
food and vaccination programmes.
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14. Emphasis on preventive and
promotional rather than curative
services.
• Curative services should be provided together
with preventive and promotional services.
• The nurse sometimes needs to treat the
illness and teach patients and their families
how to prevent the illness from recurring.
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15. Emphasis on preventive and
promotional rather than curative
services.
• The community has to be reminded that
curative services are expensive for the sick as
well as for the community.
• It is expensive for the community because sick
people cannot work and hence cannot earn
money, they cannot grow food, or care for
their children.
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16. Emphasis on preventive and
promotional rather than curative
services.
• The more the sick people, the more doctors,
nurses, and hospitals a country will need.
• All these services are costly. Hence preventive
and promotional services are found to be
cheaper in the long run and easier to provide
than curative services.
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17. Appropriate methods and technology
• This principle includes appropriate methods
and technology to implement all elements of
PHC.
• For example, building a health post by using
locally available materials, such as bricks and
wood rather than importing expensive cement
and other supplies that the community cannot
afford, or using and existing building instead
of constructing a new one.
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18. Appropriate methods and technology
• Appropriate technology means having basic
and easily repairable equipment rather than
having an expensive one that needs special
training and has complex parts to repair.
• People are more likely to build latrines if they
are taught how to make them with locally
available materials like stone, wood or
bamboo. This is cheap and easy to make.
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19. Appropriate methods and technology
• Depending on the situation nurse can use
simple methods and Medias to teach people.
• Flash cards, Puppet shows, dramas, posters
and local materials are used as cheap and
effective ways to teach a topic.
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20. Integration of health development
with social and economic
development
• Improvement in health cannot take place
without improving the social and economic
status of the people.
• Integration with social and economic
development implies a multisectoral approach
to health.
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21. Integration of health development
with social and economic
development
• The other sectors include agriculture, animal
husbandry, housing, water supply, sanitation
communication-education and Mass Media,
cooperatives and banks, social and women’s
welfare etc.
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22. Elements of PHC
• Education on prevailing health problems and
the methods of preventing and controlling
them
• Promotion of food supply and proper nutrition
• An adequate supply of safe water and basic
sanitation
• Maternal and child health including family
planning
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23. Elements of PHC
• Immunization against major infectious diseases
• Prevention and control of locally endemic
diseases
• Appropriate treatment of common diseases and
injuries
• Providing essential drugs
• Promotion of mental health
• Dental health
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24. Education on prevailing health problems and
the methods of preventing and controlling
them
• Education For Health is one of the potent
methodologies for information dissemination.
• It promotes the partnership of both the family
members and health workers in the
promotion of health as well as prevention of
illness.
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25. Promotion of food supply and proper nutrition
• One basic need of the family is food. And if
food is properly prepared then one may be
assured healthy family.
• There are many food resources found in the
communities but because of faulty
preparation and lack of knowledge regarding
proper food planning, Malnutrition is one of
the problems that we have in the country.
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26. An adequate supply of safe water and basic
sanitation
• Water is a basic need for life and it is
necessary for the maintenance of healthy
lifestyle.
• Safe Water and Sanitation is necessary for
basic promotion of health.
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27. Maternal and child health including 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.
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28. Immunization against major infectious diseases
• This program exists to control the occurrence
of preventable illnesses especially of children.
• Immunizations on poliomyelitis, measles,
tetanus, diphtheria and other preventable
disease are given for free by the government
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29. Prevention and control of locally endemic diseases
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30. Appropriate treatment of common diseases and
injuries
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31. Providing essential drugs
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32. Promotion of mental health
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33. Dental health
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34. Role of Nurse in PHC
• Health care provider
• Educator
• Manager
• Researcher
• Evaluator
• Coordinator
• Change agent
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35. Health care provider
As a health care provider the nurse primarily
provides curative care in hospitals. Preventive
and promotional care becomes secondary in
hospitals. But in the community, prevention
and promotion of health come first. Curative
services are provided to the community, when
needed.
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36. Educator
• As an educator the nurse performs the role
both in the hospital, and in the community.
Health cannot be obtained or maintained if
people don’t know that they need to make
appropriate changes in their lives.
• Because nurses come in contact with people
every day, they know what the community
needs. Therefore a nurse can teach the
community easily and constantly.
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37. Manager
• As a manager the nurse has to supervise and
control different aspects of her service.
• She helps to make sure that good work is
being done by the people she supervises.
• She maintains record properly, sees that
equipment is working and supplies are up to-
date, and that people are committed to their
jobs and are productive and happy in their
work.
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38. Researcher
As a researcher the nurse does scientific and
systematic investigation of the services or
problems of the community to learn more
about it, so that changes and improvements
can be made.
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39. Evaluator
• As an evaluator nurse evaluates the work done to
improve its quality and effectiveness in the
community.
• Evaluation should be done continuously to
determine the changes, no matter what role she
is performing, whether she is providing health
services, doing research, or promoting change in
the community.
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40. Coordinator
• As a coordinator the nurse needs to work with many
different sectors in society to increase the effectiveness
of promoting health programmes.
• In the community she has to work with the poorest to
the most influential person, so that she addresses the
needs of the majority of people.
• She also needs to work with political leaders as well as
different development sectors, such as agriculture,
banking, industry and education to promote the
development of the community in all areas.
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41. Change agent
• As a change agent the nurse helps people to
accept appropriate changes in their lives so
that their lives become easier and better.
• Change is very difficult for most people to
accept. The nurse needs to be patient and
persistent when she is trying to change the
attitudes and behavior of people.
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42. Change agent
• These qualities are especially important when she
is trying to change behavior that involves basic
values and beliefs, such as what number of
children a family should have.
• Nurses need to be change agent in their
profession as well. She should constantly develop
and implement better ways to provide qualitative
nursing care to improve the health of individuals,
families and communities.
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