This document outlines the history, definition, principles and elements of primary health care (PHC). It discusses key events that advanced PHC such as the Alma-Ata and Astana Declarations. PHC aims to provide essential health services universally and equitably through community participation using appropriate technology. It seeks to address the broader social determinants of health and achieve the highest level of health for all.
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
This is the product of compilation from various sources. I would like to acknowledge all direct and indirect sources although they have not been mentioned explicitly within the document.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
This is the product of compilation from various sources. I would like to acknowledge all direct and indirect sources although they have not been mentioned explicitly within the document.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Health policy is a national task based on meeting community needs and respecting social, geographical and cultural variations. Ministry of health and population (MOHP) is the formal organization responsible for health policy formulation. The Egyptian health care system faces multiple challenges in improving and ensuring the health and wellbeing of the Egyptian people. The system faces not only the burden of combating illnesses associated with poverty and lack of education, but it must also respond to emerging diseases and illnesses associated with modern, urban lifestyle. Emerging access to global communications and commerce is raising the expectations of the population for more and better care and for advanced health care technology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
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Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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Primary Health Care
1.
2. OUTLINE:
1. INTRODUCTION
2. HISTORY
3. DEFINITION
4. HEALTH STATISTICS
5. ALMA-ATA DECLARATION
6. ELEMENTS OF PHC
7. PRINCIPLES OF PHC
8. NATIONAL HEALTH POLICY
9. ASTANA DECLARATION
10. PRIMARY HEALTH CARE PERFORMANCE INITIATIVE
11. CONCLUSION
12. REFERENCES
2
3. Introduction:
A concept introduced by WHO. It is an essential health care system with
a concept that addresses the broader determinants of health, focusing
on the comprehensive and intertwined aspects of physical, mental and
social wellbeing.
It is a delibrate and well thought out concept designed to address the
basic issues (determinants of health) through collaborative and simple
methods.
It is people-centred with whole-of-society approach.
3
4. Brief History
▪ Barefoot doctors 1968.
▪ The barefoot doctor system increased the ratio of doctors to rural residents from 1: 8000 before
the Cultural Revolution to 1: 760 between 1969 and mid1974. Increased life expectancy of 35 to
68 years. An infant mortality drop "from 200 to 34 deaths per 1000 live births.
▪ WHO international conference on primary health care that took place at Alma-Ata from
September 6 to 12, 1978.
▪ *Selective Primary Health Care.
▪ Professor Olikoye Ransome-Kuti pioneered the comprehensive national health policy based on
PHC, 1988
▪ In 1992, the National Primary Health Care Development Agency (NPHCDA) was established to
ensure that the PHC agenda is continued and sustained
4
5. Definition:
▪ Primary Health Care is defined as 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
5
6. Definition:
▪ "PHC is a whole-of-society approach to health that aims at
ensuring the highest possible level of health and well-being,
and their equitable distribution by focusing on people’s needs
and as early as possible along the continuum from health
promotion and disease prevention to treatment, rehabilitation
and palliative care, and as close as feasible to people’s
everyday environment."
- WHO and UNICEF, A vision for primary health care in the 21st
century: Towards UHC and the SDGs.
6
7. Health Statistics:
2017 Statistics by WHO and World Bank revealed 5 million people die
annually from poor quality health care.
Up to a 100 million people are pushed in extreme poverty as a result of
out-of-pocket spending.
Up to 50% of people in the world can not acccess essential health care
services.
7
8. The Global Picture
8
INDICES
Total population
(000s)
Life expectancy
at birth (years)
Healthy life
expectancy at
birth (years)
MMR/100k
live births
Births by skilled
birth personnel (%)
Under 5MR/1000
live births
NMR/1000
live births
WHO region 2019 2019 2019 2017 2014–2020 2019 2019
*African Region 1 091 759 64.5 56.0 525 65 74 27
Region of the Americas 1 009 950 77.2 66.2 57 96 13 7
South-East Asia Region *2 001 946 71.4 61.5 152 81 32 20
European Region 930 167 78.2 68.3 13 99 8 4
Eastern Mediterranean
Region 712 276 69.7 60.4 164 81 46 25
Western Pacific Region 1 930 867 77.7 68.6 41 98 11 6
11. ▪ 1. The conference strongly affirms that health, which is a state of
complete physical, mental, and social well-being and not merely
the absence of disease of infirmity, is a fundamental human right.
▪ 2. The existing gross inequality in the health status of the people,
particularly between developed and developing countries as well
as within countries, is politically, socially and economically
unaccceptable and is, therefore of common concern to all
countries.
11
The Alma-ata Declarations
12. ▪ 3. The people have a right and duty to participate individually and
collectively in the planning and implementation of their health
care.
▪ 4. PHC as defined (definition intially stated).
▪ 5. Attain an acceptable level of health for all the people of the
world by the year 2000 through a fuller and better use of the
world’resources, redirected from military conflicts and related
developments to an affordable health for all.
12
The Alma-ata declarations continued:
13. Elements of PHC:
▪ Health promotion and disease prevention (Education)
▪ Prevention and control of Locally endemic diseases
▪ Provision of Essential medications
▪ Maternal and child health care
▪ Expanded immunization programme
▪ Promotion of food supply and proper Nutrition
▪ Appropriate Treatment of common diseases and injuries
▪ Adequate supply of Safe water and basic sanitation
▪ *Dental health *Mental health
13
14. Principles of PHC:
Ward Health Service System and the Ward Minimum Health Care Package.
14
1. Equitable distribution of resources
Health Facility Levels of Management Expected numbers
Health posts Village Development Committe
(VDC)/Community development
committee (CDC)
1 per 500 persons
Primary health clinics Local government and ward
development committee (WDC)
1 per 2000 - 5000 persons
Primary health centers Local government 1 per 10,000 - 20,000
15. Principles of PHC:
The ward health service system promoted community participation, engaging
WDC/VDC
CHEWs
JCHEWS
*Community Resource Persons (CORPs)
*These are all trained Community Volunteers including, TBA, VHW and other
community based service providers that have been duly trained and are
recognised by the LGA.
15
2. Commuity participation
16. Principles of PHC:
The World Health Organization and the Public Health Agency of Canada define
intersectoral action for health as “actions undertaken by sectors outside the health
sector, possibly, but not necessarily, in collaboration with the health sector, on health
or health equity outcomes or on the determinants of health or health equity.”
Political commitment to an intersectoral initiative is imperative as it help reduce
opposition from outlier ministries whose primary goals may conflict with public health.
Collaboration extends beyond government agencies to organizations in diaspora,
NGOS, human right society, etc.
16
3. Intersectoral collaboration:
17. Principles of PHC:
17
4. Appropriate technology
This refers “methods, procedures, techniques and
equipment that are scientifically valid, adapted to local
needs and accepted to those who use them and those
for whom they are used, and that can be maintained
and utilized with resources the community or country
can afford”
18. Principles of PHC:
18
Health posts minimum
Medical equipment: Dressing forceps - 2, Fetoscope - 1, Geo Style Vaccine
Carrier (GSVC) - 2, Ice Packs - 4 per GSVC, Injection safety box - 1, Kidney dish
- 2, ORT Demonstration Equipment - 1 set (1 set = Cup, jug, wash basin, towel,
bucket, standard beer or/and soft drink bottles), Scissors - 2, Solar Refrigerator -
1, Sphygmomanometer - 2, Stethoscope - 2, Tape rule - 1, Thermometer - 1,
Weighing scale - 1.
Other Requirements: Bicycle 1, Motorcycle 1, Community assigned canoe (in
riverine areas) 1, Mobile phone 1.
4. Appropriate technology continues:
19. Principles of PHC:
19
4. Appropriate technology continues...
Primary health clinic minimum:
Medical equipment:
Adult weighing scale - 2, Ambu-bag - 1, Artery forceps - 2, baby weighing scale - 1, Bed pan - 4, Bed
sheets - 2 per bed, Clinical thermometers - 2, Cold boxes - 1, Cord clamps - 1 pack Curtains - 1 per
window, Cuscos speculum - 2, Disposables (facemask, gloves tc) - 1 pack each, Dissecting forceps - 2,
Dressing forceps - 2, Dressing trolley - 1, Enema kits - 2, Episiotomy scissors - 2, Foetal stethoscope - 2,
Instrument tray - 2, Kidney dishes - 4, Kidney dish - 2 Lanterns, Buckets - 2 each, Multistix test kits - 1
pack of 100, Needle holding forceps - 2 ORT Demonstration Equipment - 1 set (Cup, jug, wash basin,
towel, bucket, standard beer or/and soft drink bottles), Refrigerator - 1, Scissors - 2, Sims speculum - 2,
Solar Refrigerator - 1, Sphygmomanometer - 2, Stadiometer - 1, Stethoscope - 2, Sterilisation equipment
- 1, Stove - 1, Suction machine or (mucus extractors) -1, Tape rule - 1, Urinary catheter - 2 of each size,
Geo Style Vaccine Carriers (GSVC) - 2, Ice Packs - 4 per GSVC.
Other requirements: Means of communication; e.g. mobile phone or communication radio (1), Motorcycle
(1), Bicycle (1), Small motor boat for riverine areas (1).
20. Principles of PHC:
20
4. Appropriate technology continues...
Primary health center minimum:
Equipments:
Significantly more extensive but generally easy maintain low tech. equipments
*kindly refer to MINIMUM STANDARDS FOR PRIMARY HEALTH CARE IN NIGERIA
GUIDELINES by NPHCDA
21. The National Health Policy:
▪ Overall objective is to improve accessibility to health at all levels
with emphasison PHC.
▪ Approaches adopted:
▫ Promoting community participation
▫ Enhancing intersectoral collaboration
▫ Improving functional integration across all health levels
▫ Strenthening managerial process of development at all levels
21
Established the NPHCDA in 1992 to oversee its objectives
22. Astana Declaration:
▪ Forty years after the declaration of alma-ata leaders and stakeholders
representing government, the private sector, and civil society returned
to Kazakhstan.
▪ The Global Conference on Primary Health Care, which took place in
Astana in October 2018, reaffirmed primary health care as the most
effective and efficient approach to achieve Universal Health Coverage
and the Sustainable Development Goals.
22
23. Astana declaration continued:
▪ Declarations:
1. Make bold poplitical choices for the health across all sectors
2. Build sustainable PHC
3. Empower individuals and communities
23
24. This declaration consists of 14 items (levers) that
are geared towards accelerating the advancement
of health for all (UHC) invariably bringing us closer
to achieving SDGs 2030 to which health (PHC)
plays a central role.
The Astana Declaration:
24
25. Primary Health Care Performance Initiative (PHCPI):
Due to paucity of proper data and monitoring PHCPI was initiated in
partnership with 23 countries to develop a Vital Signs Profile: an actionable
data showing the strengths and weaknesses of primary health care in the
health system.
With PHCPI we can pinpoint where action is needed most in each country,
thereby helping leaders set strategic priorities, leverage existing resources
efficiently and effectively, and accelerate progress toward affordable,
sustainable and equitable health for all.
PHCPI
25
26. The four main pillars:
▪ Financing - Per human capita
▪ Equity - Resources
▪ Performance - Community participation, surveilance, reporting
system and quality assurance/improvement
▪ Capacity - Policy creation and implimentation/enforcement,
monitoring, infrastructure.
PHCPI
26
27. Conclusion
▪ Health a fundamental human right.
▪ PHC is the foundation of the health care system and is the
minimum package of healthcare that should be provided to
every individual and community.
▪ PHC system effectively eliminates inequality, ensure
improvement in quality of health care services and coverage, all
in a cost efective manner.
▪ With the right political will the benefits of PHC are boundless.
27
29. References
▪ Aboi JKM. Principles of primary health care: NPMCN primary revision course. 2021
August 11.
▪ National Primary Health Care Development Agency (NPHCDA): Minimum standards
for primary health care in Nigeria. 2015.
▪ World Health Organization. Primary health care. Health for all monographs No 1,
Geneva. 1978
▪ World Health Organization. World health statistics 2021: Monitoring health for SDGs.
Geneva. 2021
▪ WHO. Global coference on primary health care: Declaration of astana. Astana,
Kazakhstan. October 2018.
▪ Bolaji SA, Samina MK. Primary health care in nigeria: 24 years after olikoye
ransome-kuti’s leadership. Fronties in public health. 2017; 5: 48 [accessed
November 24, 2021]
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