This ppt gives you details wisdom about primary Health centre

1. PRIMARY HEALTH
CARE
PREPARED BY:SANSKRITI OJHA
B.Sc.Nursing

2. INTRODUCTION
• In 1978 the world Health Assembly established a goal “Health for all
by the 2000.” This goal has now been adopted by many countries
throughout the world. In 1978 an International Conference on
Primary Health Care sponsored by WHO and UNICEF, was held at
ALMA ATA, that attended the conference determined that Primary
Health Care (PHC) was a realistic way to implement the goal of
‘Health For All’(HFA). In Nepal, His majesty`s Government has taken
up the goal of ‘Health For All’ and for this purpose, is implementing
PHC throughout the country.

3. What is primary health care?
The Alma Ata Conference defined primary health care as “essential health
care based on practical scientifically sound and socially acceptable
methods and technology and universally accessible to individuals and
families in the community through their full participation and at a cost that
the communities and countries can afford to maintain at every stage of
their development in the spirit of self reliance and self determination. It
forms an integral part both of the country`s health system, of which it is
the central function and main focus, and of the overall social and economic
development of the community. It is the first contact of individuals, the
family and the community with the national health system, bringing health
care as close as possible to where people live and work, and constitutes
the first element of a continuing health care process.”

4. DEFINITION
Primary health care is essential health care made
universally accessible to individuals and acceptable to
them through their full participation and at a cost the
country and community can afford.”

5. PRINCIPLES
• Primary health care is based on five major principles:
1. Accessibility of health services.
2. Full individual, family and community participation.
3. Emphasis on preventive and promotive rather than curative services
only.
4. Appropriate methods and technology.
5. Integration with social and economic development.

6. 1.Accessibility of health services.
• Traditionally speaking, a person`s first contact with the health care
system in the community is PHC. The term “accessibility” refers to the
health care system that can be reached and used by all people. This
means that health posts must be located in places where people can
go easily. 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 people living in cities.

7. CONT….
• Accessibility also refers to the availability of drugs and other supplies
at health posts and hospitals. In other words, it implies equal
distribution of resources. Providing these items to rural areas is
expensive and difficult because of the lack of accessible roads and
airports. These supplies have to be carried to the health posts by
mules, horses, or porters. Certain drugs need refrigerator , which is
also not available in many areas of the country. Therefore these
difficulties need to be addressed when planning PHC programmes.

8. 2.Full individual, family and
community participation
• According to WHO and UNICEF, 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. “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 to work on. Then, using its own manpower, 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.

9. How does a nurse help the
community in fulfilling its
responsibilities?
oThe nurse helps the community in the process of participation by
helping to identify the problems and to figure out realistic ways to
solve them. Sometimes the community`s priorities may differ from
those of the nurse. In such a situation the nurses should try to
compromise. The nurse should remember that, for many people,
health or health promotion activities may not be priorities in their
lives. They may be too busy trying to determine how they are going to
get enough food to feed their family on that day. Therefore, at times
the nurse may need to help people achieve other goals that may
indirectly affect their health such as getting a bank loan to start a
small business or to help them find out how to arrange irrigation for
their land.

10. 3.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 frim
drinking contaminated water, poor hygiene and sanitation, many
people living together in a small house, inhaling smoke from
cigarettes or chulos(home-made stove, and many other causes.
Preventing and promotive services include providing clean water to
communities, sanitation facilities, such as toilets, adequate housing,
the isolation of ill people from other family members, the availability
of adequate amount of nutritious food and vaccination programmes.

11. CONT….
• Curative services should be provided together with preventive and
promotional services. There are many sick people, especially children , in
Nepal. The nurse sometimes needs to treat the illness and teach patients and
their families how to prevent the illness from reoccurring. 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 can not earn money, they can not grow food, or care for their
children. 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. But not all promotional activities are cheap,
e.g. water supply, housing etc. are not only expensive but sometimes difficult
to meet with.

12. 4.Appropriate methods and
technology
• This principle includes appropriate methods and technology to
implement all the 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 an existing building instead of
constructing a new one. 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.

13. CONT…
• People are more likely to build toilets if they are taught how to make
them with locally available materials like stone, wood or bamboo.
This is cheap and easy to make.
• Appropriate methods and technology also mean teaching people
appropriate health care methods that are easily available, and easy to
understand and use for e.g. how to prepare Jeevan Jal, can be taught
to many people.

14. 5.Integration of health development
with social and economic
development
• Improvement in health cannot take place without improving the
social and economic status of people. Integration with social and
economic development implies a multi-sectoral approach to health.
People need land to grow food, or they need jobs that pay them
enough money to buy food for their families. Increasing the level of
education and improving the status of women in society also improve
the health of people.

15. CONT….
• Different ministries and agencies need to work together to improve
all aspects of the country. For example ,a water supply engineer
builds a tube-well in a village; a nurse or a health worker ; teaches
people how to keep the water clean once it is taken from the well. A
nurse , who knows the needs of the community where she works, can
help the local development officer and the community to work
together and plan appropriate programs that will benefit the
community.

16. ELEMENTS OF PHC
• The World Health organization has determined eight services or
elements that are necessary to implement to achieve the goal of
‘Health For All’. They are:
E- Education on prevailing Health problems and the methods of
preventing and controlling them.
N- Promotion of food supply and proper nutrition.
S- An adequate supply of safe water and basic sanitation.
M- Maternal and child Health, including family planning.
E- EPI(Immunization) against major infectious diseases.

17. CONT…
L- Prevention and control of locally endemic diseases.
T- Appropriate treatment of common diseases and injuries.
E- Providing essential drugs
M- Mental Health
D- Dental Health
For key of remembering, we have the mnemonics “ELEMENTS”. But
we have to write this in above sequence.

18. 1.Education on prevailing Health problems
and the methods of preventing and
controlling them
oHealth education is an integral part of all health services and hence all
health personnel, including nurses are responsible for educating
people as to how they can improve their own health. Health
education on the prevailing health problems on certain
community(as, in context of developing country, diarrhea, dysentery,
upper respiratory tract infection, leprosy, tuberculosis, as in develop
country HIV/AIDS, Child abuse, sexual abuse, drug addiction, heart
disease etc.) should be given with main focus on preventive aspect
and ways to control it.

19. 2.Promotion of food supply and proper nutrition
• In Nepal, about 65-93% of all children under five suffer from
malnutrition. So nurses will have to work with people engaged in
agriculture to assist community members to grow a variety of
nutritious foods. The nurses need to teach the community how to
combine these foods for an optimum level of nutrition. This is
especially important in the hilly and mountainous regions of Nepal,
where there is a very limited variety and amount of food. The nurses
should make provision to supply iodized salt, vitamin A supplement,
deworming, iron supplement etc. in collaboration with other sectors.

20. 3.Basic sanitation and safe water
• This is another area where nurses need to work with the community
and other government sectors, such as water supply and sanitation
engineers. The engineers know how to build sewers, tube-wells, and
irrigation systems. They can teach the community how to maintain
them after construction. But nurses need to make sure that people
know why it`s important to keep the latrine(charpi) clean; that the
uncontaminated water taken from tube-well is hygienic; that to keep
the surroundings clean is necessary to prevent illnesses from
occurring.

21. 4.Maternal child health, including family planning
• In 1979, the Mother and Child Health and family planning
Department of the Republic of Indonesia developed a goal to “reduce
the incidence of mortality and morbidity of mothers, infants and
children”. This goal is applicable to Nepal also; it has the following
three objectives:
To promote the best possible health conditions for mother during her
pregnancy, delivery and throughout the childbearing period of life.

22. CONT….
To promote the best possible health conditions for infants and
children with special emphasis on adequate nutrition and protection
from infectious diseases.
To promote better health within the family by helping parents to plan
for the number of children they desire. This may include advice on
adequate spacing of children or when it is appropriate or methods of
limiting the number of children.

23. 5.EPI(Immunization) against major infectious diseases
• Certain diseases such as measles, tetanus, diphtheria, pertussis,
tuberculosis, and polio cause many cases of illness, disability, and
death each year. These diseases can be easily prevented through
immunization programmes. This involves motivating families to have
their children fully immunized. To make certain that this happens,
health posts should receive enough supply of immunization regularly.
The cold chain should be maintained.

24. 6.Prevention and control of endemic diseases
• Endemic diseases are those diseases that often occur in an area,
country or a class of people. These diseases might include diarrhea,
common cold, tuberculosis, and intestinal parasites. There are
diseases like leprosy and AIDS which could easily transmit due to lack
of awareness and precaution.
• The community should therefore be taught how these common
diseases are transmitted from person to person; how to prevent them
from spreading to other people, and how to treat people who get sick
with these diseases.

25. 7.Treatment of common diseases and injuries
• Health posts should be built throughout Nepal to treat common
diseases and injuries. Adequate number of health post employees
should also be trained to work in these health posts. Appropriate
drugs and equipment should be supplied as well.
• The emergency treatment and primary care provided by nurse help to
reduce mortality and morbidity.

26. 8.Providing essential drugs
• Essential drugs are those drugs that are of proven value, good quality
, and cheap; that can be used to treat the majority of diseases in the
country. The National Drug Scheme of Nepal has established an
Essential Drug Programme and has compiled a list of 200+ drugs that
are essential for Nepal. Royal Drug Nepal Ltd. Has been entrusted
with manufacturing these drugs so that Nepal may eventually be self-
sufficient in the production of essential drugs.

27. 9.Promotion of Mental
Health
• Mental Health is the “the state of successful performance of mental
function, resulting in productive activities, fulfilling relationships with
other people and the ability to adapt to change and to cope with
adversity.”
• Characteristics of people with good mental health include possessing
a good self-image, feeling, right about people and being able to meet
the demands of every day life.

28. CONT….
• It is also an essential element of PHC. Number of mental illness is
increasing day to day. Modern life can be extremely stressful and may
provoke mental illness. Parents struggle to work and care at the same
time of aging parents and young children. Gender roles are changing.
• So PHC should concentrate on the mental problem which prevails in
the community with assistance from and collaboration with many
other groups.

29. 10. Dental Health
• The objective of dental health services is the prevention of dental
disease of all kinds, as well as the treatment of dental disorders.
• Dental problems can be reduced by the early establishment of good
dental health habits. Early recognition of problem usually can mean
correction of a minor problem for minimal cost and discomfort. oral
assessment should include a through oral health history and
inspection of color and condition of lips, gums, teeth, tongue, and
mucosa.

30. CONT….
• Nepalese people are suffering from various dental problems so the
PHC nurse should conduct School Dental Health Programme and
provide health education on oral care, treatment about oral and
tooth disorders. The dental health is added in PHC component with
the sense of complete health.

31. Role of a nurse in PHC
• Fifty years ago nurses worked in hospitals only. Nurses cared for ill
patients under the supervision of physicians. Now the role of the
nurse has expanded. She now works in the community independently
of physicians. Her work focuses on Health-related issues instead of
illness , such as the personal and environmental health of the
community. Nurses must perform the following roles while providing
primary health care:

32. CONT….
Health care provider
Educator
Manager
Researcher
Evaluator
Coordinator
Change agent

33. 1.As a health care provider
• The nurse primarily provides curative care in hospitals. Preventive and
promotional care become secondary. But in the community ,
prevention and promotion of health come first. Curative services are
needed to the community, when needed.

34. 2.As an educator
• The nurse performs the role both in the hospitals, 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.

35. 3.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 records 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.

36. 4.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. The researcher includes seven steps:
Identifying a problem.
Collecting fact pertaining to the problems and developing theories to
explain the problem and suggest a solution.
Developing a tentative solution, called a hypothesis.

37. CONT….
Setting up a suitable method to study the problem.
Collect data needed to evaluate the hypothesis.
Analyze data.
Report the findings.
The nurse should have the qualities of a researcher.

38. 5.As an evaluator
• The 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 , managing ,
doing research , teaching , or promoting change in the community.

39. 6.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.

40. 7.As a change agent
• The nurse helps people to accept appropriate changes in their lives so
that their lives become easier and better. In other words, she is called
a ‘motivator.’
• The nurses needs to encourage changes that are in the best interest
of the people and involve the least amount of risk to the poor people
of her community.
• The nurses need to be change agent in her 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.

41. Responsibility of a PHC Nurse
Monitor patient`s condition and assess their needs to provide the
best possible care and advice.
Observe and interpret patient`s symptoms and communicate them
to physicians
Perform routine procedures(blood pressure measurements ,
administering injections etc.)and fill in patients’ charts.
Adjust and administer patient`s medication and provide treatments
according to physician orders.

42.  Cont…
• Provide instant medical care in emergencies
• Assist surgeons during operations
• Referral services
• Counselling the patient`s and their families with physical and mental
problems.
• Manages a variety of minor illness or injuries
• Provide health education on good nutrition, immunization, family
planning, healthy habits, hygiene etc.