primary health care should be accessible, affordable, acceptable ,equally distributed along with use of appropriate technology.

2.  PRIMARY
HEALTH CARE.
 SECONDARY
 TERITIARY
HEALTH CARE.
HEALTH CARE.

3. “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 every stage of their development
in the spirit of self-determination.”
Declaration of Alma Ata

4. “Essential health care made universally
accessible to individuals and acceptable to
them through their full participation and
cost of the community and country can
afford.”
WHO

5.  in
post-independent era in 1947, when
the bhore committee brought its
recommendations.
 To provide comprehensive health
services to the people in rural areas
through the network of primary health
centres.
 A short term plan was formulated.

6.  1978
 launched
primary health care
RECOMMENDATIONS OF ALMA ATA
CONFERENCE:
 to incorporate and strengthen the primary
health care with other sectors.
 The health services should be
comprehensive.
 community participation and appropriate
technology.

7.  strengthen
and support primary health care
through various sectors.
 maximum care to the special risk groups.
 Training.
 proper use of resources.
 continuous supply of drugs and proper
managerial process, includes
planning, organizing, monitoring and
evaluation of health services.

8.  health
for all is ‘ the attainment of a level of
health that will enable every individual to
lead a socially and economically productive
life.’
WHO

9. SPECIFIC GOALS TO BE ACHIEVED BY 2000 AD :
 Reduction of infant mortality from the level of
125 to below 80.
 To raise the expectation of life at birth from the
level of 52 years to 64 years.
 To reduce the crude death rate from the level of
14 per 1000 population to 9 per 1000 population.
 To reduce the crude bith rate from the level of
33 per 1000 population to 21 per 1000
population.
 To achieve a net reproduction rate of one

10. Evaluation of HFA [1979-2006]:
 Insufficient political commitment.
 Failure to achieve equity in access to all PHC.
 The continuing low status of women.
 Slow socio economic development.
 Unbalanced distribution of resources.
 Wide spread inequality of health promotion
efforts.
 Weak health information systems and lack of
baseline data.
 Pollution, poor food safety and lack of water
supply and sanitation.

11.  Rapid
demographic and epidemiological
change.
 Inappropriate use and allocation of
resources for high cost of technology.
 Natural and man-made disasters.
 Misinterpretation of the PHC concept.
 Misconception that PHC is the 2nd rate of
health care for the poor.
 Lack of political will.
 Centralized planning and management.

12. Priorities:
 Nutrition.
 Prevention
of food
adulteration and quality of drugs.
 Water supply and sanitation.
 Environment protection.

13.  Immunization
programmes.
 Maternal and child health services.
 School health programmes.
 Occupational health
services

14.  To
establish one HSC for every 5000 [3000 for
hilly areas].
 To establish one PHC for every 30,000
population.
 To establish one CHC for every 1,00000
population.
 To train village health guides selected by the
community for 1,000 population in each
village.
 To train TBAs in each village.
 Training of various categories of field
functionaries

15. Indicator
IMR
PNMR
CDR
MMR
UFMR
LIFE
EXPECTANCY
 MALE
 FEMALE
LBW
Goals by 2000
60
33
9
2
10
64
64
10%
Achieved by
2000
70
46
8.7
4
9.4
62.4
63.4
26%

16. Indicator
CBR
CPR
NBR
Growth rate
Family size
AN care
TT pregnant
DPT
OPV
BCG
Fully
immunized
Goal by 2000 Achieved by
2000
21
60%
1
1.2
2.3
100%
100%
85%
85%
85%
85%
26.1
46.2%
1.45
1.93
3.1
67.2%
83%
87%
92%
82%
56%

17.  Eradicate
polio and yaws
-2005
 Eliminate leprosy
-2005
 Eliminate Kala- azar
-2010
 Eliminate filariasis
-2015
 Zero level growth of HIV/AIDS
-2007
 Decreasing mortality of TB by 50% -2010

18.  Decreasing
malaria and other vector
borne disease
-2010
 Decreasing prevalence of blindness 0.5%
-2010
 Increasing utilization of public health
service from 20% to 75%
-2010
 Decreasing IMR to 30/1000 and MMR
100/1lakh
-2010

19.  5th
april, 2005 for a period of 7
years.
 main aim of NRHM is to provide
accessible, affordable, accountable,
effective and reliable primary
health care, and bridging gap in
rural health care through creation of
a cadre of Accredited social health
activist.

20. The goals to be achieved by NRHM:
 NATIONAL
 Infant
LEVEL:
mortality rate reduced to 30/1000
live births.
 Maternal mortality ratio reduced to
100/100000.
 Total fertility rate reduced to 2.1.
 Malaria mortality rate reduction- 50% by
2010.
 Kala-azar mortality reduction-100% by
2010.

21.  Filaria
rate reduction-70% by 2010.
 Cataract operation: increasing to 46 lakhs per
year by 2012.
 Leprosy prevalence rate: reduce from
1.8/10000 in 2005 to less than 1/10000
thereafter.
 Tuberculosis DOTS services: maintain 85% cure
rate through entire mission period.
 Upgrading community health centers to public
health standards.
 Increase utilization of first referral units from
less than 20% to 75%.
 Engaging 250000 female ASHA in 10 states.

22. AT COMMUNITY LEVEL:
 Provide
drug .
 Health day at anganwadi .
 Availability of generic drugs .
 Good hospital care.
 Improved access to universal
immunization.
 Improved facilities for institutional
delivery.
 Provision of household toilets.
 Improved outreach services

23. GOALS
 Elimination
of preventable
disease, disability, injury and premature
death.
 Achievement of health equality.
 Elimination of health disparities.
 Creation of social and physical
environment that will promote good
health and healthy development and
behaviour at every stage of life.

24. targets to be achieved by the year
2020 are:
 Decease
infant mortality rate below 60.
 To increase the expectation of life from
52 years to 64 years.
 To decrease the crude death rate from
14/1000 population to 9/1000
population.
 To achieve a net reproduction rate of 1.
 To provide water to the entire
population

25. E-
Education

26. LE-
Locally endemic disease control
expanded programme
immunization.

27. M-
Maternal and child health
E-
Environment sanitation

28. N-
T-
Nutritional services
Treatment of minor
ailments.

29.  S-
School health services

30. Expanded
options of immunization.
Reproductive health needs.
Provision of essential technologies
for health.
Prevention and control of noncommunicable diseases.
Food safety and provision of
selected food supplements

31. Equity
in health care
Available
for all.
Available to all.
Available by all.
Affordable by all

32.  Community
involvement:

33.  Focus
on prevention

34. Appropriate
 Scientifically
technology:
sound.
 Acceptable.
 Compatible.
 adaptable.
 Understandable

35.  Multi-sectorial
approach

36.  Accessibility,
Availability, Affordabilit
y and Acceptability of Health
Services
Health services delivered where the
people are
 one community health worker per 1020 households
 Use of traditional medicines


37.  Provision
of quality, basic and
essential health services
Training.
 Attitudes, knowledge and skills
developed.
 Regular monitoring and periodic
evaluation.


38.  Community
Participation
Awareness on health and health-related
issues.
 Planning, implementation, monitoring and
evaluation done through small group
meetings
 Selection of community health workers
 Formation of health committees.
 Establishment of a community health
organization.
 Mass health campaigns
and mobilization


39.  Self-reliance
Community generates support for health
programs.
 Use of local resources
 Training of community in leadership and
management skills.
 Incorporation of income generating
projects, cooperatives and small scale
industries.


40.  Recognition
of interrelationship of
health and development
Convergence of
health, food, nutrition, water, sanitation and
population services.
 Integration of PHC into
national, regional, provincial, municipal
development plans.
 Coordination of activities with economic
planning, education, agriculture, industry, ho
using, public works, communication and
social services.
 Establishment of an effective health
referral system.


41.  Social
Mobilization
 Establishment of an effective health
referral system.
 Multi-sectoral and interdisciplinary
linkage.
 Information, education, communicatio
n
 Collaboration between government
and non-governmental organizations.

42.  Decentralization
Reallocation of budgetary resources.
 Reorientation of health professional
and PHC.
 Advocacy for political and support
from the national leadership down.


43. environment
Health services
nutrition
economic
Health
services
politics
Education &
communication

44.  Village
 Village
level:
health guides
 Local dais
 Anganwadi workers
 ASHA

45.  Sub-centre
 Maternal
level
health care.
 Counseling and appropriate Adolescent
health care.
 Assistance to school health services.
 Promotion of sanitation.
 Field visits.
 Community need assessment.
 Curative services.
 Training.
 Implementation of national
health programmes

46. Primary
health center level
ACTIVITES include:
 Medical care.
 MCH including family planning.
 Safe water supply and basic sanitation.
 Prevention and control of locally endemic diseases.
 Collection and reporting of vital statistics.
 Education about health.
 National health programmes.
 Referral services.
 Training of health guides, health workers,
local dais and health assistants.
 Basic laboratory services.


47.  Requirements
for a sound PHC
 Appropriateness.
 Availability.
 Adequacy.
 Accessibility.
 Acceptability.
 Affordability.
 Assessability.
 Accountability.
 Completeness.
 Comprehensiveness.
 Continuity

48.  Community
 Care
health centre level
of routine and emergency.
 24 hour delivery services.
 Essential and emergency obstetric care.
 Full range of family planning services.
 Safe abortion services.
 Newborn care.
 Routine and emergency care of sick
children.
 foreign body removal, tracheostomy etc
 Implementation of national health
programmes.

49.  Combining
country efforts and
policy instruments with global
reach
 Integrated service delivery models
 Financing universal coverage
 Human resources for health
 Medicines
 Infrastructure and technology
 Health governance

50.  Minimal
policy and organizational
commitment
 Poorly defined functions
 Poor selection:
 Deficiencies in training and
continuing education
 Lack of support and supervision
 Uncertain working conditions

51.  Undetermined
cost and sources of
finance
 Lack of monitoring and evaluation
 Lack of transport facilities
 Insecurity of female staff
 Inadequate supply of drugs and
stationeries
 Medical officers are not interested
to work in rural areas

52.  Inadequate
human resources
 Failure to deliver universally
 Failure to deliver effectively
 Poor leadership, public regard, and
professional status
 Funding models that are unresponsive
 fail to ensure treatments are effectively
distributed and universally available for
common serious acute diseases
 Lack of effective information systems

53. the
changing environment
Advances in health and
Technology
 Lack of health personnel
The double burden of disease

54.  Collaborator
 Advisor:
 Consultant
 Advocate:
 Preventor
of illness

55. Promotor
of health
Care provider
Team leader
Participant:
Observer
Manager
Potentiator