PRIMARY HEALTH CARE

1. HEALTH PROMOTION AND
PRIMARY HEALTH CARE

2. HEALTH PROMOTION
INTRODUCTION:
At the beginning of the 20th century, a new
concept, the concept of health promotion began
to take shape. It was realized that public health
had neglected the citizen as an individual and
that state had a direct responsibility for the
health of the individual.

3. INTRODUCTION CONTT……
Consequently in addition to disease control
activities, one more goal was added to public
health. I.e. health promotion of the individual.

4. DEFINITION:
Health promotion is the process of
enabling people to increase control over
and to improve health.” It is not directed
against any particular disease, but is
intended to strengthen the host through a
variety of approaches (interventions).

5. GOALS OF HEALTH PROMOTION
To create environments that allow all
the ability to access all needed services.
 To equip with the skills to determine their
own health needs.

6. STRATEGIES OF HEALTH
PROMOTION
1.Building healthy public policy
 Development of smoke free spaces
2. Creating supportive environment
3. Strengthening community Action
 Encouragement to initiate community groups

7. STRATEGIES OF HEALTH PROMOTION
CONTT……
4. Developing personal skills
 HIV/AIDS, Malaria, TB, MCH
5. Reorienting health services
Reforming of the health sector to incorporate a
department focusing on adolescent health

8. INTERVENTIONS AREA IN HEALTH
PROMOTION:
1. Health education
2. Environmental modifications
3. Nutritional interventions
4. Lifestyle and behavioral changes

9. HEALTH EDUCATION
 This is one of the most cost-effective
interventions. A large number of diseases
could be prevented with little or no medical
intervention if people were adequately
informed about them and if they were
encouraged to take necessary precautions in
time.

10. HEALTH EDUCATION
CONTT……
The targets of educational efforts may include
the general public, patients, priority groups,
health providers, community leaders and
decision-makers.

11. ENVIRONMENTAL MODIFICATION
A comprehensive approach to
health promotion requires
environmental modifications,
such as provision of safe water;
installation of sanitary latrines;
control of insects and rodents;
improvement of housing etc.

12. ENVIRONMENTAL MODIFICATION
The history of medicine has shown that many
infectious diseases have been successfully
controlled in many countries through
environmental modifications.

13. NUTRITIONAL INTERVENTIONS
 These comprise food distribution and
nutritional improvement of vulnerable
groups: child feeding programmes,food
fortification; nutritional education,etc.

14. LIFE STYLE AND BEHAVIOURAL
CHANGES
 The conventional public health measures or
interventions have not been successful in
making in roads into lifestyle reforms. The
action of prevention in this case, is one of
individual and community responsibility for
health.

15. LIFE STYLE AND BEHAVIOURAL
CHANGES
Health education is a basic element of all health
activity. It is of paramount importance in
changing the views, behavior and habits of
people.

16. PRIMARY HEALTH CARE

17. INTRODUCTION:
With increasing recognition of the failure of
existing health services to provide health care,
alternative ideas and methods to provide health
care have been considered and tried. The
concept of primary health care came into
limelight in 1978 following an international
conference in Alma-Ata, USSR

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

19. PURPOSES
Increase in life expectation.
Improvement in nutritional status.
Provision of basic sanitation.
Development of manpower and other
resources.

20. ELEMENTS OF PRIMARY HEALTH
CARE:
The Alma-Ata conference outlined 8 essential
components of primary health care.
Education concerning 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.

21. Maternal and child health care, including family
planning.
Immunization against major infectious diseases.
Prevention and control of locally endemic
diseases.
Appropriate treatment of common diseases and
injuries.
Provision of essential drugs.

22. PRINCIPLES OF PRIMARY HEALTH
CARE:
EQUITABLE DISTRIBUTION:
The first key principle in the primary health
care strategy is equity or equitable distribution
of health services.

23. EQUITABLE DISTRIBUTION
CONTT……
Health services must be shared equally by all
people irrespective of their ability to pay, and all
must have access to health services.
At present health services are mainly concentrated
in the major towns and cities resulting in inequality
of care to the people in rural areas.

24. EQUITABLE DISTRIBUTION:
CONTT……
The worst hit are the poor and the needy and
vulnerable groups of the population in rural
areas and urban slums. This has been termed as
social injustice.
The failure to reach the majority of the people
is due to inaccessibility.

25. EQUITABLE DISTRIBUTION:
CONTT……
Primary health care aims to redress this
imbalance by shifting the centre of gravity of the
health care system from cities to the rural areas
and bring these services as near people’s homes
as possible.

26. COMMUNITY PARTICIPATION:
The overall responsibility of the central and state
governments, the involvement of individuals,
families, and communities in promotion of their own
health and welfare, is an essential ingredient of
primary health care..

27. COMMUNITY PARTICIPATION
CONTT……
Countries are now conscious of the fact that the
universal coverage by primary health care cannot be
achieved without the involvement of the local
community

28. COMMUNITY PARTICIPATION
CONTT……
There must be a continuous effort to secure
meaningful involvement of the community in the
planning, implementation and maintenance of health
services, besides maximum reliance on local resources
such as manpower, money and materials .In short,
primary health care must be built on the principle of
community participation (or involvement).

29. COMMUNITY PARTICIPATION
CONTT……
One approach that has been tried successfully in India
is the use of village health guides and trained dais.
They are selected by the local community and trained
locally in the delivery of primary health care to the
community they belong, free of charge .By
overcoming cultural and communication barriers,
they provide primary health care in ways that are
acceptable to the community.

30. INTER SECTORAL COORDINATION:
There is an increasing realization of the fact that the
components of primary health care cannot be
provided by the health sector alone.

31. INTER SECTORAL COORDINATION
CONT…
The declaration of Alma-Ata states, primary health
care involves in addition to the health sector, all
related sectors and aspects of national and community
development,in particular agriculture, animal
husbandry, food,
industry, education, housing,
public works, communication
and other sectors”

32. INTER SECTORAL COORDINATION
CONTT……
This requires strong political will to translate
values into action, an important element in
intersectoral approach is planning –planning
with other sectors to avoid unnecessary
duplication of activities.

33. APPROPRIATE TECHNOLOGY:
Appropriate technology has been defined as
“technology that is scientifically sound,
adaptable to local needs, and acceptable to
those who apply it and for those for whom it is
used, and that can be maintained by the people
themselves in keeping with the principle of self
reliance with the resources the community and
the country can afford”

34. APPROPRIATE TECHNOLOGY
CONTT……
The term appropriate is emphasized because in
some countries, large luxurious hospitals that
are totally in appropriate to the local needs are
built, which absorb a major part of the national
health budget, effectively blocking any
improvement in general health services.

35. APPROPRIATE TECHNOLOGY
CONTT……
This also applies to use of costly equipment,
procedures and techniques when cheaper,
scientifically valid and acceptable ones are
available, viz, oral rehydration fluid.

36. ROLE OF NURSES IN PRIMARY
HEALTH CARE
Assessing the health status of individuals and
communities.
Health Education
Food Supply And Proper Nutrition
Water supply and basic sanitation.
Maternal and Child Health Care including Family
Planning.

37. ROLE OF NURSES IN PRIMARY
HEALTH CARE CONTT……
 Immunization
 Treatments of Minor
ailments.
Mobilizing community
involvement.
Providing integrated health
care including the treatment of
emergencies and making referrals.

38. RESEARCH STUDY
Nurse delivered lifestyle interventions in primary health care
to treat chronic disease risk factors associated with obesity: a
systematic review.
Sargent GM, Forrest LE, Parker RM.
Abstract
Nurses in primary health care (PHC) provide an increasing proportion
of chronic disease management and preventive lifestyle advice. The
databases MEDLINE, CINAHL, EMBASE and PsychINFO were
searched and the articles were systematically reviewed for articles
describing controlled adult lifestyle intervention studies delivered by a
PHC nurse, in a PHC setting. (i) no difference of effect when the same
intervention was delivered by a PHC nurse compared to other health
professionals in PHC

39. RESEARCH STUDY
(ii) the provision of counselling delivered by a PHC nurse was
more effective than health screening
(iii) counselling based on behaviour change theory was more
effective than the same dose of non-behavioural counselling
when at least three counselling sessions were delivered The
evidence supports the effectiveness of lifestyle interventions
delivered by nurses in PHC to affect positive changes on
outcomes associated with the prevention of chronic disease
including: weight, blood pressure, cholesterol, dietary and
physical activity behaviours, patient satisfaction, readiness for
change and quality of life.

40. BIBLIOGRAPHY
Basheer.P. Shebeer,KhanYaseen, Advance Nursing Practice, 1st
Edition, EMMESS, Medical Publisher,2012.Pp:689-93
Basavanthappa. BT, Community Health Nursing, 1st Edition,
Jaypee Brothers Medical Publishers,Pp.99-103.
Park.K, Textbook of Preventive and Social Medicine,17th
Edition,
M/S BanarsidasBhanot Publishers,Pp.10
http://www.ncbi.nlm.nih.gov/pubmed/19305227