Primary, secondary, and tertiary levels of care are described. Primary health care (PHC) is the first level of contact with the health system and aims to provide essential care that is universally accessible, affordable, and encourages self-reliance. PHC includes health education, disease prevention and control, nutrition promotion, maternal/child care, immunization, and treatment of common illnesses. Pakistan implements PHC through basic health units and rural health centers. PHC principles emphasize equitable distribution, community participation, and intersectoral coordination using appropriate technologies.

2. ByBy
DR: NAJEEB MEMONDR: NAJEEB MEMON
MPH,DFHCMPH,DFHC
Asst: ProfessorAsst: Professor
F.C.M & P.H.SF.C.M & P.H.S
LUMHS, Jamshoro, SindLUMHS, Jamshoro, Sind
PAKISTANPAKISTAN
e mail mnajeeb80@gmail.come mail mnajeeb80@gmail.com

4. Levels of CareLevels of Care
Primary health carePrimary health care
Secondary health careSecondary health care
Tertiary health careTertiary health care

5. Primary Health CarePrimary Health Care
 Anew approach to health care Came in to existence inAnew approach to health care Came in to existence in 19781978
following an international conferencefollowing an international conference
atat
Alma-Ata (USSR)Alma-Ata (USSR)
This known asThis known as
““Primary Health Care”Primary Health Care”

6. It has all the hallmarks of a Primary health careIt has all the hallmarks of a Primary health care
delivery, first proposed bydelivery, first proposed by “Bhore Committee“Bhore Committee
in 1946,in 1946,
& now espoused world-wide by international& now espoused world-wide by international
agencies & national Govt:agencies & national Govt:
Global strategyGlobal strategy forfor ““Health for AllHealth for All”” 3434thth
WorldWorld
Health assembly in 1981.Health assembly in 1981.
Bhore CommitteeBhore Committee

7. Primary Health carePrimary Health care
Before Alma-Ata, “Primary Health care” synonymousBefore Alma-Ata, “Primary Health care” synonymous
““Basic Health services”Basic Health services”
““First Contact Care”First Contact Care”
““Easily Accessible Care”Easily Accessible Care”
““Services provided by generalists”Services provided by generalists” etc.etc.
Alma-Ata, international conferenceAlma-Ata, international conference defined “PHC” asdefined “PHC” as
follows:follows:

8. PRIMARY HEALTH CAREPRIMARY HEALTH CARE
““ It is anIt is an essential health careessential health care made universallymade universally
accessible toaccessible to
through their full participation & at a cost thethrough their full participation & at a cost the
community & country can affordcommunity & country can afford””..
individualsindividuals & acceptable to them& acceptable to them
essential health careessential health care
individualsindividuals

9. PRIMARY HEALTH CARE ( WHO)PRIMARY HEALTH CARE ( WHO)
ISIS UNIVERSALLY ACCESSIBLEUNIVERSALLY ACCESSIBLE HEALTH CAREHEALTH CARE
THAT ISTHAT IS SOCIALLY ACCEPTABLESOCIALLY ACCEPTABLE,,
AFFORDABLEAFFORDABLE ANDAND
REQUIRES INDIVIDUALS TO BEREQUIRES INDIVIDUALS TO BE MORE SELF-MORE SELF-
RELIANTRELIANT
WITH THEIRWITH THEIR HEALTH CARE NEEDSHEALTH CARE NEEDS..

11. Primary health care
The “first” level of contact between the individual and
the health system.
Essential health care (PHC) is provided.
A majority of prevailing health problems can be
satisfactorily managed.
The closest to the people.
Provided by the primary health centers.
Secondary health care
More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1st referral level
Tertiary health care
Offers super-specialist care
Provided by regional/central level
institution.
Provide training programs
Levels ofLevels of
CareCare
LUM Hospital

12. Concepts of PHCConcepts of PHC
 For all ( especially for needy )For all ( especially for needy )
AcceptableAcceptable
 CommunityCommunity
Active involvementActive involvement

14. BASIC ELEMENTSBASIC ELEMENTS OFOF
““PRIMARY HEALTH CARE”PRIMARY HEALTH CARE”
 Health educationHealth education ( Health problems- preventing & controlling)( Health problems- preventing & controlling)
 Identifying & controlling prevailing health problems.Identifying & controlling prevailing health problems.

15.  Promotion of Food supply and properPromotion of Food supply and proper
nutrition.nutrition.
 Provision of safe water and basic sanitation.Provision of safe water and basic sanitation.
 Maternal & child health care,Maternal & child health care,
including family planning.including family planning.

16. BASIC ELEMENTSBASIC ELEMENTS (cont:)(cont:)
 ImmunizationImmunization
 Prevention and control of locally endemicPrevention and control of locally endemic
diseasedisease

17.  Appropriate treatment of common diseases andAppropriate treatment of common diseases and
injuriesinjuries
 Promotion of mental healthPromotion of mental health
 Provision of essential drugsProvision of essential drugs

18. PrinciplesPrinciples
Equitable Distribution
PHC must be given toPHC must be given to
all individuals in equalall individuals in equal
amount in communityamount in community
irrespective of theirirrespective of their
gender, age, caste,gender, age, caste,
color, urban, rural andcolor, urban, rural and
social class.social class.
Community Participation
Involvements of
Individuals, families &
communities in promotion
of their own health &
welfare is an essential
ingredient of PHC
Intersectorial coordination
Alma-Ata states that PHC
involves in addition to the
health sector, all related
sectors & aspects of
national & community
development, in particular
agriculture ,food, industry,
education, housing ,
public works,
communication & other
sectors.
Appropriate Technology
Technology i,e
scientifically sound,
adapted to local needs &
acceptable to those who
apply it & those for whom
it is used.

19. PHC in PakistanPHC in Pakistan
Health facilities are offered through severalHealth facilities are offered through several
 BHUBHU
 RHCRHC

20. Serves 5000 – 10 000 population
5 – 10 BHUs linked to one RHC
Services provided at BHUs included
-MCH services
-Child care
-Immunization
-Diarrheal control
-Malaria control
-Mental Health
-School Health services
BHU

21. RHC
Each has 25 beds
Laboratory
Provision for minor surgery
Ambulance
Each RHC ( linked to) Taluka Hospital
Taluka Hospital ( linked to) District Head quarter’s Hospital
Whole system is designed as integrated Rural Health Complex

22. Selective Primary Health CareSelective Primary Health Care
 Is a policy of selective interventions to deal withIs a policy of selective interventions to deal with
thethe most serious public health problemsmost serious public health problems,,
rather than comprehensive PHC which israther than comprehensive PHC which is
consideredconsidered too costlytoo costly && requires a large no: ofrequires a large no: of
trained persons.trained persons.

23. UNICEF’s Proposed SelectiveUNICEF’s Proposed Selective
ApproachApproach
 Growth monitoringGrowth monitoring
 ORSORS
 Breast feedingBreast feeding
 ImmunizationImmunization
 Family planningFamily planning
 Female educationFemale education

24. ComprehensivenessComprehensiveness
 Comprehensiveness of care means thatComprehensiveness of care means that care iscare is
provided for all types of health problemsprovided for all types of health problems..

25. THE FUNCTIONS OF PRIMARY HEALTH CARETHE FUNCTIONS OF PRIMARY HEALTH CARE
1. To provide continuous and comprehensive care1. To provide continuous and comprehensive care
2. To refer to specialists and/or hospital services2. To refer to specialists and/or hospital services
3. To co-ordinate health services for the patient3. To co-ordinate health services for the patient
4. To guide the patient within the network of social4. To guide the patient within the network of social
welfare and public health serviceswelfare and public health services
5. To provide the best possible health and social5. To provide the best possible health and social
services in the light of economic considerations.services in the light of economic considerations.