Primary Health Care as part of Community Medicine

1. Primary Health Care

2. Primary Health Care (PHC)
• 1978 a WHO conference was held in Alma Ata to discuss the
need for implementing primary health care throughout the
world.
• Primary Health Care was defined as:
‘It is essential health care based on practical, scientifically
sound and socially acceptable methods and technology, made
universally accessible to the individuals and families through
their full participation and at the cost that community and
country can afford’

3. WHO Constitution
• Health For All by year 2000
• Global Target for HFA :
1. 5% GNP [Gross National Product] to be spent on health
2. Basic health facilities within 2-3km
3. Immunizations for T.B, DPT and Polio
4. Decrease Infant Mortality Rate to below 50/1000
5. Life expectancy >60
• HFA beyond year 2000 since targets have not been met

4. • Promotion of food, water and sanitation
• Educating about health problems and their prevention
• Promotion of mental health
• Immunization
• Mother-Child health care
• Provision of essential drugs
• Treatment of common diseases and injury
• Control of locally endemic diseases
Elements / Cornerstone of Primary
Health Care

5. Principles of PHC
• Equity or equitable distribution of health services
• Effectiveness
• Efficiency
• Accessibility
• Affordability
• Acceptability
• Community participation
• Appropriate technology

6. Principles of PHC
• Equity : Everyone is entitled to health care according to their
need irrespective of their ability to pay. [not same as equality]
• Community Participation : involvement of individuals, families
and communities in promotion of their own health by
implementation, utilization of services, monitoring and
evaluation, e.g. trained birth attendants and lady health workers.
• Appropriate Technology : it is only appropriate if it is Available,
Affordable, Accessible and Acceptable. Example, ORS for diarrhea
would be an appropriate technology rather than admittance to
the hospital, since ORS fulfills all 4 of the above mentioned
criteria.
• Multisectoral Approach : Delivery of health services requires co-
ordination and cooperation from other governmental
organizations as well for example sanitation, housing, agriculture,
social welfare etc.

7. Primary Health Care system of
Pakistan
• Medical services are comprised of primary, secondary, and
tertiary health care facilities.
• Primary health care facilities include rural health centers,
basic health units, primary health care centers, dispensaries,
first aid posts, mother and child health centers, and lady
health visitors.
• Secondary health care facilities, including District and tehsil
headquarter hospitals, which look after clients on both out-
patient and in-patient bases.
• Tertiary care centers are mainly located in major cities and
are typically affiliated with research and teaching
organizations. Secondary and tertiary care facilities are
generally open all day and night.

9. Statistics of Healthcare System of
Pakistan
Element Number
1 doctor 1475 patients
1 nurse 3644 patients
Total Health Facility 13,937
Hospitals 965
Dispensaries 4916
BHU 4872
RHC 595
Mother-Child Health Clinic 1138
T.B Centre 371

10. Basic Health Unit
• This is the first level care facility referred by LHV or LHW, the
purpose of which is 80% preventive and 20% curative
• Caters to a population of 5000-10,000 people in 24-40 km
area
• 2 types of staff are present here : Stationed and Outreach
• Stationed : 1 MO, 1 LHV, 1 Dispenser, Dai/Midwife and
Medical Assistant
• Outreach : CDC [communicable disease control] supervisor,
EPI vaccinator, LHW
• Refers to Rural Health Center

11. Rural Health Centre
• Caters to 5 – 10 BHUs, 50,000 – 100,000 persons and covers
an area of 240-400km
• Facilities : 20-25 beds
• Lab and X-Ray
• Minor and Major OT
• Ambulance
• Plays role in Preventive and Curative forms of healthcare
• Refers to Tehsil Headquarter Hospital

12. Tehsil Headquarter Hospital
• 40 – 60 bedded hospital
• Provides specialist services
• Lab, x-ray, ECG etc
• Ambulance
• Referral arrangements to DHQ
District Headquarter Hospital
• Specialist Services
• Deals with serious and complicated cases
• Diagnostic and therapeutic
• Ambulance services

13. Differences between BHU and RHC
BHU RHC
Area 24 - 40 Km 240 - 400 Km
Population 5000 – 10,000 50,000 – 100,000
Referral From LHV and LHW Referral from BHU
Beds 1 – 2 beds 20 – 25 beds
Ambulance No Yes
Lab / x-ray / OT No Yes
Linked to 5 – 10 RHC THQ