Public health refers to all organized measures to prevent disease, promote health and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patient or diseases. Thus public health is concerned with the total system and not only the eradication of a particular disease

1. Public Health and Primary Health
Care
Prepared By:
Reena Bhagat
Senior Nursing Instructor
Maternal Health Nursing
BPKIHS

2. Definition of health
“The condition of being sound in body, mind or
spirit especially freedom from physical disease or
pain.” - Webster
“Soundness of body or mind that condition in
which its are duly and efficiently discharged .”
- Oxford English Dictionary
1/9/2023
Reena
Bhagat
2

3. Contd…
“Health is a state of complete physical, mental, social
and spiritual wellbeing and not merely an absence of
disease and infirmity.”
- World Health Organization( WHO), 1948.
WHO definition of health has the following
characteristics:
oA concern for the individual as a tool system.
oA view of health that identifies internal and external
environment.
oAn acknowledgement of the importance of an
individual role in life.
1/9/2023
Reena
Bhagat
3

4. Wellness
• The national wellness institute defines wellness as, "an
active process through which people become aware of,
and make choices toward, a more successful existence.“
• Wellness defined by Hatfield as; “ the conscious and
deliberate process by which people are actively involved
in enhancing their well-being: intellectual, physical,
social, emotional, occupational and spiritual”.
• Wellness is considered to be the positive component of
good health which reflects how one feels as well as one’s
ability to function effectively.
1/9/2023
Reena
Bhagat
4

5. Contd…
• Webster defines wellness as the quality or state of being in
good health especially as an actively sought goal.
• Wellness is more than being free from illness; it is a dynamic
process of change and growth. Wellness also implies the
achievement of highest level of health possibly in each of the
several areas.
Physical health
• Body size and shape
• Sensory acuity and responsiveness
• Susceptibility to disease and disorders
• Body functioning
• Physical fitness
• Restorative abilities
• Ability to perform normal activities of daily living
1/9/2023
Reena
Bhagat
5

6. Contd…
Intellectual health
• Think clearly
• Reason objectively
• Analyze critically
• Meet life’s challenges
• Learning from success and mistakes
• Making sound, responsible decisions
 Social Health
• Satisfying interpersonal relationships
• Interactions with others
• Adaptation to various social situations
• Daily behaviors
1/9/2023
Reena
Bhagat
6

7. Contd…
Emotional Health
• Feeling competent
• Express emotions when appropriate
• Avoid expressing emotions in an inappropriate
• Self-esteem
• Self-confidence
• Trust
• Love
Environmental Health
• Appreciation of the external environment
• The role individuals play in
• Preserving, protecting and improving environmental
conditions
1/9/2023
Reena
Bhagat
7

8. Contd..
Spiritual Health
• Belief in a supreme being or a way of living
prescribed by a particular religion
• Feeling of harmony with others and nature
• Sense of meaning or worth in life
• To care about and respect all living things.
1/9/2023
Reena
Bhagat
8

9. Community Health
• According to WHO, “Community health refers
to the health status of the members of the
community, to the problems affecting their
health and to the totality of health care provided
for the community.”
1/9/2023
Reena
Bhagat
9

10. Contd….
Public Health
• The term’’ Public Health” came into general use around
1840. It arouse from the need to protect the public from
the spread of communicable disease. Nowadays, it has
become wider in use. It has broad concept.
• The sum of all official or governmental effort to
protect, promote and preserve people’s health.
• Public health refers to all organized measures to
prevent disease, promote health and prolong life among
the population as a whole. Its activities aim to provide
conditions in which people can be healthy and focus on
entire populations, not on individual patient or diseases.
Thus public health is concerned with the total system
and not only the eradication of a particular disease.”
- WHO
1/9/2023
Reena
Bhagat
10

11. Contd….
• “The science and art of preventing disease, prolonging
life and promoting health and efficiency through
organized community effort.” - CEA Winslow, 1920
“The process of mobilizing and engaging local, state,
national, and international resources to assure the
conditions in which people can be healthy”
-The Oxford Textbook of Public Health
“The science and practice of protecting and improving
the health of the community, as by preventive medicine,
health education, control of communicable diseases,
application of sanitary measures, and monitoring of
environmental hazards.”
-The American Heritage Dictionary of Public Health
1/9/2023
Reena
Bhagat
11

12. Contd…
• Public health, in its present form, is a blend of
scientific disciplines( e.g. epidemiology,
biostatistics, laboratory sciences, social sciences,
demography, and skills and strategies(e.g.
epidemiological investigations, planning,
management interventions, surveillance,
evaluation) that are focuses to the maintenance and
improvement of people’s health.
• Terms like preventive medicine, social medicine
and community medicine are used as synonyms for
public health.
1/9/2023
Reena
Bhagat
12

13. Primary Health Care
• Primary Health Care( PHC)as defined by the
WHO in 1978 is: “ essential health care based on
practical, scientifically sound, and socially
acceptable method and technology made
universally accessible to all the individual and
families in the community through their full
participation and at a cost that the community and
the country can afford to maintain at every stage
of their development in the spirit of self-reliance
and self- determination.”
1/9/2023
Reena
Bhagat
13

14. Dimensions of health
• Health is multidimensional. World Health Organization
explained health in several dimensional perspectives:
physical, mental, social and spiritual. Besides these many
more may be cited, e.g. emotional, vocational, political,
philosophical, cultural, socioeconomic, environmental,
educational, nutritional, curative and preventive..
Physical Dimension
• Physical dimension views heath form physiological
perspective. It conceptualizes health that as biologically a
state in which each and every organ even a cell is
functioning at their optimum capacity and in perfect
harmony with the rest of body.
1/9/2023
Reena
Bhagat
14

15. Contd..
• The sign of physical health in an individual are: good
complexion, a clear skin, bright eyes, lustrous hair, well- built
body with appropriate clothing, a good appetite, sound sleep,
regular bowel and bladder and well-coordinated bodily
movements, etc.
• There are range of tools and techniques for evaluating
physical health. The techniques include general and specific
observations, questioning, physical and chemical tests and
dietary assessment. Similarly, variety of tools and devices are
also used for assessing body functioning and conducting
laboratory tests, e.g. assessment of height, weight, head
circumference, mid-arm circumference, muscle mass, blood
and serological tests, urine analysis and gas analysis. Physical
health can be assessed at community level by the
measurement of morbidity and mortality rates.
1/9/2023
Reena
Bhagat
15

16. Contd…
Evaluation of physical health:
Modern medicine has evolved tools and techniques
which may be used in various combinations for the
assessment of physical health. They include:
• Self assessment of overall health
• Inquiry into symptoms of ill health and risk factors
• Inquiry into medications: inquiry into levels of activity(
eg. Number of days of restricted activity within a
specified time, degree of fitness)
• Inquiry into use of medical services( eg. The number of
visits to a physician, number of hospitalizations) in the
recent past
• Standardized questionnaires for cardiovascular
diseases.
1/9/2023
Reena
Bhagat
16

17. Contd…
• Standardized questionnaires for respiratory
diseases
• Clinical examination: nutrition and dietary
assessment
• Biochemical and laboratory investigations: at the
community level, the state of health may be
assessed by such indicators as death rate, infant
mortality rate and expectation of life.
1/9/2023
Reena
Bhagat
17

18. Contd..
 Mental Dimension
• Mental well-being refers to the normal functioning of
mind and not merely the absence of mental illness.
Ability to think clearly and coherently. This deals
with sound socialization in communities.
• Mental health is a state of balance between the
individual and the surrounding world, a state of
harmony between oneself and others, coexistence
between the relatives of the self and that of other
people and that of the environment. Mental health is
not merely an absence of mental illness.
1/9/2023
Reena
Bhagat
18

19. Contd…
• Features of mentally healthy person
Free from internal conflicts.
Well- adjusted in the external environment.
Searches for one’s identity.
Strong sense of self-esteem.
Knows himself: his mind, problems and goal.
Have good self-controls-balances.
Faces problems and tries to solve them
intellectually.
1/9/2023
Reena
Bhagat
19

20. Contd..
Psychologists have mentioned the following characteristics
as attributes of mentally health person:
 A mentally healthy person is free from internal conflict,
he is not at “war” with himself
 He is well-adapted i.e., he is able to get along well with
others. He accepts criticism and is not easily upset.
 He searches for his identity
 He has a strong sense of self-esteem.
 He knows himself: his needs, problems and goals( this is
known as self-actualization).
 He has good self-control-balances rationality are
emotionality.
 He faces problems and tries to solve them intelligently
i.e., coping with stress and anxiety.
1/9/2023
Reena
Bhagat
20

21. Contd..
 Social dimension
• Social well-being indicates the positive relationship
which enable a person to live in harmony with his
surroundings, or society where he belongs.
• It refers the ability to make and maintain relationships
with other people or communities.
• It states that harmony and integration within and
between each individuals and other members of the
society.
• Social dimension of health includes the level of social
skills one possesses, social functioning and the ability
to see oneself as a member of a larger society.
1/9/2023
Reena
Bhagat
21

22. Contd..
• Although, it is difficult to measure, it can be assessed by
use of socio-economic status, level of literacy and
employment status, attitude scales, sociometery, etc
Additional dimensions:
Spiritual Dimension
 Spiritual health is connected with religious beliefs and
practices. It also deals with personal creeds, principles of
behavior and ways of achieving peace of mind and being
at peace with oneself.
 It is intangible “something” that transcends physiology
and psychology. It includes integrity, principle and
ethics, the purpose of life, commitment to some higher
being, belief in the concepts that are not subject to “state
of art” explanation.
1/9/2023
Reena
Bhagat
22

23. Contd..
Emotional Dimension
• Historically, the mental and emotional dimensions
have been seen as one element or as two close
related elements.
• However, as more research becomes available
now, mental health can be seen as “knowing” or
“cognition” while emotion health relates to
“feeling”.
1/9/2023
Reena
Bhagat
23

24. Contd…
Vocational dimension
• Vocational aspect of life is a new dimension. It is a
part of human existence. When work is fully
modified to human goals, capacities and limitations,
work often plays a role in promoting both physical
and mental health. It not only improves the physical
capacity but goal achievement and self-realization in
work are also a source of satisfaction and enhance
self-esteem.
• The value of this dimension is exposed when
individuals suddenly lose their jobs or are faced with
mandatory retirement.
1/9/2023
Reena
Bhagat
24

25. Contd..
 Others
A few other dimensions also been suggested such as-
• Philosophical
• Cultural
• Socio-economic
• Environmental
• Nutritional
• Curative
• Preventive
1/9/2023
Reena
Bhagat
25

26. Determinants of Health
• Health is multifactorial. The factors which influence
health lie both within the individual( genetic factors)
and externally in the society in which he or she lives.
These factors interact and these interactions may be
health-promoting or deleterious. Some of important
determinants or variables are as:
• Heredity
• Environment
• Lifestyle
• Socio-economic conditions
• Health services
• Aging factors
• Psychological factors
1/9/2023
Reena
Bhagat
26

27. Biological determinant
• The physical and mental traits of every human being
are to some extent determined by the nature of genes at
the moment of conception.
• A number of diseases are now known to be of genetic
origin, e.g. chromosomal anomalies, errors of
metabolism, mental retardations, some types of
diabetes, etc.
• From genetic stand point, health may be defined as
that” state of the individual which is based upon the
absence from the genetic constitution of such genes as
correspond to characters that take the form of serious
defect and derangement and to the absence of any
aberration in respect of the total amount of
chromosome material in the karyotype.
1/9/2023
Reena
Bhagat
27

28. Behavioral and socio-cultural conditions
• The term” lifestyle” is used to denote” the way people
live”, reflecting a whole range of social values, attitudes
and activities. It is composed of cultural and behavioral
patterns and lifelong personal habits( e.g. smoking,
alcoholism) that have developed through the process of
socialization.
• Lifestyles are learnt through social interactions with
parents, peer groups, friends and siblings and through
school and mass media.
• Many current-day health problems especially in the
developed countries ( e.g. coronary heart disease,
obesity, lung cancer, drug addiction) are associated with
lifestyle changes.
1/9/2023
Reena
Bhagat
28

29. Contd…
• In developing countries where traditional lifestyles
still persist, risk of illness and death are connected
with lack of sanitation, poor nutrition, personal
hygiene, elementary human habits, customs and
cultural patterns.
• There are also many that can actually promote
health. Examples include adequate nutrition,
enough sleep, sufficient physical activity, etc.
• In short, the achievement of optimum health
demands adoption of healthy lifestyles. Health is
both a consequences of an individual’s lifestyle
and a factor in determining it.
1/9/2023
Reena
Bhagat
29

30. Environment
• Environment is classified as “ internal and
“external”.
• The internal environment of man pertains to “ each
and every component part, every tissue, organ and
organ-system and their harmonious functioning
within the system.
• The external or macro-environment consists of
those things to which man is exposed after
conception. It is defined as” all that which is
external to the individual human host.
• It can be divided into physical, biological and social
components, any or all of which can affect the
health of man and his susceptibility to illness.
1/9/2023
Reena
Bhagat
30

31. Contd..
• It is established fact that environment has direct
impact on the physical, mental and social well-
being of those living in it. The environmental
factor ranges from housing, water supply,
psychological stress, and family structure through
social and economic supply systems, to the
organization of health and social welfare services
in the community.
• The environmental components are so inextricably
linked with one another that if environment is
favorable to the individual, he can make full use of
his physical and mental capabilities.
1/9/2023
Reena
Bhagat
31

32. Socio-economic conditions
• For majority of world’s people, health status is
determined primarily by their level of socio-economic
development, e.g. per capita GNP, education, nutrition,
employment, housing, etc. those of major importance are:
Economic status: the per capita GNP is the most widely
accepted measure of general economic performance. The
economic status determines the purchasing power, standard
of living, quality of life, family size and pattern of disease
and deviant behavior in the community. It is also an
important factor in seeking health care.
Ironically, affluence may also be a contributory cause of
illness as exemplified by the high rates of coronary heart
disease, diabetes and obesity in upper socio-economic
groups.
1/9/2023
Reena
Bhagat
32

33. Contd…
Education: A second major factor influencing health
status is education( especially female education). The
world map of illiteracy closely coincides with the maps
of poverty, malnutrition, ill health, high infant and child
mortality rates. Studies indicate that education, to some
extent, compensates the effect of poverty on health,
irrespective of availability of health facilities.
Occupation: The very state of being employed in
productive work promotes health, because the
unemployed usually show a higher incidence of ill
health and death. For many, loss of work many mean
loss of income and status. It can cause psychological and
social damage.
1/9/2023
Reena
Bhagat
33

34. Contd…
Political system: health is also related to the
country’s political system. Often the main obstacles
to the implementation of health technologies are not
technical but rather political.
• Decisions concerning resource allocation,
manpower policy, choice of technology and the
degree to which health service are made available
and accessible to different segments of the society
are examples of the manner in which the political
system can shape community health services.
1/9/2023
Reena
Bhagat
34

35. Contd…
• What is needed is political commitment and
leadership which is oriented towards social
development, and not merely economic
development.
• If poor health patterns are to be changed the
changes must be made in the entire sociopolitical
system in any given community.
• Social, economic and political actions are required
to eliminate health hazards in people’s working
and living environments.
1/9/2023
Reena
Bhagat
35

36. Health services
• The term health and welfare services cover a wide
spectrum of personal and community services for
treatment of disease, prevention of illness and
promotion of health.
• The purpose of health services is to improve the health
status of population. For example, immunization of
children can influence the incidence/prevalence of
particular diseases. Provision of safe water can prevent
mortality and morbidity from water-borne diseases. The
care of pregnant women and children would contribute
to reduction of maternal and child morbidity and
mortality.
• To be effective, health services must reach the social
periphery, equitable distributed, accessible at a cost the
country can afford and socially acceptable.
1/9/2023
Reena
Bhagat
36

37. Aging of population
• Although the elderly in many countries have
better health until now, a major concern of rapid
population aging is the increased prevalence of
chronic disease and disabilities both being
conditions that tend to accompany the aging
process and deserve special attention.
1/9/2023
Reena
Bhagat
37

38. Lifestyle
• Lifestyle refer to the way of living or the way people
live reflecting the whole range of social values, attitudes
and activities.
• It is composed of cultural( belief, traditions,
superstitions and behavioral pattern and lifelong
personal habits( e.g. smoking, alcoholism, drug abuse
that have been developed during the process of
socialization.
• Lifestyles are learnt through social interaction with
parents, peer groups, friends and siblings and through
school and mass media.
• Lifestyles also depend to a large extent on the
occupation of the head of household, income level of the
family, housing, good clothing, recreation and even
education and health care.
1/9/2023
Reena
Bhagat
38

39. Contd…
• The ways of life of people in a community and their
individual lifestyle have significant impact on health.
For example good personal hygiene, adequate nutrition,
enough sleep, sufficient physical activity and others
promote health and are termed as healthy lifestyles
whereas poor lifestyles may result in ill health.
• In most of developing countries, many health problems
are directly attributable to the lack of basic essentials of
life such as nutrition, housing because of poverty. In
contrast in developed world, the prevalence of mental
problems, obesity and other chronic diseases like
diabetes, heart and kidney problems are comparatively
higher than the developing world that are directly and
indirectly related to person’s lifestyle.
1/9/2023
Reena
Bhagat
39

40. Psychological factors
• Psychology is defined as” the study of human
behavior- of how people behave and why they
behave in just the way they do”. It is connected
with individual, his personality and his behavior.
• A knowledge of psychology is essential to know
others better, to differentiate between the normal
and abnormal, to understand attitudes, beliefs,
learning and memory process; and to help
promote mental health in individual and families.
1/9/2023
Reena
Bhagat
40

41. Gender
• The 1990s have witnessed an increased
concentration on women’s issues. In 1993 the
Global Commission on Women’s Health was
established. The commission drew up an agenda
for action on women’s health covering nutrition,
reproductive health, the health consequences of
violence, aging, lifestyle environment.
• It has brought about an increased awareness
among policy makers of women’s health issues
and encourages their inclusion in all development
plans as a priority.
1/9/2023
Reena
Bhagat
41

42. Other factors
• We are witnessing the transition from post
industrial age to an information age and
experiencing early days of two interconnected
revolutions in communication.
• The development of these technologies offer
tremendous opportunities in providing an easy and
instant access to medical information once difficult
to retrieve.
• It contributes to dissemination of information
worldwide, serving the needs of many physicians,
health professionals, biomedical scientists and
researchers the mass media and the public.
1/9/2023
Reena
Bhagat
42

43. Contd…
• Other contributions to the health of population
derive from system outside the formal health care
system i.e. health related systems( e.g. food and
agriculture, education, industry, social welfare,
rural development) as well as adoption of policies
in the economic and social fields that would
assist in raising the standards of living.
• This would include employment opportunities,
increase wages, prepaid medical programs and
family support systems.
1/9/2023
Reena
Bhagat
43

44. Responsibility for health
• Individual/ family responsibility
• Community responsibility
• State/ National responsibility
• International responsibility
• Health is on one hand a highly personal
responsibility and on other hand a major public
concern. It thus involves the joint efforts of
whole social fabric viz. the individual, family,
community and the state to protect and promote
health.
1/9/2023
Reena
Bhagat
44

45. Individual responsibility
• Although health is now recognized a fundamental
right , it is essentially an individual responsibility.
• In large measure , it has to be earned and maintained
by the individual himself , who must accept a broad
spectrum of responsibilities , now known as “self
care”.
• Self-care in health
It is defined as “ those health generating activities that
are undertaken by the persons themselves”.
It refers to those activities individuals undertake in
promoting their own health , preventing their own
disease , limiting their own illness , restoring their own
health.
1/9/2023
Reena
Bhagat
45

46. Contd..
• The generic attribute of self care is its non-
professional , non bureaucratic , non industrial
character , its natural place in social life.
• Self care activities comprise observance of simple
rules of behavior relating to diet , sleep , exercise ,
weight , alcohol , smoking , drugs , personal hygiene
, cultivation of healthful habits , lifestyle ,
submitting oneself to selective medical
examinations, screening , accepting immunization
and carrying out other specific disease preventive
measures , reporting early when sick , accepting
treatment , undertaking measures for the prevention
of a relapse or of the spread of the disease to others ,
family planning.
• Health must begin with the individual.
1/9/2023
Reena
Bhagat
46

47. Community responsibility
• The individual and community responsibility are
complementary , not antithetical.
• The current trend is to “demedicalize” health and
involve the communities in a meaningful way. This
implies a more active involvement of families and
communities in health matters , “planning ,
implementation , utilization , operation , evaluation of
health services”. In other words , the emphasis has
shifted from “health care for the people to health care
by the people” .
• The Village Health Guides scheme in India launched
in 1977 is an example of community participation.
1/9/2023
Reena
Bhagat
47

48. Contd..
• There are three ways in which a community can
participate
1. The community can provide in the shape of
facilities , manpower , logistic support , and
possibly funds .
2. It also means the community can be actively
involved in planning , management , and evaluation
3. An equally important contribution that people can
make is by joining in and using the health services.
1/9/2023
Reena
Bhagat
48

49. Contd..
• Long ago Henry Sigerist , the medical historian
stated that “ The people’s health ought to be the
concern of people themselves . They must
struggle for it and plan for it. The war against
disease and for health cannot be fought by
physicians alone. It’s a people’s war in which the
entire population must be mobilized
permanently”.
1/9/2023
Reena
Bhagat
49

50. State responsibility
• The state shall , in particular , direct the policy towards
securing that the health and strength of workers , men
and women and the tender age of children are not abused
and that citizens are not forced by economic necessity to
enter avocations unsuited to their age or strength.
• That childhood and youth are protected against moral
and material abandonment.
• That state shall , within the limits of its economic
capacity and development , make effective provision for
securing the right to work , to education , and to public
assistance in cases of unemployment , old age , sickness
and disablement and in other cases of undeserved want.
•
1/9/2023
Reena
Bhagat
50

51. Contd..
• The state shall make provision for securing just
and humane conditions of work and maternity
itself.
• The state shall regard the raising of the level of
nutrition and standard of living of its people and
the improvement of public health as among its
primary duties.
1/9/2023
Reena
Bhagat
51

52. International responsibility
• The WHO is a major factor in fostering international
cooperation in health.
• The TCDC (Technical Cooperation In Developing
Countries) , ASEAN (Association Of South East Asian
Nations ), SAARC (South Asia Association for Regional
cooperation) The eradication of smallpox , the pursuit of “
Health For All” and the campaign against smoking and
AIDS are a few recent examples of international
responsibility for the control of disease and promotion of
health.
• The eradication of smallpox, the pursuit of “ Health for
all” and the campaign against smoking and AIDS are a
few recent examples of international responsibility for the
reduction of disease and promotion of health.
1/9/2023
Reena
Bhagat
52

53. Primary Health Care
What is Primary Health Care?
“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 country can
afford.”
( Alma Ata Declaration 1978)
1/9/2023
Reena
Bhagat
53

54. Primary Health Care
"PHC is essential healthcare 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 the country can
afford. It forms an integral part of the country's
health system, of which it is the central function
and the main focus, and of the overall social and
economic development of the community".
1/9/2023
Reena
Bhagat
54

55. Goals of PHC
• To increase the proportion of the population with
access to primary health care organizations that
are accountable for the planned provision of
comprehensive services to a defined population.
• To increase the emphasis on health promotion,
disease and injury prevention and chronic disease
management.
• To expand access to essential services.
1/9/2023
Reena
Bhagat
55

56. Contd…
• To establish multi disciplinary teams, so that the
most appropriate care is provided by most
appropriate provider.
• To facilitate coordination with other health
services (such as specialists and hospital).
1/9/2023
Reena
Bhagat
56

57. Principles of PHC
• Equitable distribution- urban & rural areas
• Community participation – trained SBA
• Intersectoral co-ordination- education , nutrition
etc..
• Appropriate technology – ORS, growth
monitoring
• Focus on prevention activities- Polio, Malaria
1/9/2023
Reena
Bhagat
57

58. 1. Equitable distribution
1/9/2023 58
• The first key principle in primary health
care strategy is equity or equitable
distribution of health services
• Countries should find means to ensure
every person’s access to services.
Reena
Bhagat

59. Contd..
Something for all and most for those who
need the most.
• Health services must be shared equally by all
people irrespective of their ability to pay and
all ( rich or poor, urban or rural) must have
access to health services
1/9/2023
Reena
Bhagat
59

60. 2. Community participation
1/9/2023 60
• There must be a continuing 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.
• Community involvement: the involvement of
individuals in promoting their own health is essential
for the future well-being of the community.
Reena
Bhagat

61. 3. Intersectoral Coordination
"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 others sectors".
1/9/2023
Reena
Bhagat
61

62. 4. Appropriate Technology
1/9/2023 62
• "technology that is scientifically sound,
adaptable to local needs, and acceptable to
those who apply it and 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 country can afford".
• Should be acceptable, cost-efficient,
cheap and available at the local level.
Reena
Bhagat

63. 5. Focus on the prevention activity
1/9/2023 63
• Acquiring knowledge, through education for
health and/or the mobilization of communities for
immunization; the role of communities in making
decisions related to the provision of resources for
medical priorities
• As prevention is essential for solving the long-
term problems of the community, though it is not
always the solution to individual problems,
preventive services should exist alongside
curative services.
Reena
Bhagat

64. Elements of PHC
1. E: Education concerning prevailing health problems
and methods preventing and controlling them
2. L: Prevention and control of locally endemic
diseases
3. E: Expanded program on Immunization against
major infectious diseases
4. M: Maternal and child health care including
family planning.
1/9/2023
Reena
Bhagat
64

65. Elements of PHC…
5. E: Provision of essential drugs
6. N: Promotion of food supply and proper
nutrition
7. T: Appropriate treatment of common
diseases and injuries
8. S: An adequate supply of safe water and
basic sanitation
1/9/2023
Reena
Bhagat
65

66. Elements of PHC…
Two new elements are added
9. M: Mental Health
10.D: Dental Health
1/9/2023
Reena
Bhagat
66

67. 1. Education
• Education concerning prevailing health problems
and methods preventing and controlling them:
Health education is the integral part of the health
services and hence they can maintain, improve and
cure their health status.
• The midwife has also to play an important role in
organizing appropriate health educational
programs according to need of the community
collaborating with multi-disciplinary and multi-
sectoral team.
1/9/2023
Reena
Bhagat
67

68. 2. Prevention and control of locally
endemic diseases
• Prevention and control of locally endemic diseases:
Endemic diseases are these diseases, which
commonly occur in certain geographical area or
country.
• The endemic diseases in Nepal are malaria, goitre
and kala-azar.
• The role of midwife in community is to give health
education, visit and follow up, provide care to ill
etc.
1/9/2023
Reena
Bhagat
68

69. 3. Expanded program on Immunization
• Expanded program on Immunization
against major infectious diseases:
Immunization is importance for prevention
and control of communicable diseases.
• Immunization of children against twelve
major vaccine preventable disease had
been made great stride worldwide.
1/9/2023
Reena
Bhagat
69

70. Contd..
• These diseases cause many illness
disability and death each year.
• As these disease can easily prevent by
active immunization, midwife also can
involve to immunization directly and
indirectly.
1/9/2023
Reena
Bhagat
70

71. 4. Maternal and child health care
including FP
• Maternal and child health are important indicators
of country’s development.
• Maternal mortality rate is high in developing
country including Nepal.
• The main causes of high MMR is PPH, infection,
obstructed labour, abortion and related
complication.
1/9/2023
Reena
Bhagat
71

72. Contd..
• It is due to various factors like improper
management of health, delivery and unstable
political situation.
• So we have to carry out maternal and child
health care, which includes antenatal, intra-
natal, postnatal, neonatal, infant care,
provision of FP etc.
1/9/2023
Reena
Bhagat
72

73. 5. Provision of essential drugs
• Department of drug administration had
develop a list of national essential drug for
proper use of drugs.
• All health care organization should equipped
with emergency drugs to tackle the situation
and health personal including the nurse should
be aware of about the supply of essential
drugs.
• There are free 98 drugs in PHC which are
provided by government of Nepal.
1/9/2023
Reena
Bhagat
73

74. 6. Promotion of food supply and
proper nutrition
• There is close relationship between nutrition
and health. Nutrition is necessary for growth
and development, protection from infection
and prevention from specific deficiency.
• As a midwife, we should counsel and
motivate to grow variety of food, preparation
of supplementary food, preparation of food
with balance diet and selection of food in
sufficient quantity and quality.
1/9/2023
Reena
Bhagat
74

75. Contd..
• The midwife also takes health promotional
measures like encouraging adequate child
spacing by promoting exclusive breast
feeding, complementary feeding practice
and responsible for weighing young infant
and child, maintaining growth chart,
conducting nutritional educational program,
making provision to supply iodized salt,
Vitamin A supplement, deworming, iron
supplement etc.
1/9/2023
Reena
Bhagat
75

76. 7. Appropriate treatment of common
diseases and injuries
• Common disease and injuries should be
treated at proper place like health post,
PHC, district hospital, central hospital
according to their need.
1/9/2023
Reena
Bhagat
76

77. 8. Safe water and basic sanitation
• Adequate safe water supply & basic sanitation
(clean and proper disposal of water) are essential
for the health and wellbeing of the community as
well as people.
• The role of midwife is to teach the community
about ways of purifying drinking water, not
contaminating rivers and wells, identify sources of
safe water, encourage people to construct
household and community latrines, make provision
for composting facilities and septic tank where
drainage system is poor.
1/9/2023
Reena
Bhagat
77

78. 9. Mental Health
• Mental health is the state of successful
performance of mental function, resulting in
productive activity, fulfilling relationship with
other people and ability to adopt to change and to
cope with adversity.
• If a person is mentally disturbed she/he cannot do
anything.
• The midwife should teach community about
stress management, prevention of mental illness
and proper management of mentally disturbed
people.
1/9/2023
Reena
Bhagat
78

79. 10. Dental Health
• Dental carries and periodontal disease are the
most common causes of tooth loss.
• Nepalese people are suffering from various
dental problem so the midwife should conduct
school dental health program, and provide
health program, and provide health education
on oral care, treatment about oral and tooth
disorders.
• The dental health is added in PHC component
with sense of complete health.
1/9/2023
Reena
Bhagat
79

80. Functions of PHC
Functions
of PHC
Medical
care
MCH
including FP
Safe water
supply and
sanitation
Prevention
and control
of diseases
Collection
and
reporting of
vital
statistics
Health
Education
National
Health
Programmes
Referral
Services
1/9/2023
Reena
Bhagat
80

81. The Basic Requirements for Sound PHC
(the 8A’s and the 3 C’s)
 Appropriateness
 Availability
 Adequacy
 Accessibility
 Acceptability
 Affordability
 Assessability
 Accountability
 Completeness
 Comprehensiveness
 Continuity
1/9/2023
Reena
Bhagat
81

82. Roles of Midwives in PHC
1.Direct Care Provider
 The midwife provides direct care to individual,
families and community with reference to 8
elements of primary health care. E.g.,
 For MCH care the midwife has to identify
pregnant mothers, register them, conduct
complete physical and obstetrical examination,
identify high risk factors, give TT injection, IFA
tablets, and health educate them about diet, rest
and sleep, exercise etc.
1/9/2023
Reena
Bhagat
82

83. Contd.
2. Health Educator & Teacher
 In order to promote health, prevent disease,
regain and maintain health, the midwife educates
individuals, families and community at large
about healthful behavior, sanitary environment,
prevention of diseases etc.,
 Whatever she does, even the care of the sick at
home, she educates family members to take are
of the sick in her absence and also other
preventive measures.
 As a teacher, she trains other health workers such
as ANMs, health Guides, FCHVs..
1/9/2023
Reena
Bhagat
83

84. contd..
3. Planner & Care Manager
 The midwife working for primary health care makes
assessment of health needs, health problems of
individuals, families and community.
 The midwife plans care accordingly for them and
implements the planned care.
 The midwife involves individuals, families and
community in planning and implementing of the
care.
1/9/2023
Reena
Bhagat
84

85. contd.
 The midwife makes use of the community
resources and guides them in giving care.
 The midwife listens to and communicates with
them and advise them accordingly.
 She makes referrals when required.
 She maintains the record of care given and
evaluates the effectiveness of the same.
1/9/2023
Reena
Bhagat
85

86. Contd.
4. Guide & Supervisor
As a midwife engaged in providing primary
health care, she is expected to supervise, guide
and help other personnel in providing care,
planning health services for families and for the
community.
Specified Functions
 Assessment of health needs and health problems
of individuals and community.
 Provide integrated comprehensive primary
health care service related to 8 essential
elements.
1/9/2023
Reena
Bhagat
86

87. Contd..
 Mobilize involvement of individuals, families and
community in providing primary health care.
 Surveillance of locally endemic diseases.
 Training and supervision of health workers.
 Working in collaboration with other
socioeconomic sectors.
 Maintenance of accurate, complete and up-to-date
records of health care services rendered.
 Monitoring and analysis of health condition to
determine the progress in primary health care.
1/9/2023
Reena
Bhagat
87

88. Revitalization of PHC in Nepal
 The Revitalization of PHC has been done in 30th
anniversary year of Alma Ata Declaration.
 A Regional conference on “Revitalizing Primary
Health Care” was held in Jakarta, Indonesia, 6-8
August 2008.
 The central theme of Revitalization of PHC was
“Health System Strengthening” using PHC
approach that can also accommodate the needs of
vertical programmes..
1/9/2023
Reena
Bhagat
88

89. 1/9/2023
Reena
Bhagat
89

90. Contd.
• In 2009, Ministry of Health and Population (MoHP)
constituted Primary Health Care Revitalization Division
(PRD), a new division, under the Department of Health
Services (DoHS).
• The new division will assume the role to revitalize PHC
in Nepal by addressing emerging health challenges in
close collaboration with the other DoHS divisions and
different supporting actors.
• The division is also expected to make inroads into
translating the constitutionally stipulated fundamental
right of basic free health care into practice by
addressing the disparities in health service delivery and
promoting equitable health services.
1/9/2023
Reena
Bhagat
90

91. Contd..
Three perspectives of PHC (Alma-Ata):
• A package or set of activities: minimum 8
elements: Selective and Comprehensive PHC
• Level of care: primary-secondary-tertiary care
• Approach:
Universal coverage
Inter-sectoral collaboration
Community participation
Appropriate technology
1/9/2023
Reena
Bhagat
91

92. PHC: Then and Now
NOW Misperceptions:
• PHC is only for poor developing countries
• PHC is cheap and low quality care
• PHC is only for the rural populations
• PHC is primary care or first point of contact
Needs for better partnership with the private
sector. Alma-Ata did not specifically address it.
Health Systems Strengthening using PHC
approach to better accommodate the needs of
various vertical programmes.
1/9/2023
Reena
Bhagat
92

93. HEALTH FORALL 2000
• Not achieved in 2000
• HFA as a vision for health development, no definite
time line.
• There is misperception also:
oin the year 2000 the health professionals provided
health care for everybody or that nobody would be sick
or disabled.
 Proposed new definition:
“A stage of health development whereby everyone has
access to quality health care or practice self-care
protected by financial security so that no individual or
family is experiencing catastrophic expenditure that may
bring about impoverishment”.
1/9/2023
Reena
Bhagat
93

94. Early Attempts at
Implementing PHC
Current Thinking on
Revitalization of PHC
Extended access to a basic
package of health
interventions and essential
drugs for the rural poor
Transformation and
regulation of existing health
systems, aiming for universal
access and social health
protection
Concentration on mother and
child health
Dealing with the health of
everyone in the community
Focus on a small number of
selected diseases, primarily
infectious and acute
A comprehensive response to
people’s expectations and
needs, spanning the range of
risks and illnesses
1/9/2023
Reena
Bhagat
94

95. Early Attempts at
Implementing PHC
Current Thinking on
Revitalization Of PHC
Improvement of hygiene,
water, sanitation and health
education at village level
Promotion of healthier
lifestyles and mitigation of the
health effects of social and
environmental hazards
Participation as the
mobilization of local
resources and health-center
management through local
health committees
Institutionalized participation
of civil society in policy
dialogue and accountability
mechanisms
Government-funded and
delivered services with a
centralized top-down
management
Pluralistic health systems
operating in a globalized
context.
1/9/2023
Reena
Bhagat
95

96. Early Attempts at
Implementing PHC
Current Thinking on
Revitalization Of PHC
Management of growing
scarcity and downsizing
Guiding the growth of
resources for health towards
universal coverage
Primary care as the antithesis
of the hospital
Primary care as coordinator
of a comprehensive response
at all levels
PHC is cheap and requires
only a modest investment
PHC is not cheap: it requires
considerable investment but
it provides better value for
money than its alternatives.
1/9/2023
Reena
Bhagat
96

97. MILLENNIUM DEVELOPMENT
GOALS
• A universal framework for:
– development and
–a means for developing countries and their
development partners to work together.
 Routine monitoring of MDGs is necessary.
 Proxy indicators for U5MR and MMR (e.g.
coverage of Measles immunization; coverage of
birth attended by SBA)
1/9/2023
Reena
Bhagat
97

98. Key points related to revitalize PHC
The following key points are related to revitalize PHC:
 Adequate and competent Community based health workers
and Community health volunteers play a vital role in health
development of the community.
 NGOs and private sector working in partnership with the
government can lead health-care initiatives and enhance
community movement.
 A strong civil society can push the agenda for local
development of community health care. Health promotion,
self-care and risk prevention should be intensified.
 Decentralization of the roles and functions of health
specialists to CBHWs and CHVs as well as community
trusts contribute to positive community health outcomes.
1/9/2023
Reena
Bhagat
98

99. Challenges in Implementing Primary Health
Care
• Misinterpretations of the concept of Primary Health Care
• Burden of diseases
• Inequity in health
• Escalating health care cost
• Trade agreements
• Interdependence of the world
• Inadequate performance or low efficiency of the health
system
• Need for more research
• Financing the health system
• Need for integrated services
• Public Private Partnership
• Climate change
1/9/2023
Reena
Bhagat
99

100. New challenges of revitalization of
PHC in Nepal
 Countries and donors can do to save lives and
avoid disability.
 Three ills of life in the 21st century:
• The globalization of unhealthy lifestyles,
• Rapid unplanned urbanization, and
• The ageing of populations.
1/9/2023
Reena
Bhagat
100

101. Revitalizing PHC is outlined
1) Reaffirm high political commitment toward PHC.
2) Improve health equity through specific actions in
the health sector as well as other sectors
3) Foster more effective multisectoral collaboration
4) Strengthen health workforce including
Community-Based Health Workers (CBHW) and
Community Health Volunteers (CHV).
5) Implement equitable health-care financing such as
tax- based and social health insurance and various
community- based health financing.
1/9/2023
Reena
Bhagat
101

102. Contd..
6) Strengthen partnership with civil society that
includes the community, the private sector and
NGOs.
7) Promote better transparency and accountability
of the health systems through improved
leadership and governance (stewardship).
8) Utilize to its fullest various global health
initiatives (e.g. GAVI: Global Alliances for
Vaccination and Immunization; GF
ATM: Global Fund to Fight AIDS, TB and
Malaria) and IHP: integrated Health Plans).
1/9/2023
Reena
Bhagat
102

103. Way forward
A three year interim health plan 2007/8-2009/10 has been
prepared. The future course of action will be guided by the
objectives and activities formulated in this plan. In order to
achieve the objectives, some of the key activities for the
initial period of planning cycle are:
• To strengthen on-going high priority EHCS and achieve
MDGs in accordance with the principles of Primary
Health Care, equity and social justice.
• To redesign health system to make people oriented,
efficient and effective through reform in institutional
management and health professional education.
1/9/2023
Reena
Bhagat
103

104. Contd..
• To ensure availability of good quality services and
essential medicines to all at affordable prices.
• To strengthen public private partnership.
• To develop performance based planning and budgeting
system.
• To strengthen financial information system including
monitoring and feedback.
• To encourage the implementation of decentralization
approaches in health service delivery system.
• To develop capacity of the health workers and
stakeholders involved in health facility operation and
management.
1/9/2023
Reena
Bhagat
104

105. Conclusion
• Nepal reaffirms its political commitment to
revitalizing PHC as an effective approach to
strengthen health systems.
• This approach is anchored at the community level
and responsive to its health needs; emphasizes
overall health system strengthening to improve
equity and efficiency; and shifts from focus on
service delivery to a development orientation in
the country’s social, political and economic
contexts.
1/9/2023
Reena
Bhagat
105

106. Public Health Fundamentals
5 Ps of public health (expansion from the 3ps)
Prevention - action of stopping the disease from
arising
Promotion - enables people to improve or have
greater control over the health
Protection - concerned with policies and practice
to improve the prevention and control of diseases.
Population-based (communities, group)
Preparedness New 5th p: (e.g. bioterrorism,
natural disasters, pandemics)
1/9/2023
Reena
Bhagat
106

107. Public Health
WHO Definition
Public health refers to all organized measures
(whether public or private) to prevent disease,
promote health, and prolong life among the
population as a whole.
Its activities aim to provide conditions in which
people can be healthy and focus on entire
populations, not on individual patients or diseases.
1/9/2023
Reena
Bhagat
107

108. Contd..
The three main public health functions are:
● The assessment and monitoring of the health of
communities and populations at risk to identify
health problems and priorities.
● The formulation of public policies designed to
solve identified local and national health problems
and priorities.
● To assure that all populations have access to
appropriate and cost-effective care, including health
promotion and disease prevention services.
1/9/2023
Reena
Bhagat
108

109. CoreActivities of Public Health
1. Prevents epidemics and the spread of disease
2. Protects against environmental hazards
3. Responds to disasters and assists communities in
recovery
4. Prevents injuries
5. Promotes healthy behaviors
6. Assures the quality, accessibility and
accountability of health services
1/9/2023
Reena
Bhagat
109

110. Contd.
7. Monitoring the health status of the population
8. Mobilizing community action
9. Reaching out to link high-risk and hard-to-reach
people to needed services
10. Researching to develop new insights and
innovative solutions
11. Leading the development of sound health policy
and planning
1/9/2023
Reena
Bhagat
110

111. 1/9/2023
Reena
Bhagat
111

112. Contd..
Examples of notable public health campaigns:
 Vaccination and control of infectious diseases
 Motor-vehicle safety
 Safer workplaces
 Safer and healthier foods, safe drinking water
 Healthier mothers and babies and access to family
planning
 Coronary heart disease and stroke resulting in
declining death rates
 Recognition of tobacco use as a health hazard
1/9/2023
Reena
Bhagat
112

113. Contd..
• The term global public health recognizes that, as
a result of globalization, forces that affect public
health can and do come from outside state
boundaries and that responding to public health
issues now requires attention to cross-border
health risks, including access to dangerous
products and environmental change.
1/9/2023
Reena
Bhagat
113

114. Contd..
Functions of public health.
• Prevent disease its progression and injuries
• Protection and promotion healthy environment for
health and sanitation
• Promote health and healthy behavior
• Identify measures, monitor and anticipate health
needs of community people
• Investigation and diagnosis of health problems that
is
a. Microbial : bacteria disease, viral disease,fungal
etc.
b. Chemical hazards
1/9/2023
Reena
Bhagat
114

115. Contd..
• Develop new methodologies and research,
community mobilize for appropriate action
• Reduce health disparities in communities and
ensure HEALTH FOR ALL.
• Formulate health policies, plans, strategies and
implement for improve health status
• Organize qualities of health services and cost
efficiency services so everyone can take afford
that reduce impacts of personnel violence and
aggressive war
1/9/2023
Reena
Bhagat
115

116. Contd..
• Conduct research and evaluation for health
promotion, prevention and strategies
• Disseminate health information and
communication for community mobilize and
participation
• Prepare for mad made and natural disasters
• Trained and ensure competent public health
work forces
1/9/2023
Reena
Bhagat
116

117. Principles of public health
• Emphasis on collective responsibilities on health
• Envisaged major role of state of health by
formulating policies and rules and
implementation
• Emphasis on whole population not individually
• Focus on preventive health specially on primary
prevention also do not forget curative services
1/9/2023
Reena
Bhagat
117

118. Contd.
• Multi disciplinary ready to work in different and
diverse discipline for health and development
• Concern socioeconomic determination of health
and disease as well as proximal determination
such as primary health care
• Attitude to both qualitative and quantitative
method at working sites
• Ready to partnership with public health
1/9/2023
Reena
Bhagat
118

119. 1/9/2023
Reena
Bhagat
119