PHC

1. GROUP 4
PUBLIC HEALTH
PRESENTATION
PRIMARY HEALTH CARE

2. GROUP
MEMBER
S
 KABATEGYEKI EUNICE
 KISEMBO IVAN
 OKABO WALTER
 WOMAYI IVAN
 SEMPALA EPHRAIM

3. OBJECTIVES

4. DEFINITION
"PHC is a whole-of-society approach to health that aims at ensuring
the highest possible level of health and well-being and their equitable
distribution by focusing on people’s needs and as early as possible
along the continuum from health promotion and disease prevention to
treatment, rehabilitation and palliative care, and as close as feasible
to people’s everyday environment," WHO and UNICEF.
 OR
 It is the essential care that is made accessible and affordable with
participation and involvement of the community

5. INTRODUCTION.
 Primary health care is a whole-of-society approach to effectively
organize and strengthen national health systems to bring
services for health and wellbeing closer to communities
 It is the first level of contact of individuals, family and
community with the national health system bringing health care
as close as possible to where people live and work and
constitutes the first element of a continuing health care process.
(Alma Ata Declaration)
 Addresses the main health problems in the community
providing promotive, preventive, curative and rehabilitative
services
 It includes education concerning prevailing health problems and
the method of preventing and controlling them.
 It involves, in addition to health sector, all related sectors and
aspects of national and community development; example,
agriculture, education, housing, etc.

6.  Community based health care (CBHC) is the
bottom up approach which enables people
living together in the same given area at the
same time , sharing the same problems,
resources and benefits, working together to
improve their quality of life for their well being
with their full participation and involvement
 CBHC is the implementation of PHC , which
emphasises full community participation and
involvement

7.  The World Health Organization (WHO) estimates
that primary health care can address 80-90% of
a population's health needs, making it an
essential component of any healthcare system.
 But what exactly is primary health care (phc),
and what are its essential components?

8. THE
CONCEPT
OF PHC
 WHO established the concept of PHC (PHC concept) in 1978
in the first conference for health in Alma Ata /Kazakhstan
(in former Soviet Union).
 Most of the countries that participated in this conference
supported the Alma Ata declaration that was supposed to
be implemented. “Health for all” was the vision of the
conference.
 This concept was heavily concerned with people,
especially with the principles of social justice, accessibility,
appropriateness and acceptance of medical services with
consideration of the needs of the people in the
communities, their participation and orientation to the
concept of health services.
 PHC is a shift of emphasis to the community. It addresses
the very fundamental essential and basic needs of man.

9. The PHC concept does not only depend on
services provided by ministries of health but also
on inputs from other sectors for the basic needs
such as water, housing, education, food, disease
prevention, availability of drugs etc..
Management of common illnesses and services
for mother and child care are as a priority in life
and therefore must be;-
 Available -whenever needed
 Accessible- reachable physically, psychologically and
socially
 Acceptable- within cultural beliefs and values of
people
 Appropriate- conforming to the village technology,
life and experience
 Affordable- should be cheap so that everyone in the
community can afford it.

10. CHARACTERISTIC
S / PRINCIPLES
OF PHC
 Essential health care
 Practical and scientific sound methods and technology
 Affordability within peoples ability to acquire
 Socially acceptable methods
 Self reliance
 Full Community participation and involvement
 Self determination
 Intersectoral collaboration
 Integration of health care programmes
 Equity
 Sustainability
 Accessibility
 Proactive prevention focus
 Localised set of choices

11.  Essential health care; is the care that meets the local
needs of the majority
 Practical, scientifically sound methods and
technology; Health care system should be able to solve
the health problems in question
 Affordability; cost of the health service should be
affordable both by the community and the country
 Socially acceptable methods; health care should not
conflict with the norms of a community that receives
services, instead it should be appreciated

12.  Self- reliance; community should be independent ,
confident and trusting itself by change of attitude in
being passive recipients to active partners with the
government/ NGOs/Donors. Therefore the
community /government should be able to maintain
PHC activities with minimal external influence
 Full community participation and involvement; This
the process in which individuals and families assume
responsibilities for their own health and welfare in the
community. If people are involved in the planning,
organisation, implementation , monitoring and
evaluation of their services, then these services will be
socially acceptable and sustainable

13.  Self-determination; community should be able
to decide and take action on matters concerning
their health and development.
 Integration; all sectors working towards the
socio-economic development of a community
with health as a nucleus should work together
to promote the health status of their people/
community throughout its referral system

14. ELEMENTS/
COMPONENT
S OF PHC
 Maternal and child health/family planning (MCH/FP)
 Nutrition and food production
 Immunisation against the killer diseases
 Adequate and safe water supply and sanitation
 Management of common conditions
 Appropriate treatment of minor diseases and injury
 Community based rehabilitation
 Prevention and control of locally endemic diseases
 Provision of essential drugs
 Mental health services
 Control of diarrhoeal diseases
 Health education
 STD/HIV/AIDS control and prevention
 Dental and oral health

15.  Maternal and child health/family planning;
Services rendered to mothers and children through ante
natal, post natal and child spacing .The aim is to improve
the health status of women and children
 Nutrition and food production
The process of food production , processing , storage,
marketing, preparation and consumption with the ultimate
goal of improving the health , nutrition and the economic
status of the community

16.  Immunization against the preventable diseases
The administration of vaccines to susceptible members of
the community so as to raise their body defence
mechanism against the vaccine preventable diseases e.g
polio, TB, Diphtheria, measles, Tetanus, whooping cough,
hepatitis B.
 Adequate safe water supply and sanitation
The quality of water in terms of colour, taste, odour,
microorganisms and chemicals
The adequacy in terms of amount and distance to the
source
Sanitation is the control and improvement of all those
factors in the total human environment that have a bearing
to health for example housing refuse and excreta disposal,
vector control, food hygiene, personal hygiene

17. PILLARS OF
PHC
 Political and administrative commitment
 Community participation and involvement
 Intersectoral collaboration
 Appropriate technology

18. Political
commitmen
t
Is the support provided to promote PHC by the leaders who
influence decision making at various levels
 These include;
 Policy makers e.G cabinets, districts, sub-county, local council
committees
 Administrators eg permanent secretaries, chief administrative
officers, chiefs
 Opinion leaders eg religious, traditional leaders at all levels
Why political commitment?
 Advocacy to support phc as a national priority for health care
delivery
 As a form of attraction and assurance for external and donor
support in resource mobilisation
 To build sustainable PHC activities
 Pave way to community mobilisation and participation

19. Feature of PHC Quotation from Alma Ata
declaration
1 An element of health
system
Primary health care forms an integral part
of the country’s health system. It is the
first level of contact of individuals, the
family and the community with the
national health system bringing health
care as close as possible to where people
live and work
2 Focus on priorities ....essential health care
3 Scientific basis .....based on scientifically sound...
4 Culture sensitivity .....socially acceptable methods and
technology.....
5 Equity .....made universally accessible to
individuals to individuals and families in
the community....
6
7
Community
participation
Sustainability and self-
reliance
....through their full participation...
....at a cost that the community and
country can afford to maintain at every
stage of their development in the spirit of
FEATURES OF
PRIMARY HEALTH
CARE(PHC)

20. THE THREE
GOALS OF
PHC
Improve access to health care
services
Improve quality of health care
services
Improve the health of the
population.

21. PHC
PROGRAMM
E DESIGN
CYCLE
Implementation (policy goals)
Organization; (structures,
resources, budget
Planning; ( goals,
priorities, and strategies
defined)

22. Problems in PHC
implementation
• Political instability
• Language barrier
• Embezzlement of PHC funds
• Inadequate finance
• Lack of enough man power
• Emergency of new diseases
• Uncooperative community
• Poor communication means
• Unclear or non-existing health policy in the country
• Low economic status of the community
• Cultural resistance
• Lack of enough equipment
• Natural calamities eg during rainy seasons

23. Community
based
health care
CBHC
 Community Based Health Care (CBHC) is a bottom
up approach, which enables people living together
in the same given area at the same time, sharing
the same problems, resources and benefits,
working together to improve their quality of life for
their wellbeing with their full participation and
involvement.
 Its important to note that CBHC is the
implementation of PHC which emphasizes full
community participation and involvement
 CBHC is the care initiated by the community ,
implemented by community members and for the
community members
 CBHC should be initiated in the community and
community members should identify what
problems they can manage and what they cant
manage.

24. Stages of
initiating
CBHC
 Collect background information about the community using silent
survey (5Ls) i.e look, listen, learn, lie, low
 Community entry to meet local leaders and sell the idea to them
 Probe and put information together from local leaders and silent
survey
 Sensitize community ( creating awareness) about CBHC through
organized local meetings
 Together with the community members , identify health and
health related problems, the severity of the problem
 Prioritize the stated problems with the community members
( identify which problems to handle first depending on the
resources available and the severity of the problem
 Analyze your priorities and causes of certain problems
 Find out possible solutions by considering the feasibility and
affordability
 Discuss alternative clinical solution
 Together with the community do planning for implementation,
monitoring and evaluation

25. PHC Vs
CBHC
PHC CBHC
Originated and implemented by health work Originated within the community and
implemented by the community
Uses both top to bottom and bottom to top
approach
Uses bottom to top approach only
Foreign to culture and practices of the
communities, may not care for what cultures
say and there is often conflicts
Relevant ( normal) to community culture
Concerned with structural changes
( generalization of health for all )
CBHC activities initiated have a
consideration / concerned with changes in
people
Owned by support systems eg NGO, WHO Owned by the community
Dependence is high Little dependence
PHC is broader and has global elements Based on priorities of the community
Vision of PHC is external ( goals and
objectives)
CBHC activities are controlled internally
PHC is rigid and has defined roles CBHC is flexible with un defined roles
PHC is stated as a program health care
system
CBHC is an approach of ensuring community
participation
PHC tends to be a profession prescription of
outsiders
CBHC is a community initiative and
experiences in dealing with their own health

26. PHC and
SDGs.
 To maintain momentum in the provision of primary health care
and UHC, governments have recently reaffirmed their
commitments to the SDGs through the 2018 Astana
Declaration and the 2019 UN High-Level Meeting on UHC.
 The Astana Declaration redefined the three main functions of
primary health care as:
 (i) meeting the health needs of a population through the
provision of a comprehensive range of promotive, protective,
preventive, curative, rehabilitative and palliative health-care
services throughout the life course
 (ii) systematically addressing the broader determinants of health
including social, economic and environmental contexts through
evidence-informed public policies and multisectoral action
 (iii) empowering individuals, families and communities to
optimize their health, and supporting people such as self-carers
and caregivers as co-developers of health and social services.

27. SUSTAINAIBL
E
DEVELOPMEN
T GOALS
Sustainable Development Goals;- Development
that meets the needs of the present without
compromising the ability of future generations
to meet their own needs.
In other words, Sustainable Development is the
criteria for achieving social and economic
progress in ways that will not exhaust the earth’s
finite resources and not exploit or impoverish
one grouping of people for the enrichment of
another

28. 2030
SDGs
Who wrote the 2030 Agenda and the 17 Goals
 Representatives from all 193 member nations of
the UN and hundreds of Non-Government
Organizations (NGOs) and civil society groups
representing indigenous people, small farmers,
working people, environmental movement
people, scientists, social workers, minorities,
women’s groups and other stakeholders over a
three year period of time.
 On September 25, 2015, after three years of
debate and negotiations,
all 193 member-nations of the UN, including the
United States, voted unanimously to adopt
these global Sustainable Development Goals
(SDG’s), stating:

29. SDGs cont.
 No poverty i.e. End poverty in all its forms
everywhere
 Zero hunger i.e. End hunger, achieve food
security and improve nutrition and promote
sustainable agriculture
 Good health and well- being i.e. Ensure
healthy lives and promote well-being for all at
all ages.
 Quality education i.e. Ensure exclusive and
equitable quality education and promote
lifelong learning opportunities for all
 Gender equality i.e. Achieve gender equality
and empower women and girls.

30.  Clean water and sanitation i.e. Ensure
availability and sustainability management of
water and sanitation for all
 Affordable and clean energy i.e. Ensure access
to affordable, reliable, sustainable and modern
energy for all
• Decent work and economic growth i.e.
Promote sustained, inclusive and sustainable
economic growth, full and productive
employment and decent work for all
 Industry, innovation and infrastructure i.e.
Build resilient infrastructure, promote inclusive
and sustainable industrialisation and foster
innovation

31. SDGs cont.
 Reduced inequalities i.e. Reduce inequality
within and among countries
 Sustainable cities and communities i.e. Make
cities and human settlement inclusive safe
resilient and sustainable
 Responsible consumption and production ie
Ensure sustainable consumption and
production patterns
 Climate action i.e. Take urgent action to
combat climate change and its impacts
 Life below water i.e. Conserve and sustainably
use the oceans, seas and marine resources for
sustainable development

32. SDGs cont.
 Life on land i.e. Protect, restore and promote
sustainable use of terrestrial ecosystems, sustainably
manage forests, combat desertification, and halt and
reverse land degradation and halt biodiversity loss
 Peace , justice and strong institution i.e. Promote
peaceful and inclusive societies for sustainable
development, provide access to justice for all and
build effective, accountable and inclusive institutions
at all levels.
 Partnerships for the goals i.e. Strengthen the
means of implementation and revitalise the global
partnership for sustainable development.

33. Challenges
encountere
d while
implementi
ng
sustainable
developmen
t goals
 Lack of political will
 Weak capacity and technical know how
 Inadequate mechanisms, structures to recognize
financial opportunities and access available financial
resources
 Poor project planning
 Lack of accountability
 Unrealistic plans
 No measures to evaluate equality
 Inadequate management skills
 Lack of stakeholder involvement
 Poverty
 Poor, inconsistent project management discipline
 Climate changes

34. MILLENNIUM
DEVELOPMEN
T GOALS
MDGs
The 8 millennium development goals
 Eradicate extreme poverty and hunger
 Achieve universal primary education
 Promote gender equity and empower women
 Reduce child mortality
 Improve maternal health
 Combat HIV/AIDS, malaria and other diseases
 Ensure environmental sustainability
 Develop a global partnership for development

35. SDGs
Vs
MDGs
What are the differences between MGDS and SDGs?
 Unlike the MGDs which only targets the developing
countries, the SDGs apply to all countries whether rich,
middle or poor countries. The SDGs are also nationally-
owned and country-led, where each country is given the
freedom to establish a national framework in achieving
the SDGs.