How a hospital can play role in PHC

1. ROLE OF HOSPITAL IN PRIMARY
HEALTH CARE
Col Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)

2. HEALTH FOR ALL
‘ATTAINMENT OF A LEVEL OF HEALTH THAT WILL
ENABLE EVERY INDIVIDUAL LEAD A SOCIALLY
AND ECONOMICALLY PRODUCTIVE LIFE’

3. Levels of Care
• Primary health care
• Secondary health care
• Tertiary health care

4. 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.

5. 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

6. Primary health care (PHC) became a core policy for
the World Health Organization with the Alma-Ata
Declaration in 1978, which emphasized on reducing
the gap of access and service of healthcare among
haves and have-nots; and the ‘Health-for-All by the
Year 2000’ Program.
The commitment to global improvements in health,
especially for the most disadvantaged populations,
was renewed in 1998 by the World Health Assembly.
This led to the ‘Health-for-All for the twenty-first
Century’ policy and program, within which the
commitment to PHC development is restated.

7. WHAT IS PRIMARY HEALTH CARE
PRIMARY HEATLH CARE IS ESSENTIAL
HEALTH CARE based on practical,
scientifically sound and socially acceptable
methods and technology, MADE
UNIVERSALLY ACCESSIBLE TO INDIVIDUALS
AND ACCEPTABLE TO THEM, THROUGH
their FULL PARTICIPATION AND AT A COST
THE COMMUNITY AND COUNTRY CAN
AFFORD

8. Primary Health Care is different in each community
depending upon:
– Needs of the residents;
– Availability of health care providers;
– The communities geographic location; &
– Proximity to other health care services in the area.

9. ELEMENTS OF PRIMARY HEATH
CARE
• Education concerning prevailing health
problems and the methods of preventing an
controlling them
• Promotion of food supply and proper nutrition
• An adequate supply of safe water and basic
sanitation
• Maternal and child health care including FP

10. • Immunization against major infections
diseases
• Prevention and control local endemic
diseases
• Appropriate treatment of common
diseases
• Provision of essential drugs

11. PRINCIPLES OF PRIMARY HEALTH
CARE
• EQUITABLE DISTRIBUTION
• COMMUNITY PARTICIPATION
• INTERSECTORAL COORDINATION
• APROPRIATE TECHNOLOGY
• DECENTRALISATION

12. FIVE COMMON SHORT COMINGS OF
HEALTH CARE DELIVERY
• INVERSE CARE
• IMPOVERISHING CARE
• FRAGMENTED AND FRAGMENTING CARE
• UNSAFE CARE
• MISDIRECTED CARE

13. Inverse care: People with the most means – whose needs for
health care are often less – consume the most care, whereas
those with the least means and greatest health problems
consume the least. Public spending on health services most often
benefits the rich more than the poor in high- and low-income
countries alike.
Fragmented and fragmenting care. The excessive specialization of
health-care providers and the narrow focus of many disease
control programmes discourage a holistic approach to the
individuals and the families they deal with and do not appreciate
the need for continuity in care. Health services for poor and
marginalized groups are often highly fragmented and severely
under-resourced, while development aid often adds to the
fragmentation.

14. Impoverishing care: Wherever people lack social protection and
payment for care is largely out-of-pocket at the point of service, they
can be confronted with catastrophic expenses. Over 100 million
people annually fall into poverty because they have to pay for health
care.
Unsafe care: Poor system design that is unable to ensure safety and
hygiene standards leads to high rates of hospital-acquired infections,
along with medication errors and other avoidable adverse effects
that are an underestimated cause of death and ill-health.
Misdirected care: Resource allocation clusters around curative
services at great cost, neglecting the potential of primary prevention
and health promotion to prevent up to 70% of the disease burden.
At the same time, the health sector lacks the expertise to mitigate
the adverse effects on health from other sectors and make the most
of what these other sectors can contribute to health.

15. Obstacles to the implementation of the
PHC strategy
• Misinterpretation of the PHC concept
• Misconception that PHC is a 2nd rate health
care for the poor.
• Selective PHC strategies
• Lack of political will
• Centralized planning and management

17. Roles of hospital on PHC
1. Supporting PHC activities:
a. Developing a referral system
b. Improvement of quality of care (Including
providing technical guidance to health workers)
2. Promoting community health development action
a. Hospital should play leadership role to ensure
active involvement of community at all level of PHC .
b. Hospital should aim at encouraging community
decision making and in protecting and promoting health of
people
c. Hospital should give proper information to the
community on health problem and ways to solve them

18. 3. Basic and continuing education of all categories of health
workers.
a. Training and education, incorporating basic components of
PHC
b. Not only giving information; but also at problem solving
c. Health education and training of both staffs and community
d. Participate in training of field workers
e. Doctors working in the hospitals, to spend some time
visiting villages and unions from where patients come
f. Health educators and PHC workers to utilize UHC and District
Hospitals to disseminate health information at OPDs

19. 4. Supporting health services research and development
a. To enable to discover most efficient and effective ways of
applying appropriate medical technologies
b. Remove barriers in implementing PHC
c. Help people to participate in decision making about their
own health problems
d. To involve community in implementing health program
d. Taking part in monitoring and evaluation of health programs