The document discusses selective primary health care (SPHC) versus comprehensive primary health care (CPHC). SPHC focuses on specific interventions like immunizations, while CPHC aims to improve overall population health through multisectoral coordination. Nepal has achieved success with SPHC but still struggles with CPHC indicators. While SPHC can reduce disease burdens quickly, CPHC is needed long-term to increase life expectancy. The recommendation is that Nepal should continue SPHC while gradually implementing more CPHC through improved coordination.

1. Selective vs Comprehensive
Primary Health Care in Nepal
Presented by
BPH V
Manik Rajbhandari
La Grandee International College
Pokhara University
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2. Background of PHC
• After the second world war developing countries had poorer health
status along with minimal access to health care services.
• For example, MMR<10 per lakh in developed countries and 500 to
1000 per lakh in developing countries.
• Similarly, IMR<10 per thousand in developed countries and 100 to
200 per thousand in developing countries.
• Life expectancy >70 in developed countries and < 50 in developing
countries.
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3. • There was inadequacy of health resources and inequality in the
distribution of health services not only between the countries but even
with in a country between the rich and poor population.
• Most people in the developed countries and the elite of the developed
countries(only 20% of world’s population) were enjoying the
determinants of good health.
• This wide disparity was unacceptable and it was necessary to address
the 80% of the world’s people to have equal access to health services.
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4. • Therefore The Declaration of Alma-Ata Conference was held on
Primary Health Care in Kazakhstan, 6–12 September 1978.
• According to Declaration of Alma-Ata, “Primary health care is a
essential health care 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 country can
afford to maintain every stage of their development in the spirit of
self-determination.”
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5. Comprehensive Primary Health Care
• PHC is necessarily comprehensive addressing primary care for all of
reproductive and child health, communicable and non-communicable
diseases and accidents and injuries through health communication,
technologies and care provision.
• CPHC also include nutrition, geriatric health care, palliative care and
rehabilitative care services.
• “Some argue that comprehensive primary health care was an
experiment that failed; others contend that it was never truly tested.”
• There were some important successes, particularly in the 1980s.
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6. • Mozambique, Cuba, and Nicaragua expanded their primary health care
coverage and greatly improved their population health indices.
• Whereas the progress in Mozambique and Nicaragua was short-lived
• But Cuba has maintained steady progress.
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7. Selective Primary Health Care
• One year after the Alma-Alta declaration, Julia Walsh and Kenneth
Warren presented “selective primary health care”.
• They proposed that a selective PHC, maximize improvement of health
in developing countries.
• SPHC focus on four vertical programs i.e. GOBI & 3F was added later
1. Growth monitoring
2. Oral rehydration therapy
3. Breastfeeding
4. Immunization Family planning
5. Female education
6. Food supplementation
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8. • These interventions targeted only women of childbearing age (15–45)
and under five children.
• That’s why SPHC only cover 20% of primary health care.
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9. Objectives
General objectives
• To review arrival literatures to find about comprehensive and selective
primary health care.
Specific Objectives
• To find out the status of SPHC and CPHC in Nepal.
• To find out the different between SPHC and CPHC.
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10. Methodology
For this review, Literature was searched using PubMed. Literature was
search on March 7, 2018. Restrictions were put on location, and
language of publication. The key word used to prepare this article are
primary health care, SPHC, CPHC, Ama-Aata conference and so on. By
using PubMed search engine, we find 800 articles in which we read first
50 article and 3 are used in it.
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11. Results
SPHC CPHC
Low budget needed
Nepal separate 5.8% GDP for health in 2014
High budget needed
Cuba separate 11.06% GDP for health in 2014
Focus on GOBI & 3F
Immunization coverage is 78% in 2016
Focus on reproductive & child health, diseases,
accidents and injuries
Road traffic accidents in Cuba reach 830 and 1.06% of
total deaths.
Take short time for result
In Nepal infant mortality rate is 32 per 1000 in 2014
Take long time for result
Life expectancy of Cuba is 80 year.
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12. SPHC CPHC
SPHC is an approach to implement specific
strategy for the improvement of health.
CPHC is a strategy towards achieving “ health for
all” which covers the different approaches for the
improvement of health.
Its main aim is to reduction of specific disease for
the improvement of overall health of the country
and individuals.
Its main aim is to Improve the overall health
status of public(specially people of rural areas
and vulnerable) through organized approaches.
Emphasize on selective, cost effective
interventions.
12
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13. SPHC CPHC
Planning by donors(Top down approach) Planning by community participation
Health care providers are specially medical
doctors.
Health care providers are multi-disciplinary teams
from public health, agriculture, environment etc
Fragmented interventions. Comprehensive interventions.
Success of SPHC-eradication of smallpox and
elimination of polio from Nepal.
Success of CPHC-Health care system in Kerala state
of india, Cuba, China etc.
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14. Situation of SPHC & CPHC in Nepal
• Nepal has gained impressive achievements in selective primary health
care markers: 45.43% maternal mortality and 62.34% child mortality
reduction during 1990-2005.
• But gain in comprehensive health care markers is not impressive: 58%
Skilled Birth Attendant, 45.8% having access to improved sanitation
and 53.1% of females are literate.
• Socio-political environment was not favourable in the past for
comprehensive primary health care.
• Now due to province system, it allow health sector decentralisation
and community empowerment.
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15. • Health activities were focussed more on selective health care strategy
in the form of disease control, immunisation, vitamin A
supplementation, oral rehydration solution use and contraceptive use.
• Nepal's rural hilly geography posed great challenge on logistic supply,
communication and retention of health workers rendering public
health centres of low quality with negative perceptions of consumers.
• Nepal is on the pathway to build equitable comprehensive primary
health care.
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16. Conclusion
• Primary health care is a basic and essential health care for prevention
and treatment of disease.
• In developing country, SPHC is better to control and prevention
specific disease which have high mortality and morbidity.
• SPHC shows rapid effect by decreasing prevalence and mobility of
disease.
• SPHC especially focus on child and reproductive age women.
• CPHC is also effective to increase life expectancy and improve
determinant of health.
• CPHC need multi sectoral coordination.
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17. Recommendations
• To decrease the mortality and morbidity of infectious disease SPHC is
best choice.
• Nepal need to go slow towards CPHC by controlling infectious
disease.
• More intersectoral coordination necessary for CPHC.
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18. References
1. Karkee R, Jha N. Primary health care development: where is Nepal
after 30 years of Alma Ata Declaration? JNMA; journal of the Nepal
Medical Association. 2010;49(178):178-84.
2. Demographic and Health Survey 2016. Minister of health
3. Magnussen L, Ehiri J, Jolly P. Comprehensive Versus Selective
Primary Health Care: Lessons For Global Health. Health Affairs.
2004;23(3):167-76.
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