11 PRIMARY HEALTH CARE (PHC).pptx

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1. PRIMARY HEALTH CARE ( PHC )

2. Objectives At the end of this chapter, the student will able to Describe the historical development of PHC. Identify the philosophy, principles, components and strategies of PHC. Analyze the situation in the Ethiopian context.

3. Definition The international conference on PHC, held At ALMA-ATA in 1978 defines as : PHC is Essential Health Care based on practical, scientifically sound, socially acceptable methods and technology made universally accessible to individual and families in the community 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 self reliance and self determination.

4. Cont…. It forms an integral part of both the country's health system, and main focus overall social and economic development of the community. It forms the first level of contact of individual, the family and the community with the national health system. It brining health care as close as possible to where people live.

5. HISTORICAL DEVELOPMENT WHO which was established in 1948, has always had as a major objective the attainment by all people of the highest possible level of health . However due to political and socio-economic factors ,between 1948 and 1978 WHO not meet the stated objective.

6. Cont…. In the 1950s the vertical health service strategy was implemented.( which included mass campaigns and specialised disease control programmes for selected communicable diseases). such as control of malaria, tuberculosis and venereal diseases . However the delivery of vertical programmes was found to be expensive and unsuccessful. Later in the mid 1950s the concept/strategy of Basic health Service came into being. This approach gave more attention to rural areas through construction of health centres and health station providing both preventive and curative care.

7. Cont….. In the early 1970s integration of the specialised disease control programmes with the basic health services was emphasised. All these approaches were disease oriented based on high cost Health institutions requiring advanced technology to solve the health needs of the people. thus ultimately failed to reach the desired goal. Specially in developing countries where their health problems required emphasising health promotion and preventive care.

8. PHC PRINCIPLES Inter- sectoral collaboration Community participation Appropriate technology Equity Focus on prevention and health promotion Decentralization

9. Inter- sectoral Collaboration It means a joint concern and responsibility of sectors responsible for development in identifying problems All those sectors involved in the development process such as Health, Agriculture, Education, Information, transport and communication and NGOs.

10. Community Involvement Communities should not be passive recipients of services. Every body should be involved according to his/her ability The communities should be actively involved In the assessment of the situation Problem identification Priority setting and making decisions Sharing responsibility in the planning, implementing, monitoring and evaluation.

11. Appropriate Technology Take account of both the health care needs and the socio-economic context of a country. This must include consideration of:- Costs (both capital and recurrent). Appropriate technology does not necessarily mean low cost. Efficiency and effectiveness in dealing with health problems. The sustainability including the capacity to maintain equipment.

12. Criteria for Appropriateness To be appropriate, a technology must be:- Effective - it must work & fulfil its purpose in which it needs to be . Culturally acceptable and valuable. Affordable i.e . cost effective. Locally Sustainable. :- We should not be over dependent on imported,. Environmentally accountable. Measurable :- The impact and performance of any technology need proper and continuing evaluation  

13. Equity Universal coverage of the population with care provided according to need is the call for equity . If all cannot be served, those most in need should have priority. Possible definition of equity include:- Equal health Equal access to health care Equal utilization of health care Equal access to health care according to need Equal utilization of health care according to need

14. Cont…. Focus on Prevention and Promotive Decentralization :- After the Alma-Ata conference, a sixth theme has emerged, that of decentralization , reflecting the two key principles ;- community participation and multisectorialism

15. PHILOSOPHY of PHC Equity and Justice -equitable distribution of services, resources and health care. Effective PHC makes an important contribution to greater social justice and equity by reducing the gap between the "have's and the "have not's 2. Individual and community self-reliance -personal responsibility for their own and their families health. 3. Inter-relationship of health and development.

16. STRATEGY of PHC 1. Change In the Health Care System Total coverage with essential health care Integrated systems Involvement of communities Use and control of resources Redistribution of existing resources Reorientation of human resources Legislative changes Design, Planning & management of health system

17. 2 Individual and Collective Responsibility for Health First aspect- is a political issue :- Decentralization of decision-making. Second aspect:- self-realization personal responsibility for their own and their families’ health. For both aspects it is important to have Informed and motivated public

18. 3 Inter- sectoral Action for Health Practical Action Attention of over all economic development. More consciously and directly towards the maximization of health Sharpening awareness :- At the community level, District, Regional etc

19. PHC - THE LEVEL OF CARE Level Administrative area Health Facilities Types of Care Levels of Prevention Local Kebele + Woreda PHCU=HC+ 5CHP, District Hospital Primary Care Primary Prevention + Secondary and Tertiary Prevention Intermediate Zonal/Region Zonal Hospital Regional Hospital Secondary Care Primary Prevention + Secondary and Tertiary Prevention Central National Central Referral & teaching Hospital Tertiary care Tertiary Prevention

20. THE COMPONENTS/ELEMENTS OF PHC elements incorporated During Alma-Ata Health Education Provision of Essential Drugs Immunization MCH/FP Treatment of Common Diseases & Injuries Adequate Supply of Safe Water & Basic Sanitation Communicable Disease Control Food Supply And Proper Nutrition Additional elements incorporated after Alma-Ata 9.Oral Health 10. Mental Health 11.The use of traditional Medicine 12.Occupational Health 13.HIV/AIDS 14.ARI  

21. PHC IN ETHIOPIA PHC activities in Ethiopia, which formally began in 1980s, include the following Education on the existing health problems and methods of preventing and controlling them. Locally endemic diseases prevention and control. Expanded program on Immunization Maternal and child health including family planning Essential drugs provision Nutrition promotion of food supply Treatment of common diseases and injuries Sanitation and safe water supply

22. Cont…. Since 1980 PHC has been the main strategy on which the health policy has been based. The 1985 review of PHC revealed the following achievements. Expansion of health services to the broad masses especially by establishing new health station and health posts. Expansion of Immunization programmes against six major communicable disease. Increasing number of medical and paramedical personnel. Increased health propaganda attempts to improve health consciousness of the population. Established PHC committees at the lowest local administrative level.

23. Cont…. The health policy which was established in 1976 by the ministry of health includes Emphasis on disease prevention Priority to rural health service Promotion of self reliance and community involvement The health policy has been further consolidated by the adoption of PHC as a strategy. Failures to implement these policies due to several factors (including low government attention and support to the health sector.

24. The transitional government of Ethiopia also further strengthened PHC strategy for delivery of health services by giving due emphasis to the development of preventive and promotive component of health care and by strengthening inter- sectoral activities.

25. Major problems in the implementation of PHC in Ethiopia Absence of infrastructure at the district level. Difficulty in achieving inter- sectoral collaboration. Inadequate health service coverage and mal-distribution for available health services. Inadequate resource allocation. PHC is not as cheap as some people think. Absence of clear guidelines or directives on how to implement PHC. PHC is a very wide concept, subjects needs various interpretations &specific guidelines. Presence of culturally dictated harmful traditional practices.

26. APPROACHES IN PRIMARY HEALTH CARE Countries and individual interpreted PHC according to their perceptions, and variations were marked in their approaches. In 1979/80 two distinct approaches in PHC implementation were grounds . The two main approaches are Comprehensive PHC ( cPHC ) Selective PHC ( sPHC )

27. Cont…. The selective PHC approach states "with the limited human and financial resources” available, to be most effective, health services should be directed toward controlling those diseases producing the largest number of deaths and disability And care should be made accessible to the greater number, using criteria of prevalence, morbidity or severity and disability, risk of mortality and feasibility of control, including relative efficacy and cost of intervention .“

28. Cont… S PHC views health a s the absence of disease . It measures achievements in terms of reducing those diseases which are the most harmful and also are the most feasible to control

29. Cont… The low cost strategy of S PHC is to treat and prevent few selected diseases which have great impact to mortality: GOBI - FF G = Growth monitoring through the use of growth charts for promotion of child health and nutrition O= Oral rehydration B= Breast feeding I = Immunization F = Female education F = Family planning  

30. Advantage of sPHC approach Decision making is easier Results are achieved faster It gives more satisfaction

31. Cont…. Disadvantages of the sPHC approach Limited scope of activities it is disease oriented. (treats who are sick) doesn't address the general health problems of the community It doesn't address priorities of the community It doesn't made self-reliance i.e it causes the patient to be dependent on the doctor, rather than capabling the community to look after themselves. It doesn't recognize contribution and co-operation by other sectors

32. Cont…. The c PHC on the other hand focus on a positive state of well being i.e. a more holistic approach . Advantage of the cPHC approach It looks at health holistically The approach is development oriented and sees health as part of the development It involves people and leads to empowerment It promotes equity It advocates multi- sectoral collaborations It deals with priorities of the community

33. Cont… Disadvantages of the cPHC approach it is expensive initially to set up an infrastructure It requires conscious planning Results are gradual It is a long process It is a complex process

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