CM 17.3 Principals of Primary Health Care.pptx

HEALTH CARE SCENARIO:
 
Health care has always been a problem area for India, a nation with a large population and a larger percentage of this population living in urban slums and in rural area, below the poverty line.
Before independence the health structure was in dismal condition i.e. high morbidity and high mortalities, and prevalence of infectious diseases. Since independence emphasis has been put on Primary Health Care and we have made considerable progress in improving the Health Status of the country.
CG:Central Government
PH:Primary Health
MCH:Maternal and Child Health
Health is a human right, which has also been accepted in the constitution. Its accessibility and affordability has to be insured. While the well-to-do segment of the population both in rural & urban areas have acceptability and affordability to wards medical care, at the same time cannot be said about the people who belong to poor segment of the society. It is well known that more then 75% of the population utilizes private sectors for medical care unfortunately medical care becoming costlier day by day and it has become almost out of reach of the poor people. Today there is need for injection of substantial resources in the health sectors to ensure affordability of medical care to all. Health insurance is an important option, which needs to be considered by the policy makers and planners.

1. CM17.3 Primary Health Care- Definition, Principles, and Components Dr Anjali Mall

2. Specific Learning Objectives At the end of lecture 1 st year MBBS students must-know-(60mts) Introduction to Health care in India(5mts) Health Care Scenario in India(10mts) Evolution of Primary Health care (10mts) Definition of Primary Health care(10mts) Components of Primary Health care(10mts) Principles of Primary Health Care (10mts) Challenges (5mts)

3. 1. INTRODUCTION TO HEALTH CARE HEALTH IS A FUNDAMENTAL HUMAN RIGHT(Article 21) ITS AFFORDABILITY & ACCEPTABILITY HAS TO BE ASSURED FOR URBAN/ RURAL, WELL TO DO AND THE POORER SECTION OF THE SOCIETY .

4. 2. Health Care scenario After independence - dismal condition. High morbidity, -Infectious diseases. Problems High mortality, negligible MCH care. Urban-Rural divide:70:30. Population Size of the country. Declining funds to HealthCare Sector-CG/State. After independence - emphasis on Primary Health care

5. Health Care scenario 5

6. Health Care Scenario……contd. 6

7. Recognizing the crisis in India

8. Recognizing the crisis in India

9. 3. EVOLUTION OF PRIMARY HEALTH CARE ALMA ATA Declaration on 6-12th September 1978 at Alma Ata(USSR ) Promote the concept of PHC Evaluation of the situation of health Defining the principals Define the role of Government and international org. Formulating recommendation

10. EVOLUTION OF PRIMARY HEALTH CARE (Cont.) Integrated care comprising preventive, promotive, curative &rehabilitation services. Extending from “womb to tomb”. Key to socio economic development and progress of the country. Organized in three levels.

11. 4. Definition of Primary Health Care Primary health care -“an 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 to maintain at every stage of their development in the spirit of self reliance and self determination”.

12. ATTRIBUTES OF PRIMARY HEALTH CARE • Essential health care • Universally accessible • Acceptable • Community based • First point of contact • Affordability

13. 5. Elements of Primary health care Education concerning prevailing health problems and the methods of preventing and controlling them. Promotion of food supply and proper nutrition. Adequate supply of safe water and basic sanitation. Maternal and child health care and family planning Prevention and control of endemic diseases. Immunization against major infectious diseases. Appropriate treatment of common diseases and injuries. Provision of essential drugs.

14. 6. PRINCIPLES OF PRIMARY HEALTH CARE Equitable distribution Community participation Intersectoral coordination Appropriate technology

15. A. EQUITABLE DISTRIBUTION Inequity in the availability of health services - major concern First key principle in the primary health care. Ensures that individuals with more compromised health conditions will receive more health services. Commitment to health equity focuses not only on ensuring program inputs but also reducing differences in health outcomes.

16. A. Equitable Distribution

17. Who are we talking about?

18. Dr Aaron Momin, Medical Officer of Jorhat Boat Clinic shared this experience. An elderly villager from Majuli came to one of the camps and just observed the team’s work. He smiled when Dr Momin asked him if he needed treatment. No, he was fine. Then why did he come? “To see a doctor- I have never seen what a doctor looks like”

19. EQUITABLE DISTRIBUTION Equal resources Equal access to health care Equal utilization of health services Equal health

20. Examples of equitable distribution in access to health care in India: Tripura- helicopter service to reach the remote set of tribal hamlets . Andhra Pradesh- free bus passes to pregnant women for the antenatal visits. Assam -Akha-ship to provide primary care services in riverine Island through boat clinics. Tamil Nadu – concept of birth resorts is introduced in remote and hilly areas for institutional deliveries.

21. B. COMMUNITY PARTICIPATION Involvement of the individuals, families and community. Determines both collective needs and priorities. Important role in formulating a health problem. Universal coverage cannot be achieved without the involvement of the local community.

22. Examples of Community Participation in India: Village health guides, trained dais, ASHA Selected by the local community and trained locally. Essential feature of health care in India.

23. Village Health and Sanitation Committee: Play multiple roles including IEC, household surveys, preparation of health registers, organisation of meetings , promoting household toilet, sanitation programme. Rogi Kalyan Samitis/ patient welfare society. Jan Swasthya Abhiyan Initiative- People Rural Health watch.

24. C. INTERSECTORAL CO-ORDINATION “Primary care involves in addition to the health sector, all related sectors and aspects of national and community development” Includes sustainable participation that combine inter-organizational cooperative working alliances. Possibly, but not necessarily, in collaboration with the health sector.

25. Intersectoral Coordination

26. D. Appropriate technology

27. D. APPROPRIATE TECHNOLOGY “ Technology that is scientifically sound , adaptable to local needs and acceptable to those who apply it and those for whom it is used and is maintained by the people themselves in keeping with the principle of self reliance with the resources the country and the community can afford.”

28. An appropriate technology should be: (WHO-1989) • Scientifically valid • Adapted to local needs • Acceptable to users and recipients • Maintainable with local resources

29. Examples of the appropriate technology Use of coloured tapes for measuring mid-upper arm circumference. Use of ORS. Growth chart maintenance for under-five children. Insecticide Treated Bed nets. Low-cost mosquito repellent creams. Simple water purification.

30. 7. Challenges faced in implementation lack of political commitment and vision. Too idealistic, expensive, and unachievable. Focussed more on MCH care. Community participation could not be realized. Lack of availability of resources. Civil war, disasters, political instability, changing demography, and epidemiology.

31. Comment

32. References Park K .Textbook of preventive and social medicine. 26th ed. Jabalpul : M/S Banarsidas bhanot publications; 2021. Primary health care [Internet]. Who.int. 2022 [cited 3 August 2022]. Available from: https://www.who.int/news-room/fact-sheets/detail/primary-health-care Primary health care [Internet]. Who.int. 2022 [cited 3 August 2022]. Available from: https://www.who.int/news-room/fact-sheets/detail/primary-health-care Baris E, Silverman R, Wang H, Ali Pate M. Walk The Talk: Reimagining Primary Health care after Covid-19. World Bank Group; 2022.