FAILURE OF PRIMARY HEALTH CARE PPTX.pptx

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1. FAILURE OF PRIMARY HEALTH CARE SUBMITTED BY SHREE RAM KASICHHWA SYMBOL NO: 7621108 A Seminar Report Submitted to Population and Health Department in Practical Fulfillment of the Seminar Issue in Population Education

2. Acknowledgement I would like to express our deep sense of gratitude to our teacher Mr. Balaram Devkota of the Sanothimi Bhaktapur for guiding us clearly to that made our work so worthy and ease. I would like to express our gratitude to his cooperative friendliness, invaluable suggestions instruction and comprehensive guidance to undertake this as a seminartopic . I would like to express our gratitude to all the member of the department of Health Physical and Population Education of their direct or indirect contribution in carrying out this work we are indented to our family and group who were always on hand to accomplish this seminar.

3. Introduction Background of the study Nepal has made significant progress on health indicators over the past several decades. The impressive achievement in health indicators was the result of globalization in health including economic development via-a- viz strengthening of primary (mostly peripheral) health care ( PHC ) health care ( PHC ) system particularly through investments to establish the health care infrastructure. PHC service in Nepal has been active since 1978 through a network of district and the distal network that reaches to the community served by health posts and sub-health posts. At the community level, nearly 50,000 Female Community Health Volunteers are mobilized throughout the country. Significant progress has been achieved by such a vast network of PHC in Nepal, a lot of which are reflected in millennium and sustainable development goal indicators. Transforming health system to achieve millennium and sustainable development goal indicators also reflects how globalization has promoted health system to adopt these goals. The infant mortality rate declined by two fold from 78 deaths per 1000 live births in 1990 to 32 deaths per 1000 live births in 2016 and pregnancy related mortality rate declined by half from 543 deaths per 100,000 live births in 1989–1996 to 259 deaths in 2009–2016

4. Objectives of the study Every piece of work Aims to achieve specific result with a time frame and available result I have also set some objective and as follows. To list out the health problem To identify failure of primary health care  

5. Materials and methods To prepare this seminar paper I have reviewed and collected information from manual as well as electronic data based secondary sources from the journals articles and webs like Nepal.

6. Review of Content: The primary health care ( PHC ) principles of universal accessibility, community involvement, inter- sectoral coordination, and appropriate technology have been central to the national health care policies of the Government of Nepal, since the signing of the Alma Ata declaration by Nepal in 1978. During the 1970s the Government looked beyond vertical control programs for diseases such as malaria, smallpox and leprosy and focused on the establishment of district health services. The Government’s emphasis also shifted from curative health care towards provisions for family planning, services for maternal and child health and facilities for drinkable water. However, Nepal’s path to provide equitable as well as affordable preventive, curative and rehabilitative health care services has not been straightforward.

7. Contd … Nepal’s Himalayan terrain has always provided challenges for infrastructural improvements in health service delivery. Additionally, Nepal’s ever-changing political landscape has impeded stable governance and delivery of governmental services. Multiparty democracy was restored in Nepal following the People’s Movement of 1990. After this political transition a new National Health Policy was introduced in 1991, with the primary aim of expanding PHC services to rural and disadvantaged populations. The government aimed to set up a health facility for every village development committee and a PHC Centre with a birthing facility for every electoral constituency. The delivery of PHC in Nepal is still based on networks of district level and below district level health care facilities such as Sub-Health Posts. The Government has also been successful in mobilising Female Community Health Volunteers for basic health care services such as distribution of contraceptives, folic acid, Vitamin A and oral rehydration packets. At the grassroots level the combination of Health Posts and Female Community Health Volunteers has been at heart of PHC work in Nepal .

8. Contd … Currently, PHC is being bolstered by the Nepal Health Sector Program-II (2010–2015), which aims to improve essential health care services through the Primary Health Care Revitalisation Division established in 2009. Pilot programs have begun for community health insurance. The government is also working on public-private partnerships. Free health care services have also been provided: 70 essential drugs can be obtained from governmental Health Posts. The Government has also made inpatient and emergency services free for groups such as senior citizens, poor citizens, Dalits , Female Community Health Volunteers and differently- abled people. The Government is also initiating urban health programs, implementing the Equity and Access Program for women’s empowerment and continuing primary health care outreach services to improve access to family planning and safe birthing facilities. The Government is additionally making an effort to provide universal access to essential medical services.

9. Analysis Nepal is a poor country, one which has been put in the group of those which are least developed. In this context, therefore, we have nothing to boast about. They tell us however that things are going to get better by the end of this century viz. by the year 2000. We have been hearing this for some time now. More recently there has been talk of liberalisation and privatisation . The talk is of public and private mix in the delivery of health care services. Though the writing is not quite clear on the wall, the intention seems to be to hand over the curative services to the private sector and for the government to restrict itself to just promotive health care. Whilst this is an easier option this seems tantamount to washing ones hands from having to do the difficult task of providing reasonable health services to the people at large. As one looks over the list of diseases occurring in Nepal, one realises that the people are subjected to a relatively large number of afflictions, present almost all the time. Besides these endemic illnesses, one sees as one looks over the medical records, that a number of other diseases take epidemic proportions from time to time. The cholera epidemic during the time of Chandra Shumsher was but one of such episodes in the history of diseases in Nepal. At such times it is necessary to shift large amount of resources viz. men, money and materials to tackle the problems as they occur. In such situations it is also realised that this is not the best way to do things, it being costly and unsatisfactory. It makes much more sense to try to work on the premise, “Prevention is better than cure”. This is the reason why health policies are made and it is obligatory to try to put into practice what has been delineated as policy. The post Rana period is an example of this as a number of specific projects were started to deal with the various problems of the populace. Primary Health Care in Nepal 75 + The major causes of morbidity and mortality vary tremendously according to which sources one has consulted or which data one has unearthed. By examining some of these figures, one can deduce that the summer months are the time of the year when most people are ill. A large part of this illness is due to gastrointestinal upset, brought about by way of faecal contamination of water or food by various offending organisms. A clean environment with a good water supply and proper sewage disposal will get rid of all the major illnesses associated with this.

10. Causes of Failure 1.    Managerial Deficiencies 2.    Service Delivery Failure 3.    Community Causes

11. Causes of Failure Managerial Deficiencies •    Lack of trained managers •    Lack of selection and training criteria for managers •    Lack of proper performance evaluation of health managers •    Lack of motivation leading to professional and financial corruption   Service Delivery Failure a)    Accessibility problems b)    Utilization Failure c)    Efficiency problems   Community Causes •    Community participation has been virtually non-existent in PHC •    Gap in Community and Public sector has widened the bridge. •    Health education has been given a backseat in PHC . •    Low literacy levels and economic deprivation has forced people to shift entire responsibility of their health on state shoulders.  

12. Problem of PHC lack of adequate health human resources, poor supply chain logistics -medicines and equipment, attrition of health staff, their responsiveness and poor account abilit lack of education

13. Issues and challenge Because of the progress made over the years by PHC service delivery system in the area of behavior change, the time has now come to address other areas of importance besides Child Health, Family Health and Communicable Diseases. For example, high death and high birth rate scenario has changed into low birth and high death phase of demographic change in our country. The age structure is changing with more elderly population. Something is to be done for the care of elderly. Likewise, with population pressure in the urban areas, the issue of urban health should now be another priority. Roll back malaria and HIV/AIDS are few diseases demanding fresh look and higher attention. The non-communicable diseases such as high blood pressure, cancer, diabetes etc are increasing as a result of life-style changes in the population. These diseases now need to be addressed Nepal 17 through prevention and curative service at PHC service delivery level. Unprecedented diseases like Avian Influenza are a big threat for public health and MoHP has started work on it.   The GON / MoHP has initiated strengthening public private partnership for proving better, quality health care service and covering more people. In order to materialize this, there is a need to give more attention in the area of human resource development working in the private sector and their involvement in public sector. The private sector should join hand with the government for delivery of primary health care.  

14. Conclusion The main role of primary health care is to provide continuous and comprehensive care to the patients. It also helps in making the patient available with the various social welfare and public health services initiated by the concerned governing bodies and other organizations. The other major role of a primary health care center is to offer quality health and social services to the underprivileged sections of the society. As for the benefits of primary health care to the members of a community, it offers the first set of professional care to the patients by incorporating a proactive approach that utilizes several preventive measures, management of chronic disease, and promoting self-care. Along with that, primary health care provides increased accessibility to advanced health care system for the community, which results in excellent health outcomes and prevention of delay. All primary health care clinics contain a dedicated team of healthcare professionals offering the best medical services. They provide a coordinated approach to the delivery of health care that ensures that the beneficiaries receive the best care from the right health provider.

15. Suggestion The government must support to primary health care. Government for providing health services and free medical care . Improving the Economic and Social Welfare of Old Age Persons → Improving the Health Status of Old Age Persons . The community should facilitate economic help to the aged. The aged can be helped to receive their pension, and be made aware of the different grant-in-aid sachems of the government . Social workers can help the elderly to be aware about the various policies and programs related to the welfare of the aged in our country . This will help the elderly to protect their rights. To help them psychologically counseling classes to be arranged . The elder people with physical disabilities should be exemplaryand facilities various part of the state.

16. Reference https://www.ncbi.nlm.nih.gov/books/NBK316266/   http:// howmed.net /community-medicine/primary-health-care-global-targets-and-causes-of-failure/