Primary health care and alma ata

Primary health care and alma ata

1. Primary health care and Alma-Ata Declaration

2. Origins of Primary Health Care Health care in pre, during and post colonial period Evidences and themes leading to PHC Revitalization of PHC Primary Health Care In The 21 st Century

3. Before colonial period/19th century Throughout the country , traditional healers (shamans , herbalists, witch doctors, bonesetters, etc .)have for centuries been the major providers of health care. Even today, traditional healing is common in many developing countries .

4. During Colonial Period Western medical services introduced to serve only their European employees and provided by Western doctors linked to trading companies Public health activities were initiated either to combat diseases that affected the European populations (e.g ., malaria and sleeping sickness) or as attempts to maintain a healthier work-force and so ensure healthy profits.

5. Result of colonial period By the end of the colonial period, the pattern of health care which had developed in most of the Third World was largely modeled on the system in the industrialized countries. High-technology and urban-based curative care almost wholly confined to the larger towns, plantations and mines The needs of people living in rural areas and urban slums were largely neglected.

6. After colonial period The 1950s and 1960s--Independence from colonial rule . Newly independent states drew up plans to expand adequate health services into underserved areas. However The public health campaigns after colonial period tended to be quite narrow, disease specific (malaria, smallpox etc) and vertical. Often these narrow campaigns absorbed more resources than did all the rest of the country’s rural health services.

7. Some poor countries spent over half their national health budgets maintaining one or two huge, urban, tertiary care hospitals

8. From these alternative approaches emerged the concept of Community-based health care/programs during(CBHs) 1960s and 1970s . Key to this concept were community health workers or health Promoters --persons selected from and by their own communities --- brief courses showing them how to help their neighbors meet their most important health needs Such participatory, awareness-raising grassroots initiatives arose in a number of regions, including Nicaragua, Costa Rica, Guatemala,Honduras, Mexico, South Africa, India, Bangladesh, and the Philippines

9. Finally, It was possible… Scholars and developmental planners backed by WHO and UNICEF analyzed closely CBHP models and convinced A growing social consciousness that health—and health care—was a basic human right led to international support for a basic needs approach to national health services

10. In 1978 in Alma Ata , Kazakhstan (then the Soviet Union), a grand meeting of health ministers from around the world led to the formulation of a plan whereby basic health services would be available to all people . “An unusually progressive document with far-reaching structural and economic implication”

11. Themes leading to Alma Ata Increasing reliance and effectiveness upon alternative approaches to medical care model Success of CHWs and associated emphasis on community participation Changing theories of health and development: shift away from GNP as measure of development towards recognition of the need of social development Revival of interest in Public Health: tackling causes of ill health rather than symptoms

12. Actors and institutional changes WHO Halfdan Mahler WHO Director General. 15 years (1973-1988). Background in TB, Ecuador & India Charisma & Continuity. According to a CMC member “I felt like a church mouse in front of an archbishop .” UNICEF Henry Labrouisse UNICEF’s Exec. Director 1965-1979 emphasized community-work in health and nutrition projects in rural areas and urban slums. 1975 Alternative Approaches to Meeting Basic Health Needs in Developing Countries . Successful PHC experiences in 9 countries 1975 28th World Health Assembly. “National Programs in PHC, a…priority.”

13. Declaration of Alma-Ata (1978)

14. Health is a fundamental human right & requires inter- sectoral action 2. Existing gross health inequality unacceptable 3. Improved health and peace require economic and social development based on a new international economic order (NIEO ) 4. Governments have responsibility to provide adequate health and social measures for health

15. 5. Primary health care is appropriate, accessible, acceptable, affordable and requires community participation (Specifies components of PHC) 6. Governments need the will to formulate and implement PHC policies 7. International cooperation is necessary 8. HFA 2000 requires redirecting resources from military to social expenditures (including health)

16. Key to achieve the vision To achieve the Health for All vision, the world’s nations together with WHO, UNICEF , and major funding agencies pledged to work toward meeting people’s basic needs through a comprehensive and remarkably progressive approach called Primary Health Care (PHC ) PHC was seen as “ the key to achieving an acceptable level of health throughout the world in the foreseeable future as a part of social development and in the sprit of social justice ”

17. PHC Definition… “PHC is 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 the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination .”

18. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community . It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process

19. Four fold objective of PHC 1.To enable people to seek better health at home, in schools, in fields and work places 2 . To enable people to prevent disease and injury, and not rely on doctors to treat illness that could have been avoided 3 . To enable people to exercise their right and responsibility in shaping the environment to bring about conditions for a healthy life 4 . To enable people to participate and exercise control in managing health and related systems; to ensure that basic pre-requisites for health and access to health are available

20. Four P illars of PHC: 1. Political and societal commitment and to move towards health for all role: implement programs, policies, and laws should have political will and budget follows standard protocol/things to be done 2. Community participation Includes mobilization of societal forces for health development

21. 3. Inter- sectoral cooperation between the health sector and other key development sectors Includes agriculture, education, communications, industry, energy, transportation, public works and housing 4 . Systems support: scientifically sound and affordable health technology Technology: equipment, drugs, and educational tools to train health professionals/workers/medical personnel Four Pillars of PHC……………..

22. PHC is a blend of A set of Activities—What to do? 8 components of PHC/Essential care/Basic care---Emphasis more on public health rather than medical care . A level of Health Care– Where to do ? Emphasis on Primary level (first level of contacts with health system/gatekeeper ) but linked with secondary and tertiary level car through referral . Approach or strategy or principle-- How to do ? The central theme is ensuring Equity and social justice (Affordable, Accessible, Acceptable)

23. Principles Of PHC 1. Universal coverage : Accessible to all, more to needy ones 2. Community Participation : Taking care of their own health, self-reliance and social awareness Fundamental concept of PHC 3. Inter- sectoral Approach: For overall social and economic development

24. 4. Appropriate Technology : Cost effective methods and equipments for the level of care, locally available and cheap if possible 5. Health Promotion and Prevention : Multi- sectoral public health interventions as well as facility based health services

25. In the other way……. Principles of Primary Health Care (PHC) 1 . Focus on lifestyle and the needs of the population. 2 . Integration in the National Health System 3 . Consider other sectors relevant for health like agriculture, education and public services 4. Participation of the population in the search for solutions 5 . Use of locally available resources considering their scarcity 6 . Integrate and coordinate promotional, preventive, curative and rehabilitative measures 7 . Decentralize services

26. “ Essential components” (Essential/Basic Health Care) of Primary Health Care 1. Health education 2. Environmental sanitation, especially food and water 3. The employment of community or village health workers 4. Maternal and child health programs, including immunization and family planning 5. Prevention of local endemic diseases 6. Appropriate treatment of common diseases and injuries 7. Provision of essential drugs 8. Promotion of nutrition 9. Traditional medicine . Source: Alma-Ata Conference documents

27. A primary health care approach Meeting people’s health needs throughout their lives Addressing the broader determinants of health through multi- sectoral policy and action; and Empowering individuals, families and communities to take charge of their own health.

28. WHAT IS THE REASON BEHIND FAILURE?

29. LACK OF COMMUNITY PARTICIPATION : A result of conviction that the state is responsible for providing the totality of health services. In addition, the civic infrastructure and civic organizations are not well developed. LACK OF INTERSECTORAL COLLABORATION : limited inter- sectoral cooperation for health development .

30. MISMANAGEMENT. A major reason was weaknesses of national health systems with respect to policy analysis and formulation, coordination and regulation. Weak managerial capabilities at all levels of care have hindered the effective and efficient implementation of health programmes. Weak management also caused poor organization and delivery of health services at all levels including ineffective referral systems . The weakness of health information systems at central and peripheral levels has resulted in difficulties in collecting and using information to measure performance of health facilities. Lack Of Inter Country Collaboration And Lack Of Operational Research.

31. Why to revitalize? How to revitalize? The theme “Health System Strengthening using PHC approach”

32. Why to revitalize PHC values Equity Prevention Universal Coverage The only effective and affordable strategy (community health workers, community participation, self- reliance ….) Importance of Health System and role of PHC Achieving MDGs—Revitalize PHC Primary Health Care matters to all Goals, revitalizing PHC will definitely catalyze MDGs achievements

33. How to revitalize? Clarify Misperceptions about PHC Address changed scenario and new challenges Attitude changing and innovative ways

34. Misperceptions about PHC Misperceptions: PHC is only for poor developing countries PHC is cheap and low quality care PHC is only for the rural populations PHC is primary care or first point of contact Needs for better partnership with the private sector. Alma-Ata did not specifically address it There is misperception also: in the year 2000 the health professionals provided health care for everybody or that nobody would be sick or disabled .

35. Proposed new definition : “A stage of health development whereby everyone has access to quality health care or practice self-care protected by financial security so that no individual or family is experiencing catastrophic expenditure that may bring about impoverishment” Regional Conference on “Revitalizing Primary Health Care” Jakarta , Indonesia 6-8 August 2008

36. PRIMARY HEALTH CARE IN THE 21 ST CENTURY

37. The principles of PHC were first outlined in the  Declaration of Alma-Ata  in 1978, a seminal milestone in global health. Forty years later, global leaders ratified the  Declaration of Astana  at the   Global Conference on Primary Health Care  which took place in Astana, Kazakhstan in October 2018

38. It explains how PHC aligns with and contributes to the Sustainable Development Goals (SDGs) and universal health coverage (UHC). It highlights some of the lessons learned over the past 40 years with regard to successful implementation of PHC and describes the challenges faced.

39. The focus on PHC is critical at this moment for three reasons The features of PHC allow the health system to adapt and respond to a complex and rapidly changing world . With its emphasis on promotion and prevention, addressing determinants, and a people- centred approach, PHC has proven to be a highly effective and efficient way to address the main causes of, and risk factors for, poor health, as well as for handling the emerging challenges that may threaten health in the future. Universal health coverage (UHC) and the health-related sustainable development goals (SDGs) can only be sustainably achieved with a stronger emphasis on PHC .