Role of Hospitals on Primary Health Care (PHC)

How a hospital can play role in PHC

1. ROLE OF HOSPITAL IN PRIMARY HEALTH CARE Col Zulfiquer Ahmed Amin M Phil, MPH, PGD (Health Economics), MBBS Armed Forces Medical Institute (AFMI)

2. HEALTH FOR ALL ‘ATTAINMENT OF A LEVEL OF HEALTH THAT WILL ENABLE EVERY INDIVIDUAL LEAD A SOCIALLY AND ECONOMICALLY PRODUCTIVE LIFE’

3. Levels of Care Primary health care Secondary health care Tertiary health care

4. Primary health care The “first” level of contact between the individual and the health system. Essential health care (PHC) is provided. A majority of prevailing health problems can be satisfactorily managed. The closest to the people. Provided by the primary health centers.

5. Secondary health care More complex problems are dealt with. Comprises curative services Provided by the district hospitals The 1 st referral level Tertiary health care Offers super-specialist care Provided by regional/central level institution. Provide training programs

6. Primary health care (PHC) became a core policy for the World Health Organization with the Alma-Ata Declaration in 1978, which emphasized on reducing the gap of access and service of healthcare among haves and have-nots; and the ‘Health-for-All by the Year 2000’ Program. The commitment to global improvements in health, especially for the most disadvantaged populations, was renewed in 1998 by the World Health Assembly. This led to the ‘Health-for-All for the twenty-first Century’ policy and program, within which the commitment to PHC development is restated .

7. WHAT IS PRIMARY HEALTH CARE PRIMARY HEATLH CARE IS ESSENTIAL HEALTH CARE based on practical, scientifically sound and socially acceptable methods and technology, MADE UNIVERSALLY ACCESSIBLE TO INDIVIDUALS AND ACCEPTABLE TO THEM, THROUGH their FULL PARTICIPATION AND AT A COST THE COMMUNITY AND COUNTRY CAN AFFORD

8. Primary   Health   Care   is different in each  community  depending  upon:  Needs of the residents; Availability of health care providers; The communities geographic location; & Proximity to other health care services in the area.  

9. ELEMENTS OF PRIMARY HEATH CARE Education concerning prevailing health problems and the methods of preventing an controlling them Promotion of food supply and proper nutrition An adequate supply of safe water and basic sanitation Maternal and child health care including FP

10. Immunization against major infections diseases Prevention and control local endemic diseases Appropriate treatment of common diseases Provision of essential drugs

11. PRINCIPLES OF PRIMARY HEALTH CARE EQUITABLE DISTRIBUTION COMMUNITY PARTICIPATION INTERSECTORAL COORDINATION APROPRIATE TECHNOLOGY DECENTRALISATION

12. FIVE COMMON SHORT COMINGS OF HEALTH CARE DELIVERY INVERSE CARE IMPOVERISHING CARE FRAGMENTED AND FRAGMENTING CARE UNSAFE CARE MISDIRECTED CARE

13. Inverse care: People with the most means – whose needs for health care are often less – consume the most care, whereas those with the least means and greatest health problems consume the least. Public spending on health services most often benefits the rich more than the poor in high- and low-income countries alike . Fragmented and fragmenting care. The excessive specialization of health-care providers and the narrow focus of many disease control programmes discourage a holistic approach to the individuals and the families they deal with and do not appreciate the need for continuity in care. Health services for poor and marginalized groups are often highly fragmented and severely under-resourced, while development aid often adds to the fragmentation.

14. Impoverishing care: Wherever people lack social protection and payment for care is largely out-of-pocket at the point of service, they can be confronted with catastrophic expenses. Over 100 million people annually fall into poverty because they have to pay for health care. Unsafe care: Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital-acquired infections, along with medication errors and other avoidable adverse effects that are an underestimated cause of death and ill-health . Misdirected care: Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.

15. Obstacles to the implementation of the PHC strategy Misinterpretation of the PHC concept Misconception that PHC is a 2 nd rate health care for the poor. Selective PHC strategies Lack of political will Centralized planning and management

16. Roles of hospital on PHC Supporting PHC activities: a. Developing a referral system b. Improvement of quality of care (Including providing technical guidance to health workers) Promoting community health development action a. Hospital should play leadership role to ensure active involvement of community at all level of PHC . b. Hospital should aim at encouraging community decision making and in protecting and promoting health of people c. Hospital should give proper information to the community on health problem and ways to solve them

17. 3. Basic and continuing education of all categories of health workers. a. Training and education, incorporating basic components of PHC b. Not only giving information; but also at problem solving c. Health education and training of both staffs and community d. Participate in training of field workers e. Doctors working in the hospitals, to spend some time visiting villages and unions from where patients come f. Health educators and PHC workers to utilize UHC and District Hospitals to disseminate health information at OPDs

18. 4. Supporting health services research and development a. To enable to discover most efficient and effective ways of applying appropriate medical technologies b. Remove barriers in implementing PHC c. Help people to participate in decision making about their own health problems d. To involve community in implementing health program d. Taking part in monitoring and evaluation of health programs