Chapter 2 1primary Health Care-1

Concept of Primary Health Care
HEALTH CARE
The Alma-Ata Declaration
The International Conference on
Primary Health Care (PHC) in Alma-
Ata, Kazakhstan, in 1978, brought together
134 countries and 67 international
organizations. The conference defined and
granted international recognition to the
concept of Primary Health Care as a
strategy to reach the goal of Health for All in
2000.
HEALTH FOR ALL by 2000
• Attainment of a level of
health that will enable every
individual lead a socially
and economically productive
life
Levels of Care
Primary health care

Secondary health care
Tertiary health care
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.
Secondary health care
More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1st referral level
Tertiary health care
Offers super-specialist care
Provided by regional/central level institution.
Provide training programs.
Primary health care (PHC) became a core policy for the
World Health Organization with the Alma-Ata
Declaration in 1978 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.
WHAT IS PRIMARY HEALTH CARE
Primary health care is essential

health care made universally
accessible to individuals and
acceptable to them, through full
participation and at a cost the
community and country can afford.
Definition
PHC is an essential health care that is a socially
appropriate, universally accessible, scientifically sound
first level care provided by a suitably trained
workforce supported by integrated referral systems and
in a way that gives priority to those most in need,
maximises community and individual self-reliance and
participation and involves collaboration with other
sectors.
Contd...
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.
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 Family
Planning(FP).
Immunization against major infections diseases.
Prevention and control local endemic diseases.
Appropriate treatment of common diseases.
Provision of essential drugs & basic
b
laboratory services.
Training of health guides, health workers and
health assistants.
Referral services.
Elements of PHC (cont…)
Mental health.
Physical handicaps.
Health and social care of the elderly.
Primary Health Care
Preventive services Curative services

Outpatient clinic (referral)
General services Care of vulnerable groups Dispensary
Health education Maternal &child health Laboratory services
Monitoring of environment School health services First aid and emergency
Health office services Geriatric health services services
Preventive & control of endemic diseases

Occupational health services
PRINCIPLES OF PRIMARY HEALTH
CARE
EQUITABLE DISTRIBUTION
COMMUNITY PARTICIPATION
INTERSECTORAL COORDINATION
APROPRIATE TECHNOLOGY
DECENTRALISATION
GOALS TO BE ACHIEVED BY
2000
REDUCTION OF IMR
RAISE THE EXPECTATION OF LIFE
REDUCE THE CDR
REDUCE THE CBR
ACHIEVE A NET REPRODUCTION RATE OF ONE
TO PROVIDE POTABABLE WATER TO ENTIRE
RURAL POPULATION
Millennium Development Goals( MDGs target
2015)
Sustainable Development Goals (SDGs Target
2030)
The Basic Requirements for Sound PHC (the 8
A’s and the 3 C’s)
Appropriateness Assessability
Availability Accountability
Adequacy Completeness
Accessibility Comprehensiveness
Acceptability Continuity
Affordability
Strategies of PHC
1.Reducing excess mortality of poor marginalized
populations:
PHC must ensure access to health services for the most
disadvantaged populations, and focus on interventions
which will directly impact on the major causes of mortality,
morbidity and disability for those populations.
2. Reducing the leading risk factors to human health:

PHC, through its preventative and health promotion roles,
must address those known risk factors, which are the major
determinants of health outcomes for local populations.
Strategies contd...
3. Developing Sustainable Health Systems:
PHC as a component of health systems must develop in
ways, which are financially sustainable, supported by
political leaders, and supported by the populations served.
4. Developing an enabling policy and institutional

environment:
PHC policy must be integrated with other policy domains,
and play its part in the pursuit of wider social, economic,
environmental and development
policy.
Evaluation of HFA : 1979-2006
Reasons for slow progress:
Insufficient political commitment
Failure to achieve equity in acess to all PHC components
The continuing low status of women
Slow socio- economic development
Difficulty in achieving inter sectoral action for Health
Unbalanced distribution of resources
Reasons for slow progress(contd…)
Widespread inequity of health promotion efforts
Weak health information systems and lack of baseline
data
Pollution, poor food safety, and lack of water supply and
sanitation
Rapid demographic and epidemiological changes
Inappropriate use and allocation of resources for high cost
technology
Natural and man made disasters
Obstacles to the implementation of the
PHC strategy
Misinterpretation of the PHC concept
Misconception that PHC is a 2nd rate health care for the
poor.
Selective PHC strategies
Lack of political will
Centralized planning and management
The Challenges of changing World
Unequal growth, unequal outcomes
Adapting to new health challenges
Trends that undermine the health systems’ response
Changing values and rising expectations
PHC reforms: driven by demand
EXTENDED ELEMENTS OF PHC
Expanded options of immunization
Reproductive health needs
Provision of essential technologies for health
Prevention and control of non communicable diseases
Food safety and provision of selected food supplements.
HOW EXPERIENCE HAS SHIFTED
THE PHC MOVEMENT
Extended access to a basic Transformation and
package of health regulation of existing
interventions health systems aiming for
universal access
Concentration on MCH Dealing with the health of
everyone
A comprehensive response
Focus on small number of
selected diseases to peoples’s expectations
Contd...
 Improvement of hygiene,  Promotion of health
water and sanitation lifestyles and mitigation of
 Simple technology for health effects of social and
volunteer, community environmental hazards
health workers  Teams of health workers
 Participation as the facilitating access to and
mobilization of local appropriate technology
resources  Institutionalized
 Government funded and participation of society in
delivered services, with a policy dialogue and
centralized top down accountability mechanisms
management
Contd...
 Government funded and  Guiding the growth of

delivered services with a resources for health
centralized towards universal coverage
 Management of growing  Global solidarity and joint
scarcity and downsizing learning
 Bilateral aid and technical  Primary care as
assistance coordinator of a
 Primary care as the comprehensive response
antithesis of the hospital  PHC is not cheap. It
 PHC is cheap and requires requires considerable
only a modest investment investment .
FOUR SETS OF PHC REFORMS
UNIVERSAL COVERAGE REFORMS

SERVICE DELIVERY REFORMS
PUBLIC POLICY REFORMS
LEADERSHIP REFORMS

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Chapter 2 1primary Health Care-1

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Concept of Primary Health Care

Primary health care

The commitment to global improvements in health,

Primary health care is essential

Primary Health Care is different in each

Preventive services Curative services

Preventive & control of endemic diseases

2. Reducing the leading risk factors to human health:

4. Developing an enabling policy and institutional

 Government funded and  Guiding the growth of

UNIVERSAL COVERAGE REFORMS

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