الرحيم الرحمن الله بسم

Primary Health CareBasic Concepts

Health “A state of complete physical, mental

and social wellbeing and its not merely

the absence of disease or infirmity”

WHO 1946

Concepts of health care • Provision of services by health personnel It

includes: –Prevention – Diagnosis –Treatment – Rehabilitation–Promotion

Levels of Health Care

• Primary health care• Secondary health care• Tertiary health care

Levels of Health Care Primary health care • The “first” level of contact between the

individual and the health system.

• The closest to the people.

• Cover all people with essential care.

• Addresses the main health problems in the community, providing preventive and curative services.

• A majority of prevailing health problems can be satisfactorily managed.

• Provided by the primary health centers.

Levels of Health Care 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.

PHC history

•PHC appeared as a concept since 1975 in the 25th conference for WHO

•Health for All by the year 2000 (Assembly) -1977•International Conference on Primary Health Care (Alma – Ata) -1978

PHC history WHA 1977

• The 30th World Health Assembly Comes with new philosophies: • Social justice and equity are essential for health • Recognition of the role of community

participation • The importance of the political will• The relation between health and development

(health is essential for development and development is essential for health)

Health for All

• The ideas concluded in the international objective of Health for All

• Definition of HFA: Attainment by all peoples of the highest level of health that permit them to lead socially and economically productive life

Fundamental Principles for Health for All

1. Health is fundamental human right and a worldwide social goal

2. Health is an integral part of development

3. The existing gross inequality in the health status of people is of common concern to all countries and must be drastically reduced.

4. People have the right and the duty to participate individually and collectively in the planning and implementation of their health care

5. Governments have a responsibility for the health of their people

6. Countries must become self-reliant in health matters.

7. Fuller and better use must be made of the world’s resources to promote health and development.

Alma-Ata Conference (1978)

• proclaimed PHC as way to achieving HFA

Primary Health Care

• It is the first level of contact of individuals, the family and the community with the national health system, bringing health care as close as possible to where people live and work

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 that community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

Alma Ata declaration, 1978

Primary Health Care

Principles of Primary Health Care•

1.Equitable Distribution: Health services should be available to each and every one in the

community – not depend on one’s capability to pay for the services (rich & poor) Rural or urban

2 .Appropriate Technology: Appropriate technology is one which is – scientifically sound, adapted to local

needs, acceptable to those who apply it and to those on whom it is applied, within the resources which can be afforded by the community and the nation.

Examples of appropriate technology are Oral rehydration therapy DOTS and Immunization programme

Principles of Primary Health Care

3.Inter-Sectoral Coordination: in addition to the health sector, all related sectors in

particular agriculture, animal , food, industry.

4.Community Participation: While most of the efforts in providing health care come from

the Ministry of health, the system of primary health care should be based on full participation and involvement of the community in planning, implementation and evaluation.

.

The Basic Requirements for Sound PHC

• Appropriateness• Availability • Adequacy• Accessibility• Acceptability• Affordability • Assessability

Appropriateness

• Appropriate service is provided according to essential human needs, priorities and policies.

Adequacy

• Sufficient volume of care to meet the need and demand of a community

• Adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.

Affordability

• The cost should be within the means and resources of the individual and the country.

Accessibility

• Geographic, economic, cultural accessibility

Acceptability

• Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.

Availability

• Availability of medical care means that care can be obtained whenever people need it.

Assessability

• Assessebility means that medical care can be readily evaluated.

1. Health Education concerning prevailing health problems and the methods of preventing and controlling them;

2. Promotion of food supply and proper nutrition;

3. An adequate supply of safe water and basic sanitation.

Main Elements of PHC

4. Maternal and child health care, including family planning

5. Immunization against the major infectious diseases

6. Prevention and control of local endemic diseases

7. Appropriate treatment of common diseases and injuries

8. Provision of essential drugs

Main Elements of PHC

(secondary) elements of PHC • Mental Health• Care of elderly• Occupational Health• School Health• Reproductive Health• Adolescent Health

Elements of PHC (cont.)

Primary Health Care

Preventive services Curative services

General services Care of vulnerable groupsOutpatient clinic (referral)Laboratory servicesDispensary First aid and emergency services

Health educationMonitoring of environmentPrev.&control of endemic diseases

Maternal &child health s.School health servicesGeriatric health servicesOccupational health services

Primary Health Care - Benefits• PHC focuses on keeping people healthy & addressing

illness early so as to increase probability of cure

• Individuals have access to appropriate care

• Services are matched to community needs

• Targeted services will have a positive impact on the utilization of health and social services

• Healthy communities with healthy people contribute to a stable economy

• PHC is Cost-effective

Why PHC is Cost-effective?• Reduces the disease burden. Effectively addressing the

most common health needs (70% - 90% of health services).

• Produce economic savings. improving family health by prevention, close services and sustainable follow up.

• Assure greater equity. Geographically, Financially, and culturally accessible to local communities

• Efficient allocation of resources (Spending 1 US$ in PHC saving 10 US$ to the government)

• Operationally sound ,cheap and simple knowhow.• Fund raiser tool, attract the community to finance &

participate in provision of health services. 29

Comparison between Primary & Secondary health care costs

Country & Maternal health services

PHC level of service provision cost (US$)

Secondary level of service provision cost

(US$)

Uganda

Antenatal Care 2.21 $ 4.18 $

Vaginal delivery 2.71 $ 33.90 $

Malawi

Antenatal Care 3.23 $ 5.48$

Vaginal delivery 10.22 $ 24.03 $

Ghana

Antenatal Care 3.17 $ 5.25 $

Vaginal delivery 7.66 $ 14.60 $ 30

Problems that impede the implementation of PHC in Sudan

1. The burden of communicable and non-communicable diseases is rising which put more demand on PHC services.

2. Inequitable distribution of health care services3. Shortage of qualified human resources.4. Inadequate PHC level management capacity.5. Absence of sustainable financial mechanism for PHC

services.6. The focus of government spending on hospitals leading to

an unbalanced health system. Most of the government health expenditure is directed to the secondary and tertiary hospitals

Population & Health Expenditure (Inverted Pyramid)5 % of population 15 %

population

80% of population

32

80% of Health Expenditure

15% of Health Expenditure5

%Healt

h Expenditur

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