Download - Phc & Health for All
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Organized at 3 levels & each lvl sp by a higher lvl
to which Patient is referred Primary Health Care
First lvl of contact between indl & health sys Essential health care is provided BHU, RHC Closest to people & less costly Majority of health problems satisfactorily
dealt here
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Secondary Health Care Lvl at which more complex problems are dealt Usually provided at district hospitals Comprises curative services 1st referral level
Tertiary Health Care Lvl which offers super specialist care Provided by regional & central hospitals Provide training progms Costly
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Growing concern in world over unacceptably low
lvls of health status of world population Special concerns
Rural areas Disparities in health between rich & poor Urban & rural
both between countries and within countries
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3 decades of dissatisfaction World Health Assembly (May 1977) decided that
main social goal of govts & WHO in coming yrs should be:“Attainment by all people of the world by yr 2000
of lvl of health that will permit them to lead a socially & economically productive life”
Given the name “ Health for all by year 2000” HFA
Decision to hold conference to achieve this concept in 1978
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Unicef collaborated effort (1978) held at Alma Ata
(former USSR) with 188 countries & NGOs
All countries should deliver at least basic health
svc to indls by 2000
All govts to plan & develop policies / take actions
to implement Primary Health Care in the country
Key to attainment of health for all ???
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“Essential health care that is based on practical,
scientifically sound, socially acceptable methods &
technologies made universally accessible to indls &
communities through their full participation & at the
cost that community & country can afford to
maintain at every stage of their dev in the spirit of
self reliance & self determination”
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E – Health edn about prevailing health problems
L – Prevention & Control of locally endemic diseases
E – Provision of essential drugs
M – MCH care (Maternal & Child health) incl family
planning
E – (EPI) Immunization against infectious diseases
N – Proper nutrition and food supplies
T – Treatment of common diseases & injuries
S – Adequate safe water supply & sanitation
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Equity According to needs”First key principle - equitable distribution of health svcs
Health svcs must be shared equally by all irrespective of their ability to pay & as per need
Aim of PHC is to redress the imbalance by: Shifting the centre of gravity of health care
sys from cities to villages Imbalance of preventive health care svcs &
curative health svcs
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Community Participation A process by which people individually or
collectively assume inc responsibility for their own health needs
No universal coverage without involvement of local community
Community should be involved from Inception of needs Planning Implementation & maint of health svcs
besides reliance on local resources(MMMT)
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Intersectoral Coordination Componants of PHC cannot be provided by health sector alone Alma Ata declaration states: PHC Involves in addition to health sector all related
sectors & aspects of national & community dev in particular agriculture, food, edn,
public works, & others It can be at the lvl of
PlanningPolicy makingProgm & Svc deliveryImplementation, monitoring & eval
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Appropriate Technology Technology that is scientifically sound,
adoptable to local needs, acceptable to those who apply it & can be maint by people themselves
4 x As Available to community Accessible to community Acceptable to community Affordable by the community is called the appropriate technology
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“Essential health care that is based on practical,
scientifically sound, socially acceptable methods &
technologies made universally accessible to indls &
communities through their full participation & at the
cost that community & country can afford to
maintain at every stage of their dev in the spirit of
self reliance & self determination”
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Safe water supply within 15 minute walk 100% safe excreta disposalProvn of health svcs at max of 20 min drive or 01
hour walk100% immunization coverage to all under 5
children IMR should be less than 50/1000 live births MMR should be less that 2/1000 live births
INDICATORS / TGTS OF PHC EVAL STRATEGIES
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Literacy rate more than 70%Family planning coverage to 60% or more eligible
couple Life expectancy > than 62 (for both genders) Provn of 23 essential drugs to all Birth wt of all newborn babies should be > 2500
gm (2.5 kg)
INDICATORS / TGTS OF PHC EVAL STRATEGIES
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Govt of Pakistan embarked on PHC prior to Alma
Ata declaration
Build up sys of “Integrated rural health complex”
which comprises of whole sys of BHU, RHCs,
Tehsil hospitals and DHQs
EPI, CDD, TBA’s trg, malaria &TB control progm
are integral part of this sys
PHC IN PAKISTAN
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PHC IN PAKISTAN
BHUBHU
RHCRHC
BHU BHU BHU
BHUBHU
BHU BHU BHU
THQ
DHQ
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Almost one third of Pakistan's 170 million people live in poverty
More than 60 % live on less than 2 dollars/ day The infant mortality rate for Pakistan is 76.7 per
1,000 live births Maternal Mortality Rate 350/ 100,000 live births 40% of population has access to safe water
supply Literacy rate ??? Life expectancy ???
CURRENT STATUS / INDICATORS OF PAKISTAN
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Political Climate Afghan Russian War with large number of
refugees Rapidly changing political climate -- failure of
proper implementation Law & Order Sit in various areas of Pakistan were
the reason of failure to achieve goals Lack of political cmt by govt Lack of appreciation of multifaceted apch Multiple horizontal progm Curative svcs given pri over preventive svcs
WHY PHC FAILED
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Lack of involvement of community & pte sector Lack of awareness regarding PHC among health
professionals Shortage of health manpower & unequal distr of
resources Technical reasons & lack of implementation Illiteracy, Poverty & population explosion
WHY PHC FAILED
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Idea was to give pri to certain diseases Prevalence of disease Morbidity & disability Effectiveness of measures and their cost
UNICEF proposed selective apch (1982) G - Growth monitoring O - ORT B - Breast feeding I - Immunization F - Family planning F - Female literacy F - Food supplements for children & pregnant women
SELECTIVE HEALTH CARE APCH
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Cmt to Health For All again renewed (1998) by
World Health Assembly
HFA for 21st century or HFA by yr 2000 & beyond
Progm cmt to continue till achievement of its tgts
ANOTHER MILESTONE
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AppropriatenessAvailability AdequacyAccessibilityAcceptabilityAffordability AssessabilityAccountability
BASIC REQ FOR SOUND PHC 8 A’S & 3 C’S
Completeness
Comprehensiveness
Continuity
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MDGs
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MDGs Millennium declaration (Sep 2000) -- 189 members
states of UN made cmt to address poverty
Set date of 2015 for MDG achievement
8 goals defined -- broken down in 21 quantifiable
tgts & measured by 60 indicators
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MDGs Eradicate extreme poverty & hunger Achieve universal primary edn Promote gender equity Reduce child mortality Improve maternal health Combat HIV/AIDS / Malaria & other diseases Ensure environmental sustainability Dev a global partnership for dev
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THANK THANK YOU YOU