Primary Health Care
Primary Health Care
Hospital based does not cover the needs of poor's or those in rural areas
2. New studies on community health
J.Bryant, Health and developing world, 1969 Questioned the hospital-based health care
system
K.Newell (ed) Health by the people, 1975 Excellence in the community health
ILLICH Medical nemesis : the expropriation of health, 1976
McKeown The role of medicine: Dream, mirage or nemesis, 1976. The overall health of
the population bore less relationship to medical advances than to standards of living and
nutrition.
3. New political context (crisis of the cold war)
1974 UN Resolution on the need of a “New International Economic Order” to improve social
conditions in underdeveloped countries
4. Christian movements, NGO’S and alternative experiences
The Luteran Christian medical commission (CMC) emphasized training of village workers.
Red Cross Societies tradition of voluntary work in the community. (Chinese barefoot doctors)
1. Equity/Equitable Distribution
The first key principle in primary health care strategy is equity or equitable distribution of health
services. Health services must be shared equally by all people irrespective of their ability to pay
and all (rich or poor, urban or rural) must have access to health services. Currently health
services are mainly in towns and inaccessibility to majority of population in the developing
world.
2. Community Participation
Overall responsibility is of the State. The involvement of individuals, families, and communities
in promotion of their own health and welfare is an essential ingredient of primary health care.
PHC coverage cannot be achieved without the involvement of community in planning,
implementation and maintenance of health services.
3. Intersectoral Coordination
Declaration of Alma –Ata states that PHC involves in addition to the health sector all related
sectors and aspects of national and community development, in particular education,
agriculture, animal husbandry, food, industry, education, housing, public works and
communication. To achieve cooperation, planning at country level is required to involve all
sectors
3. Affordability
The cost should be within the means and resources of the individual and the country.
4. Accessibility
Reachable, convenient services
Geographic, economic, cultural accessibility
5. 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.
6. Availability
Availability of medical care means that care can be obtained whenever people need it.
7. Assessability
Assessability means that medical care can be readily evaluated.
8. Accountability
Accountability implies the feasibility of regular review of financial records by certified
public accountants.
9. Completeness
Completeness of care requires adequate attention to all aspects of a medical problem,
including prevention, early detection, diagnosis, treatment, follow up measures, and
rehabilitation.
10. Comprehensiveness
Comprehensiveness of care means that care is provided for all types of health problems.
11. Continuity
Continuity of care requires that the management of a patient’s care over time be
coordinated among providers.
COMPREHENSIVE AND SELECTIVE PHC
WHAT HAPPEN TO THE ALMA ATA MODEL OF PRIMARY HEALTH
CARE/COMPREHENSIVE PHC
1980-93
• Infant mortality reduced by 25%
• Life expectancy increased by at least 4 years
•
1985-93
• Children under 5 dying of vaccine preventable diseases reduced by 1.3 M deaths/year
• Yet these diseases still cause 2.4 M deaths/year
Models of primary health care
COMPREHENSIVE SELECTIVE MEDICAL MODEL
View of Positive wellbeing Absence of disease Absence of Disease
health
Increased MMR
Increased child mortality rate
Halts in women empowerment
Lack of essential health care
Anemia and Malnutrition
Cut spending the financial allocations in women’s health.
Conclusion
SAPs designed by the IMF and World Bank have been the framework for economic and
social policy in most of the south since the early 1980s. No less than 34 African countries
have implemented SAP.
Human resource training: major progress but deployment and retention still big problem.
Service delivery infrastructure expanded, still in adequate, quality needs to improve.
Maternal child health indicators improving
Efforts at Inter-sectoral actions/healthy public policies minimal
Community empowerment- some progress
Objective and strategies of Revitalization of PHC
Objective:
Is to strengthen health system of Nepal and attain universal coverage of EHCS
Strategies:
Increasing access coverage and utilization of quality essential health care and reducing
inequity
Empowerment of, community leaders in planning and management at all levels
Promoting Healthy public policy to protect health of people and the communities through
intersect oral actions.
Human resource development reforms through involvement of academia and public health
institution
Four PHC Reform
1. Public policy reform
2. Leadership reform
3. Universal coverage reform
4. Service delivery reform
1. Public policy reform
Policies to support universal coverage
Revitaliz
ation of PHC works mainly on three thematic issues
1. National Free Health Care
2. Social Health Protection
3. Urban Health and Environment
1. National Free Health Care
According to National Free Health Care Program 32 in items in HP, 35 in PHCC
items/medicine are available for free respectively.
Apart from that free health service delivery is also targeted for people at extreme poverty,
poor people, physically challenged, senior citizen (above sixty) and FCHVs.
2. Social Health Protection
Social health protection the division is working for pilot testing and networking for
expansion of protection mechanism as outlined in National Health Insurance strategy.
3. Urban Health and Environment
Urban clinic and deploying FCHVs at municipal areas for delivering Essential Health
Care System is the major activities under urban health and Environment program.
Bilateral Partners
United States Agency for International Development (USAID)
The United States Agency for International Development (USAID) is the United States
Government agency which is primarily responsible for administering civilian foreign aid.
President John F. Kennedy created USAID from its predecessor agencies in 1961 by executive
order. USAID's programs are authorized by the Congress in the Foreign Assistance Act, which
the Congress supplements through directions in annual funding appropriation acts and other
legislation. Although it is technically an independent agency, USAID operates subject to the
foreign policy guidance of the President, Secretary of State, and the National Security Council.[5]
USAID operates in Africa, Asia, Latin America, the Middle East, and Eastern Europe.
Goals:
• Disaster relief
• Poverty relief
• Technical cooperation on global issues, including the environment
• U.S. bilateral interests
• Socioeconomic development
Mode of Assistance:
Technical assistance
Financial assistance
GIZ
GIZ has been active in Nepal since 1975 on behalf of the German Federal Ministry for Economic
Cooperation and Development (BMZ) and opened its own office in the capital, Kathmandu, in
1979.
Nevertheless, it is expected that the country, with the help of the international community and the
efforts of its own government, will be able to achieve almost all the
Millennium Development Goals.
School enrolment rates, for instance, are very encouraging. Today, nine children out of ten
are able to go to school.
Goal of GIZ
The goals of our work there are to
reduce poverty,
to ensure inclusive development
Published on 4 November 2010 (and updated on 10 June 2011), the 2010 Human Development
Report (HDI) combines three dimensions:
World scenario
Very high HDI country:
Norway
HDI=0.944
LIFE EXPECTANCY AT BIRTH=81.6
EXPECTED YEARS OF SCHOOLING=17.5
MEAN YEAR OF SCHOOLING=12.6
Category of HDI
Human Life Expected Mean
Human development
Development expectancy years of years of
groups
Index (HDI) at birth schooling schooling
Very high human
0.896 80.5 16.4 11.8
development
Medium human
0.630 68.6 11.8 6.2
development
Low human development 0.505 60.6 9.0 4.5
“Event”: “a manifestation of disease or an occurrence that creates the potential for disease”
"Public health risk": "the likelihood of an event that may adversely affect the health of human
populations,"
Public health
Incubation period
P.Falciparum P.Vivax P.Malariae P.Ovale
IP (9-14)days (8-17)days (18-40)days (16-18)days
Sign and symptoms
Fever
Headache
Birdflu viruses infect birds,including chicken,poultry and wild birds such as ducks. On rare
occasions,these bird viruses can infect other species,including pigs and humans.
This could lead to pandemic ,or a worldwide outbreak of illness.
Category A
These high-priority agents include organisms or toxins that pose the highest risk to the public and
national security because:
Category C
These third highest priority agents include emerging pathogens that could be engineered for mass
spread in the future because:
History
The World Bank is one of the two Bretton Woods institutions which were created in 1944 to
rebuild a Western Europe after World War 2
Operations
Fund generation
Loans
Grants
Analytic and advisory services
Capacity building
Fund generation
Loans
Investment loans
Development policy loan
World bank treasury
Grants
Poverty assessments
Public expenditure reviews
Topics in development
Capacity building
Advisory services
Global development learning network
Area of operation
Criticism
It was started to reduce poverty but it support United States business interests The
president of the bank is always a citizen of the United States.
Lack transparency to external publics
It is an instrument for the promotion of US or western interests
The decision making structure is undemocratic
The IMF was conceived in July 1944, when representatives of 45 governments meeting in the
town of Bretton Woods, New Hampshire, in the northeastern United States, agreed on a
framework for international economic cooperation.
• Surveillance
Surveillance
Lending
- IMF lending enables countries to rebuild their international reserves; stabilize their currencies;
continue paying for imports; and restore conditions for strong economic growth.
- IMF does not lend for specific projects.
- It eases the adjustment policies and reforms that a country must make to correct its balance of
payments problem and restore conditions for strong economic growth.
Technical assistance
TRIPs came into effect in 1995. It imposes minimum standards in seven areas of intellectual
property i.e. patents, copyright, trademarks, geographical indication, industrial design, and
undisclosed information (trade secrets) and covers diverse areas as computer programming and
circuit design, pharmaceuticals and transgenic crops.
Negative Impact
Differences in economic and technological capabilities between the North and the South,
‘technological protectionism’ aimed at consolidating an international division of labour where
the North generates the innovations and the South will be the market for the resulting products
and services.
In the area of medicine and health, stronger and wider IPR protection will affect the practice of
medicine and the spread of medical knowledge. Protectionism of medical knowledge and
medical practice commodifies medicine further and threatens well being and public health.
EXAMPLE.
Trade Marks
TRIPs protection of ‘well known’ trademarks even if they are known on the basis of publicity
and not of effective use in a country.
TRIPs will have the greatest impact on the pharmaceutical industry and the Third World’s access
to medicines. Third World countries are going to suffer from substantial price increases and
other costs.
Except for China, no Third World country is self-sufficient in essential drugs. Some 2.5 billion
people have little or no access to essential drugs (UNDP 1991). WHO estimates that some
countries pay 150-250 percent more than the world market prices for essential drugs while others
are faced with unreliable suppliers and poor quality drugs?
Patenting of life forms and biological materials through genetic engineering, also raises adverse
health and environmental concerns. Genetically modified food can cause allergies, toxicity and
antibiotic resistant organisms.