Welcome to the

Seminar on
Primary Health Care
and
Modes of Prevention
Primary Health Care - Definition

Primary health care is an 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 the community and
country can afford to maintain at every stage of their
development in the spirit of self reliance and self
determination
Primary Health Care - Definition

"Essential health care made universally accessible to

individuals and acceptable to them through their full

participation and at a cost the community and

country can afford" (WHO).

 THE PHC PHILOSOPHY

Health is fundamentally related to availability and

distribution of resources - not just health resources such
as doctors, nurses, clinics, medicines, but also other
socio-economic resources such as educa­tion, water
supply and food supply. Therefore, PHC is concerned
with equity to ensure that available health and social
resources are distributed with justice and due
consideration for those whose needs are greatest
 THE PHC PHILOSOPHY

Health is an integral part of overall development. Thus

factors, which influence health are social, cultural
and economic as well as biological and
environmental.
 THE PHC PHILOSOPHY

Achievement of better health requires much more

involvement of people them­selves as individuals,
families and com­munities, in taking action on their
own behalf by adopting healthy behaviour and
ensuring a healthy environment. Self-reliance,
separate from and additional to the contributions of
conventional health services, is required to a much
greater extent.
THE PHC STRATEGY

• The Need for Change in the Health Care

System
• Intersectoral Action for Health

• Individual and Collective Responsibility for

Health
• PHC as a Level of Health Care
The Declaration of Alma Ata stated that
primary health care includes at least:
• education about prevailing health problems and
methods of preventing and 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;
• immunization against infectious diseases;
• prevention and control of endemic diseases;
• appropriate treatment of common diseases and
injuries; and
• provision of essential drugs.
 PRINCIPLES OF P.H.C

• Equity

• Community involvement

• Focus on prevention

• Appropriate technology

• Multi-sectoral approach
ELEMENTS OF PRIMARY HEALTH CARE
• education concerning prevailing health problems and
the methods of preventing and 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;
• immunization against major infectious diseases;
• prevention and control of locally endemic diseases;
• appropriate treatment of common diseases and
injuries; and
• provision of essential drugs.
ELEMENTS OF PRIMARY HEALTH CARE

E—Ensure safe water supply

L—Locally endemic diseases control
E—Education/Expanded Programme on
Immunisation / UIP
M—Maternal and child health
E—Environment sanitation
N—Nutritional services
T—Treatment of minor ailments
S—School health services
PRIMARY HEALTH CARE IN INDIA

The functions of the primary health centre in

India cover all the 8 "essential" elements of
primary health care as outlined in the Alma-
Ata Declaration
The functions of the primary health centre in India
• Medical care
• MCH including family planning
• Safe water supply and basic sanitation
• Prevention and control of locally endemic diseases
• Collection and reporting of vital statistics
• Education about health
• National Health Programmes - as relevant
• Referral services
• Training of health guides, health workers, local dais
and health assistants
• Basic laboratory services
 HEALTH POLICY
"A health policy generally describes fundamental
principles regarding which health providers are
expected to make value decisions." 'Health Policy'
provides a broad framework of decisions for guiding
health actions that are useful to its community in
improving their health, reducing the gap between
the health status of haves and have-nots and
ultimately contributes to the quality of life.
 NATIONAL HEALTH POLICY (1983)
• Provision of universal comprehensive primary health care
services with special emphasis on the preventive, promotive
and rehabilitative aspects.
• Securing small family norms through voluntary efforts and
moving towards the goal of population stabilisation and
enunciation of a National Population Policy.
• To formulate a National Medical and Health Education Policy
for health, manpower development and to ensure that
personnel at all levels are socially motivated to adopt
community health approach.
• To decentralise the primary health care system by
restructuring the health care services to promote community
partici­pation and linking it with a systematic back-up support
of referral services at secondary and tertiary levels.
 NATIONAL HEALTH POLICY (1983)
• Integrally linking the health education and extension
activities with primary health care services.
• Transferring simple health care knowledge, skills and
appropriate technology to community so that majority of
common health actions could be handled effectively by
the community.
• Mobilising untapped health resources and encouraging
investment by private sector, NGOs and voluntary
bodies to establish curative services wherein all affluent
sectors could be looked after by paying.
• To remove the existing regional imbalances and to
provide services within the reach of all, whether
residing in rural or the urban areas.
NATIONAL HEALTH POLICY (1983)
• Assist in the enlargement of the services being
provided by private voluntary organisations active in the
health field, especially those which seek to serve the
needs of the rural areas and the urban slums.
• The entire approach to health manpower development
should ensure their functioning as a 'Health Team'
• To integrate the services of ISM practitioners at the
appropriate levels, within specified areas of
responsibilities and functioning in the overall health
care delivery system, especially with regard to the
preventive, promotive and public health care aspects.
NATIONAL HEALTH POLICY - APPROACHES

• To extend the outreach of primary health care

services' through a network of health centres based
on the organised support of health volunteers,
auxiliaries, para-medical workers of both sexes.
• Intermeshing of the efforts of NGOs, voluntary
organisations with the govern­mental efforts in a
planned and integrated manner.
• Improving the quality of the training of the frontline
workers, and support manpower in health.
NATIONAL HEALTH POLICY - APPROACHES

• Planning the optimal utilisation of specialists at the

higher levels of the hierarchical structure.
• Creation of nationwide chain of sanitary and
epidemiological units.
• Provision of integrated package of services seeking
to tackle entire range of poor health conditions
rather than disparate health interventions.
• Fullest utilisation of domiciliary care and field health
camp approach to reduce pressure on curative
regarding tuber­culosis, leprosy and blindness,
normal deliveries and family planning measures.
NATIONAL HEALTH POLICY - APPROACHES

• Package of services seeking to tackle entire range of

poor health conditions as well as to endemic disease-
affected populations and the vulnerable sections of
the society.
• Increasing the mobility of health personnel at all
levels to enhance their accessibility and ensure
availability in need.
• Reorientation of the existing health personnel towards
the concepts of primary health care and goals of HFA.
• To move towards a meaningful phased integration of
the indigenous and the modern systems of medicine.
The Priorities according to National Health Policy
• a. Nutrition
• b. Prevention of food adulteration and quality of
drugs
• c. Water supply and sanitation
• d. Environmental protection
• e. Immunisation programmes
• f. Maternal and child health services
• g. School health programme
• h. Occupational health services
The Priorities according to National Health Policy
Other aspects
• Health Education.
• Development of Managerial Information
System (MIS).
• Production of Drugs and Equipments.
• Health Insurance and Legislation.
• Medical Research.
• Policy Formulation
• Identifying Policy Needs
• Formulating Policy
• Designing Policy Strategies
• Reviewing the Policy
 Existing Weaknesses in Implementation of
Primary Health Care
1. Minimal policy and organisational commitment:
a. Community Health Welfare programmes tended to be
vertical programmes. Little attention to follow and integration
into existing health system.
b. Programmes were implemented with little professional
interests.
c. Structural, political and economic factors were neglected.
d. Lessons have not been learned from other sectors.

Pilot projects often very successful in small areas have tended

not to be extended successfully to larger areas or
into national programmes owing to the consequence dilution of
resources or to difficulty in assuring supplies.
Existing Weaknesses in Implementation of
Primary Health Care Contd ...
2.Poorly defined functions:
• Community Health workers have broader
responsibilities often they have given numerous
tasks, many more than they have been trained for.
3. Poor selection - community leaders are not informed
and motivated enough.
4. Deficiencies in training and continuing education
• Irrelevant curricula
• Poorly trained teachers
• Poorly prepared teaching materials
• Too long or too short courses
• Unfamiliar with the conditions
Existing Weaknesses in Implementation of
Primary Health Care Contd ...
5. Lack of support and supervision,
6. Uncertain working conditions
• pay is not sufficient
• no proper residential quarters
7. Undetermined cost and sources of finance.
8. Lack of monitoring and evaluation
• Frequent lack of well-defined objectives makes
credible monitoring and eva­luation. Impossible and
attempts to involve communities have been very
few and generally half-hearted.
Existing Weaknesses in Implementation of
Primary Health Care Contd ...

9. Lack of transport facilities

10. Insecurity of female staff

11. Inadequate supply of drugs and stationeries

12. Medical officers are not interested to work in rural areas

 New concept of health care
Millennium Development Goals (MDGs)

• eight international development goals

• that all 192 United Nations member states and
at least 23 international organizations have
agreed to achieve by the year 2015.
• They include eradicating extreme poverty,
reducing child mortality rates, fighting disease
epidemics such as AIDS, and developing a
global partnership for development.
 The Millennium Development Goals
Goal 1: Eradicate extreme poverty and hunger

• Target 1A: Halve the proportion of people living on

less than $1 a day

• Target 1B: Achieve Decent Employment for

Women, Men, and Young People

• Target 1C: Halve the proportion of people who

suffer from hunger
 The Millennium Development Goals
Goal 2: Achieve universal primary education
• Target 2A: By 2015, all children can complete a full
course of primary schooling, girls and boys
Goal 3: Promote gender equality and empower
women
• Target 3A: Eliminate gender disparity in primary and
secondary education preferably by 2005, and at all
levels by 2015
 The Millennium Development Goals
Goal 4: Reduce child mortality rate
• Target 4A: Reduce by two-thirds, between 1990 and
2015, the under-five mortality rate

Goal 5: Improve maternal health

• Target 5A: Reduce by three quarters, between 1990
and 2015, the maternal mortality ratio
• Target 5B: Achieve, by 2015, universal access to
reproductive health
 The Millennium Development Goals

Goal 6: Combat HIV/AIDS, malaria, and other diseases

• Target 6A: Have halted by 2015 and begun to reverse
the spread of HIV/AIDS
• Target 6B: Achieve, by 2010, universal access to
treatment for HIV/AIDS for all those who need it
• Target 6C: Have halted by 2015 and begun to reverse
the incidence of malaria and other major diseases
 The Millennium Development Goals
Goal 7: Ensure environmental sustainability
• Target 7A: Integrate the principles of sustainable
development into country policies and programs; reverse
loss of environmental resources
• Target 7B: Reduce biodiversity loss, achieving, by 2010,
a significant reduction in the rate of loss
• Target 7C: Halve, by 2015, the proportion of the
population without sustainable access to safe drinking
water and basic sanitation
• Target 7D: By 2020, to have achieved a significant
improvement in the lives of at least 100 million slum-
dwellers
 The Millennium Development Goals
Goal 8: Develop a global partnership for development
• Target 8A: Develop further an open, rule-based, predictable,
non-discriminatory trading and financial system
• Target 8B: Address the Special Needs of the Least Developed
Countries (LDC)
• Target 8C: Address the special needs of landlocked developing
countries and small island developing States
• Target 8D: Deal comprehensively with the debt problems of
developing countries through national and international
measures in order to make debt sustainable in the long term
• Target 8E: In co-operation with pharmaceutical companies,
provide access to affordable, essential drugs in developing
countries
• Target 8F: In co-operation with the private sector, make
available the benefits of new technologies, especially
information and communications
MODES OF PREVENTON
 CONCEPTS OF PREVENTION
The goals of medicine are
• to promote health
• to preserve health
• to restore health when it is impaired
• and to minimize suffering and distress
Successful prevention depends upon
• knowledge of causation
• dynamics of transmission
• identification of risk factors and risk groups
• availability of prophylactic or early detection and treatment
measures
• an organization for applying these measures to appropriate
persons or groups
• and continuous evaluation of and development of procedures
applied.
 LEVELS OF PREVENTION
In modern day, the concept of prevention has
become broad-based. It has become customary
to define prevention in terms of four level:
• primordial prevention
• primary prevention

• secondary prevention
• tertiary prevention
 MODES OF INTERVENTION
Intervention can be defined as any attempt to intervene or
interrupt the usual sequence in the development of disease
in man
Five modes of intervention have been described which form a
continuum corresponding to the natural history of any
disease. They are:

1.Health promotion
2. Specific protection
3. Early diagnosis and treatment
4. Disability limitation
5. Rehabilitation
Thank You