DR - Nesreen Farouk Lecturer of Public Health and Community Medicine

Dr .
Nesreen Farouk
Lecturer of public health and community medicine
Levels of health care
Primary health care
• The first level of contact between the individual and the health system.
-It responds to 80% of the community needs

-Provided through urban and rural health facilities
-Provided by general practitioners (newly graduates)
It includes the following:

1)Health Promotion
2)Illness Prevention
3)Care of the sick
4) Advocacy
What is primary health care?
• Primary health care is an approach to health and wellbeing centered on the
needs and circumstances of individuals, families and communities.
• It addresses comprehensive and interrelated physical, mental and social health
and wellbeing
• It is about providing whole-person care for health needs throughout life, not
just treating a set of specific diseases.
• Primary health care ensures people receive comprehensive care, ranging from
promotion and prevention to treatment, rehabilitation and palliative care as
close as feasible to people’s every day environment.
• Primary health care is the most efficient and cost effective way to achieve
universal health coverage around the world.
What is primary health care?
•WHO has developed a cohesive definition based on three components:
 meeting people’s health needs through comprehensive promotive, protective,
preventive, curative, rehabilitative, and palliative care throughout the life course,
strategically prioritizing key health care services aimed at individuals and families through
primary care and the population through public health functions as the central elements of
integrated health services;
 systematically addressing the broader determinants of health (including social,
economic, environmental, as well as people’s characteristics and behaviours) through
evidence-informed public policies and actions across all sectors; and
 empowering individuals, families, and communities to optimize their health, as
advocates for policies that promote and protect health and well-being, as co-developers of
health and social services, and as self-carers and care-givers to others.
What is Primary Health Care?
• It is the essential health care based on:
1) practical, scientific and socially acceptable methods.
2)Accessible technology to all individuals and families.
3) Affordable cost for the community and the country.

Principles of PHC
1)Accessible:
-Geographic accessibility
-Social accessibility
-Financial accessibility
2)Affordable
The community and the country can pay for the health services
3)Acceptable
It is measured by utilization
4)Social equity:
Equitable distribution of services
5)Continuity of care:
6)Proper referral system
7)Provided by a health team including:

physicians ,dentists, pharmacists,
lab technicians , sanitarians and social workers
Elements of PHC
1)Health education : concerning the prevailing health problems ,their

prevention and control
2)Promotion of food supply and proper nutrition
3)Basic sanitation and safe water supply
4)Maternal and child health(MCH),and family planning
5)Immunizations
• 6)Prevention and control of locally endemic diseases
7)Appropriate treatment of common diseases and injuries
8)Basic laboratory services and provision of essential drugs
9)Training
10)Referral system
Primary Health Care Services Include:
1)Health Promotion Services
2)Preventive Care services
3)Curative care services
1) Health Promotion Services: it include the following:
-Health education and counseling
-Food safety measures and food handlers’ care
-Supporting environmental sanitation activities
-Outreaching people in the remote areas to raise health awareness
2.Preventive Care Services:
-Screening for high risk pregnancy
-Early detection of neonatal problems
-Implementation of Expanded Program of Immunization (EPI)
-Growth monitoring of the children
-Supplementation with micronutrients
-Family planning activities (Information ,education and communication services)
-Screening for T.B and parasitic infections
-Screening for reproductive malignances(Breast and cervix)
-Early Detection of mental disorders
-Referral of identified problems to prevent complications

Curative Care Services:
-Management of common non-complicated health problems.
-Treatment of childhood illness : Diarrhea , malnutrition and fevers
-First aid, emergency, and life-saving services
-Control of infectious diseases, outbreaks and epidemics
-Management of chronic non-communicable disease (Diabetes and hypertension)
- Conduction of minor surgeries
-Basic lab work and ultrasound
-Referral of needy cases and follow up

PHC Programs: examples
1)Maternal health care
2)Child health care
3)School health Care
4)Reproductive health care
5)Occupational health care
6)Geriatric health care

Secondary health care
-Provides higher levels of curative cure
-Responds to 15% of the community needs
-Provided in public the district hospitals
-Provided by specialists
-Referral system exists between primary care and secondary care facilities
Tertiary health care

-Offers super-specialist care
-Provided through specialized hospitals and institutions
-Responds to 5% of the community health needs
-Provide training programs

Universal Health coverage
UHC is a goal (aspirational)
All people have access to effective and high-quality health services, without
experiencing financial hardship
Universal: All people regardless of race, gender, social status
Health services: curative, health promotion, prevention, rehabilitation, and

palliative
Quality: sufficient quality to be effective
Financial hardship: lowering out of pocket costs and the risk of catastrophic
health expenditure
Key facts- global picture
• 400 million people globally lack access to one or more essential health
services.
• Every year 100 million are pushed into poverty and 150 million people
suffer financial catastrophe because of out-of-pocket expenditure on
health services.
• 32% of total health expenditure worldwide comes from out-of-pocket

payments.
All UN Member States have agreed to try to achieve universal health
coverage (UHC) by 2030, as part of the Sustainable Development Goals
Millennium Development Goals
What UHC is not
There are many things that are not included in the scope of UHC:
 UHC does not mean free coverage for all possible health
interventions, regardless of the cost, as no country can provide
all services free of charge on a sustainable basis.
 UHC is not just about health financing. It encompasses all
components of the health system: health service delivery systems,
the health workforce, health facilities and communications
networks, health technologies, information systems, quality
assurance mechanisms, and governance and legislation.
What UHC is not
 UHC is not only about ensuring a minimum package of health

services, but also about ensuring a progressive expansion of coverage of
health services and financial protection as more resources become
available.
 UHC is not only about individual treatment services, but also includes
population-based services such as public health campaigns, adding
fluoride to water, controlling mosquito breeding grounds, and so on.
 UHC is comprised of much more than just health; taking steps towards
UHC means steps towards equity, development priorities, and social
inclusion and cohesion.
Can UHC be measured?
Yes. Monitoring progress towards UHC should focus on 2

things:
• The proportion of a population that can access essential
quality health services.
• The proportion of the population that spends a large

amount of household income on health.
Can UHC be measured?( cont.)
• Together with the World Bank, WHO has developed a framework to track the
progress of UHC by monitoring both categories, taking into account both the
overall level and the extent to which UHC is equitable, offering service
coverage and financial protection to all people within a population, such as
the poor or those living in remote rural areas.
• WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage
in countries:

•Reproductive, maternal, newborn and child health:

family planning
antenatal and delivery care
full child immunization
health-seeking behavior for pneumonia.
•Infectious diseases:
tuberculosis treatment
HIV antiretroviral treatment
Hepatitis treatment
use of insecticide-treated bed nets for malaria prevention
adequate sanitation.

•Non communicable diseases:

prevention and treatment of raised blood pressure
prevention and treatment of raised blood glucose
cervical cancer screening
tobacco (non-)smoking.
•Service capacity and access:
basic hospital access
health worker density
access to essential medicines
health security: compliance with the International Health Regulations.
• Each country is unique, and each country may focus on different areas,
or develop their own ways of measuring progress towards UHC.
• But there is also value in a global approach that uses standardized
measures that are internationally recognized so that they are
comparable across borders and over time.

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Dr .

-It responds to 80% of the community needs

It includes the following:

1) practical, scientific and socially acceptable methods.

2)Accessible technology to all individuals and families.

3) Affordable cost for the community and the country.

6)Proper referral system

7)Provided by a health team including:

1)Health education : concerning the prevailing health problems ,their

2)Promotion of food supply and proper nutrition

3)Basic sanitation and safe water supply

4)Maternal and child health(MCH),and family planning

7)Appropriate treatment of common diseases and injuries

8)Basic laboratory services and provision of essential drugs

-Early detection of neonatal problems

-Implementation of Expanded Program of Immunization (EPI)

-Growth monitoring of the children

-Supplementation with micronutrients

-Family planning activities (Information ,education and communication services)

-Screening for T.B and parasitic infections

-Screening for reproductive malignances(Breast and cervix)

-Early Detection of mental disorders

-Referral of identified problems to prevent complications

-Treatment of childhood illness : Diarrhea , malnutrition and fevers

-First aid, emergency, and life-saving services

-Control of infectious diseases, outbreaks and epidemics

-Management of chronic non-communicable disease (Diabetes and hypertension)

- Conduction of minor surgeries

-Basic lab work and ultrasound

-Referral of needy cases and follow up

1)Maternal health care

2)Child health care

3)School health Care

4)Reproductive health care

5)Occupational health care

6)Geriatric health care

-Responds to 15% of the community needs

-Provided in public the district hospitals

Tertiary health care

-Provided through specialized hospitals and institutions

-Responds to 5% of the community health needs

-Provide training programs

Universal: All people regardless of race, gender, social status

Health services: curative, health promotion, prevention, rehabilitation, and

Quality: sufficient quality to be effective

• 32% of total health expenditure worldwide comes from out-of-pocket

 UHC is not only about ensuring a minimum package of health

Yes. Monitoring progress towards UHC should focus on 2

• The proportion of the population that spends a large

•Reproductive, maternal, newborn and child health:

•Non communicable diseases:

or develop their own ways of measuring progress towards UHC.

• But there is also value in a global approach that uses standardized

measures that are internationally recognized so that they are

comparable across borders and over time.

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