Topic One

Primary Health Care (PHC)

Slide 1
 Session Overview
Overview
• Primary Health Care is practised globally especially in low and middle income settings to
ensure access to health services. Eight important elements characterize the concept and
PHC’s success depends highly on maximum community participation. Intersectoral
collaboration is another principle of PHC. Health issues cannot be resolved by the health
sector alone but collaboration and cooperation of all health-related sectors. PHC has
important benefits, one of which is a self reliant community and one that works at its
identified problems in a spirit of self determination
Goals and Objectives
At the end of the session, the student should be able to:
• Define PHC
• Describe the elements of PHC
• State the principles of PHC
• Describe the benefits
• Discuss the importance of PHC
Slide 2
 PRIMARY HEALTH CARE
• Primary health care is essential health care which is made universally
accessible to individuals and families in the community by means
acceptable to them through their full participation, and at a cost that the
community and country can afford. It forms the nucleus (central part) of
the country’s health system.
Primary Health Care

• PHC is a strategy for ensuring basic health care to

all people.
• PHC focuses on the development of universally
acceptable, affordable and accessible essential health
care services which are community based and
emphasize health promotion and maintenance, self
reliance, and community participation in making
decisions about health
Primary Health care

• Primary health care is a form of health care delivery where the

consumers of health care are stakeholders with health professionals
and work together to achieve the common goal of improved health
• PHC fosters self care and self management in health and social
welfare aspects of daily living
• Community members are educated and empowered through the PHC
strategy to use their knowledge and skills in activities that promote
their health, that of their families and the entire community
• Through PHC, individuals, families and communities develop
competence and self reliance
Primary Health Care

• PHC guarantees every one a minimum level of health care

• The community health nurse has an important role in PHC.
• She is responsible for helping people learn to care for themselves and
to work together with other community members to develop the
capacity needed to ensure essential health care for all
• PHC is an important community health nursing approach
• PHC ideas and principles are useful in community health practice
Primary Health Care(PHC)

• PHC is defined as ‘essential health care based on practical,

scientifically sound and socially acceptable methods and technology
and 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

Based on the WHO’s definition of essential elements in health

services, there are eight at least essential health elements in the
provision of PHC:
• Education on prevailing health problems and methods of preventing
and controlling them
• Promotion of food supply and proper nutrition
• Adequate supply of safe water and basic sanitation
• Maternal and child health care & family planning
Primary Health Care

• Immunization against the major infectious diseases

• Prevention and control of locally endemic diseases
• Appropriate treatment of common diseases and injuries and
• Provision of essential drugs
Primary Health Care

• Primary Health Care is an approach to health care that can be adapted

to varying cultures and health needs
• Team work is essential in Primary Health Care
• A typical PHC team may comprise:
Nurses, health educators, dietitians, pharmacists, physicians, midwives,
sanitarians and volunteers from the local communities
Primary Health Care

• Nurses liaise between the community volunteers and other health

professionals
• The professionals of the PHC team visit the community periodically
to work with the local people on a particular aspect of PHC
• In PHC team work, nurses are responsible for collecting health and
social data, maintaining records and working with the volunteers from
the community
Why Primary Health Care (reasons)?

• PHC came about due to:

• A wide gap between the health of the rich and the poor.
• The economy of developing countries could not support or sustain
the existing health system i.e. inability of economy to support health
policies planned to care for the country
• Preventable diseases formed a bulked of the health problems in the
developing countries. E.g. malaria, TB
• Majority of the people who lived in rural areas did not have access to
scientific health care.
• Very little resources were committed to the health sector.
• There was high population growth which did not match with
economic growth.
 Principles of PHC
• The rules and guidelines governing the PHC concept
• Team work.
• Community participation.
• Equitable distribution of resources.
• Inter-sectorial collaboration.
• Appropriate technology.
• Emphasis laid on health promotion and disease prevention (good
nutrition, good health cleaning of environment)
• 
 Levels of Care

• Primary health care

• Secondary health care
• Tertiary health care
Primary health care

• The “first” level of contact between the individual

and the health system.
• Essential health care (PHC) is provided.
• A majority of prevailing health problems can be
satisfactorily managed.
• The closest to the people.
• Provided by the primary health centers.
Services at Primary Health Care level

•  Diagnosis and Treatment

•  Emergency Services
•  Family Planning
•  Preventive health services, including immunizations
•  Health education
• Laboratory, x-ray or other appropriate diagnostic services
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.
• Provide training programs
Secondary level

• Nutrition services
• Health screenings
• Home health care
• Dental care, transportation
• Prescription drugs and devices
• Environmental health services
• social services
• Primary health care (PHC) became a core policy for the
World Health Organization with the Alma-Ata
Declaration in 1978 and the ‘Health-for-All by the Year
2000’ Program.

•The commitment to global improvements in health,

especially for the most disadvantaged populations, was
renewed in 1998 by the World Health Assembly. This
led to the ‘Health-for-All for the twenty-first Century’
policy and program, within which the commitment to
PHC development is restated.
What is Primary Health Care?

PHC is essential health care that is a socially appropriate,

universally accessible, scientifically sound first level care
provided by a suitably trained workforce supported by
integrated referral systems and in a way that gives priority to
those most in need, maximises community and individual
self-reliance and participation and involves collaboration
with other sectors. It includes the following:
health promotion
illness prevention
care of the sick
advocacy
community development
Primary Health Care (PHC)
• 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 the
country can afford … (Alma-Ata, 1978)
Principles for PHC
• PHC based on the following principles :

– Social equity
– Nation-wide coverage
– Self-reliance
– Inter-sectoral coordination
– People’s involvement in the planning and implementation
of health programs
 Principles of PHC
The 1978 Declaration of Alma-Ata proposed a set of
PRINCIPLES for primary health care. PHC should:

1.“Reflect and evolve from the economic conditions and socio-

cultural and political characteristics of the country and its
communities, and be based on the application of the relevant
results of social, biomedical and health services research and
public health experience”

2. “Address the main health problems in the community,

providing promotive, preventive, curative and rehabilitative
services accordingly”
3. “Involve, in addition to the health sector, all
related sectors and aspects of national and
community development, in particular agriculture,
animal husbandry, food, industry, education,
housing, public works,
4. “Promote maximum community and individual self-
reliance and participation in the planning,
organization, operation and control of primary
health care, making fullest use of local, national and
other available resources; and to this end develop
through appropriate education the ability of
communities to participate”
5. “Be sustained by integrated, functional and mutually-
supportive referral systems, leading to the progressive
improvement of comprehensive health care for all, and
giving priority to those most in need”

6. “Rely, at local and referral levels, on health workers,

including physicians, nurses, midwives, auxiliaries and
community workers as applicable, as well as traditional
practitioners as needed, suitably trained socially and
technically to work as a health team and to respond to
the expressed health needs of the community.”
SCOPE OF PRIMARY HEALTH CARE

PHC addresses the main health problems in the community, providing;

 Promotive

 Preventive

 Curative

 Rehabilitative services
Core Activities for PHC

There is a set of CORE ACTIVITIES, which were

normally defined nationally or locally. According to
the 1978 Declaration of Alma-Ata proposed that
these activities should include:
1. 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
4. Maternal and child health care, including family planning
5. Immunization against the major infectious diseases
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 of health guides, health workers and health assistants.
10. Referral services
• Mental health
• Physical handicaps
• Health and social care of the elderly
 The Basic Requirements for Sound
PHC (the 8 A’s and the 3 C’s)
• Appropriateness • Assessability
• Availability • Accountability
• Adequacy • Completeness
• Accessibility • Comprehensiveness
• Acceptability • Continuity
• Affordability
IMPORTANCE OF PRIMARY CARE

•Importance of Primary Care

 Cost Effective

 High Patient Satisfaction

 Better health outcomes

 Lower costs

 Greater equity in health