Unit 5. PHC

Chapter Five: Primary Health Care
Unit objectives
At the end of this chapter, the student is able to:
 Describe the historical development of PHC.
 Identify the philosophy, principles, components and
strategies of PHC.
 Analyze the situation in the Ethiopian context.
 Discuss the PHC approaches

Primary health care
Definition
It 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
the country can afford
3
The PHC philosophy
1. Equity and justice
• Ensures equitable distribution of health care by
narrowing the gap B/n the "have's and "have not's".
2. Individual and community self reliance
• Personal responsibility for their own health.
3. Inter relation ship of health and development
• Good health status leads to productive life.
4
Principles of PHC
1. Inter-sectoral collaboration
2. Community participation
3. Appropriate technology
4. Equity
5. Focus on prevention and health promotion
6. Decentralisation
5
1. Inter sectoral collaboration
 It means a joint concern and responsibility of other

sectors for identifying problems, plan and implement
 This is to identify community needs together b/c the

causes of ill health are not limited only to health sector.
6
2. Community Participation
The communities should be actively involved in:
• Problem identification
• Priority setting and making decisions (Planning)
• Implementing,
• Monitoring and evaluating programs
7
3. Appropriate technology for Health
Criteria for Appropriate technology
• Effective
• Culturally acceptable
• Affordable---cost effective
• Locally sustainable
• Measurable
• Politically responsible
• Environmental accountable (harmless) 8

4.Equity (Equitable distribution)
 Implies addressing differences that are

unnecessary, avoidable and unfair.
 Planning for equity requires identification of
disadvantaged groups in terms of access to or
utilization of health services.
9
5. Focus on prevention and promotion of health
• Adopting a promotive and preventive approach to health

problems.
• Such an approach sees health as a positive attribute,

rather than simply" the absence of disease“.
10
6.Decentralization
• Bring decision making to the communities and to field

level providers of services.
• Enhance multisectoral collaboration at the lower service-
delivery level.
11
Elements of PHC
1. Health education
2. Provision of food supply and nutrition
3. Prevention and control of common disease
4. Expanded program on immunization
5. MCH including family planning
6. Adequate supply of safe water and basic sanitation
7. Treatment of common disease and injuries
8. Provision of essential drugs 12

Additional elements incorporated After Alma-Ata:
• Oral Health
• Mental Health
• Occupational Health
• HIV/AIDS
• The use of traditional Medicine
• ARI
13
PHC in Ethiopia
 Increased health awareness of the population.
 Increasing number of medical and paramedical
personnel.
 Expansion of health services to the broad masses
 Locally endemic diseases prevention and control.
 EPI against six major CDs, MCH (FP)

14
PHC in Ethiopia….
 Provision of essential drugs

 Nutrition & promotion of food supply
 Treatment of common diseases and injuries
 Sanitation and safe water supply
Major problems in implementation of PHC in Ethiopia
 Absence of infrastructure
 Failure to achieve intersectoral collaboration
 Inadequate resource allocation
 Absence of clear guidelines on how to implement

PHC
 Weak community involvement
 Poor leader ship

16
Approaches in PHC
Two approaches in PHC implementation
1. Selective PHC (sPHC)
2. Comprehensive PHC (cPHC)
17
Approaches in PHC
1. Selective PHC approach
 Directing health services toward diseases

with high mortality and morbidity
 Making health care accessible to the greater
number, using criteria of morbidity,
prevalence, mortality and disability 18
Selective PHC approach . . . . . .
• Views health as the absence of disease.

• sPHC is a low cost strategy to treat and prevent few
selected diseases which have greater impact to mortality.
19
The low cost strategy of sPHC
G = Growth monitoring
O= Oral rehydration
B = Breast feeding
I = Immunization
F = Female education
F = Family planning
Approaches in PHC . . . . . . .
Advantage of sPHC approach

• Easier decision-making
• Faster and more satisfactory results
21
Disadvantage of sPHC approach
• Limited scope of activities
• Is disease oriented. (treats individuals who are sick)
• Failure to address general community
• Failure to address priorities of the community
• It is Doctor dependent
• Failure to involve other sectors

Comprehensive PHC
Focus on a positive (holistic ) state of well being
Advantage of the cPHC approach
• It looks at health holistically
• Sees health as part of the development
• It involves and empowers people
• It promotes equity and priorities of the community
• It advocates multisectoral collaborations 23

Disadvantages of the cPHC approach

• It is expensive initially to set up an infrastructure
• It requires conscious planning
• Results are gradual
• It is a long and complex process
24

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Chapter Five: Primary Health Care

At the end of this chapter, the student is able to:

 Describe the historical development of PHC.

 Identify the philosophy, principles, components and

 Analyze the situation in the Ethiopian context.

 Discuss the PHC approaches

• Personal responsibility for their own health.

3. Inter relation ship of health and development

• Good health status leads to productive life.

 It means a joint concern and responsibility of other

 This is to identify community needs together b/c the

The communities should be actively involved in:

• Priority setting and making decisions (Planning)

• Monitoring and evaluating programs

Criteria for Appropriate technology

• Environmental accountable (harmless) 8

 Implies addressing differences that are

• Adopting a promotive and preventive approach to health

• Such an approach sees health as a positive attribute,

• Bring decision making to the communities and to field

2. Provision of food supply and nutrition

3. Prevention and control of common disease

4. Expanded program on immunization

5. MCH including family planning

6. Adequate supply of safe water and basic sanitation

7. Treatment of common disease and injuries

8. Provision of essential drugs 12

 Increased health awareness of the population.

 Increasing number of medical and paramedical

 Expansion of health services to the broad masses

 Locally endemic diseases prevention and control.

 EPI against six major CDs, MCH (FP)

 Provision of essential drugs

 Failure to achieve intersectoral collaboration

 Inadequate resource allocation

 Absence of clear guidelines on how to implement

 Poor leader ship

1. Selective PHC approach

 Directing health services toward diseases

• Views health as the absence of disease.

Advantage of sPHC approach

• Is disease oriented. (treats individuals who are sick)

• Failure to address general community

• Failure to address priorities of the community

• Failure to involve other sectors

• Sees health as part of the development

• It involves and empowers people

• It promotes equity and priorities of the community

• It advocates multisectoral collaborations 23

Disadvantages of the cPHC approach

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