PRIMARY HEALTH

CARE
DR.NASEER AHMED
DEFINITION:
 Primary health care, often abbreviated as
"PHC", has been defined as "essential health
care based on practical, scientifically sound
and socially acceptable methods and
technology, made universally accessible to
individuals and families in the community.
CONT…
 PHC goals are achieved through full
community participation and at a cost that
the community and the country can afford.
 PHC includes all areas that play a role in
health, such as access to health services,
environment and lifestyle.
CONT….
 This ideal model of health care was adopted
in the declaration of the International
Conference on Primary Health Care held in
Alma Ata, Kazakhstan in 1978 (known as the
"Alma Ata Declaration"), and became a core
concept of the World Health Organization's
goal of Health for all.
CONT…
 The Alma-Ata Conference mobilized a
"Primary Health Care movement" of
professionals and institutions, governments
and civil society organizations, researchers
and grassroots organizations that undertook
to tackle the "politically, socially and
economically unacceptable" health
inequalities in all countries.
GOALS & PRINCIPLES OF PHC :
 The ultimate goal of primary health care is
better health for all. The WHO has identified
five key elements to achieving that goal:

1.Reducing exclusion and social disparities in

health (universal coverage reforms).
CONT…
2.Organizing health services around people's
needs and expectations (service delivery
reforms).

3. Integrating health into all sectors (public

policy reforms).
CONT….
4. Self Reliance

5.Community Involvement
CONCEPT OF HEALTH DISEASE
& ILLNESS :
 HEALTH :
In 1948, WHO proposed a definition that
aimed higher, linking health to well-being, in
terms of "physical, mental, and social well-
being, and not merely the absence of
disease.
CONT…….
 Illness & Disease :
Illness and disease are two words that are heard
commonly and are often interchanged.

 Illness actually refers to the state of a person in

comparison to a medical condition. it is used to
describe a person who is in a poor state of
health. It is also referred to as Ill-health or
ailment.
CONT….
 A person that is ill is usually feeling
discomfort, distress or pain of some kind.

 An illness cannot be considered to have a

symptom as it describe the patient’s feeling.

 The patient may be feeling discomfort due to

some kind of stress or diseases.
CONT….
 A person can also suffer from emotional
turmoil due to internal factors (medical
conditions, bacteria, pathogens) or external
factors (stress, exhaustion, sadness).
 Illness may or may not have a cure, it could
just be healed by time or rest.
CONT…..
 A disease is an abnormal condition that
affects the normal physiological functions of
body.
 It is often termed as a medical condition and
has symptoms and signs that can help
identify the type of disease it is.
CONT….
 Diseases can be caused by internal source
(autoimmune diseases) or external sources
(pathogens) Pathogens or infectious agents
are microorganism such as a virus, bacteria,
fungus, etc.
CONT….
 Diseases can also cause death in a person if
the infection is not eliminated.
 Diseases can be classified into four main
types: pathogenic disease, deficiency
disease, hereditary disease, and
physiological disease.
 Disease often impairs the patient’s normal
functions and disrupts its homeostasis.
ICEBERG OF DISEASE :
 The "iceberg phenomenon" is a metaphor
emphasizing that for virtually every health
problem the number of known cases of
disease is outweighed by those that remain
undiscovered, much as the unseen part of an
iceberg is much larger than the part that is
visible above the water.
Figure . The pyramid and iceberg of disease

1 Diseased, diagnosed & controlled

Diagnosed
2 Diagnosed, uncontrolled disease

3 Undiagnosed or wrongly
diagnosed disease
Undiagnosed or
wrongly diagnosed disease
4 Risk factors for disease

5 Free of risk factors

CONT….
 This term was first applied in the context of
the natural history of disease by John M Last.
 The iceberg phenomenon attempts to assess
the burden of disease and the need for
services, as well as the selection of
representative cases for study.
THE ICEBERG MODEL OF
HEALTH AND DISEASE
 Illness and health are only the tip of an
iceberg. To understand their causes, you
must look below the surface.
 Icebergs reveal only about one-tenth of their
mass above the water. The other nine-tenths
remains submerged.
CONT….
CONT…
 Your current state of health, be it one of
disease or vitality, is just like the tip of the
iceberg.
 If you don't like it, you can attempt to
change it, do things to it, chisel away at an
unwanted condition.
 But, whenever you knock some off, more of
the same comes up to take its place.
CONT….
 To understand all that creates and supports
your current state of health, you have to look
underwater.
 The first level you encounter is the
lifestyle/behavioral level - what you eat, how
you use and exercise your body, how you relax
and let go of stress, and how you safeguard
yourself from the hazards around you.
CONT…
 Many of us follow lifestyles that we know are
destructive, both to our own wellbeing and
to that of our planet. Yet, we may feel
powerless to change them.
 To understand this, we must look still deeper,
to the cultural/psychological/motivational
level.
CONT….
 Here we find what moves us to lead the
lifestyle we've chosen.
 We learn how powerfully our cultural norms
influence us, sometimes in insidious ways -
like convincing us that excessive thinness is
attractive.
CONT…..
 We can learn, for example, what "payoffs"
we get from being overweight, smoking,
driving recklessly - or from eating well, being
considerate of others, and getting regular
exercise.
CONT…
 Exploring below the cultural, psychological,
& motivational level, we encounter the
spiritual/being/meaning realm.

 Actually, it is more a realm than a level,

because it has no clear boundaries.
CONT….
 It includes the mystical and mysterious, plus
everything in the unconscious mind, as well
as concerns such as your reason for being,
the real meaning of your life, or your place
in the universe.
CONT….
 The way in which you address these
questions, and the answers you choose,
underlie and permeate all of the layers
above.
 Ultimately, this realm determines whether
the tip of the iceberg, representing your
state of health, is one of disease or
wellness.
LEVELS OF PREVENTION :
 The definition of epidemiology encompasses
preventing and controlling diseases in human
populations.
 This is usually accomplished using three
levels of preventions:

1. PRIMARY 2. SECONDARY 3. TERTIARY

PRIMARY LEVEL OF
PREVENTION:
 Primary prevention seeks to reduce the
frequency of new cases of disease occurring in a
population and, thus is most applicable to
persons who are in the stage of susceptibility.
 Primary prevention strategies emphasize
general health promotion, risk factor reduction,
and other health protective measures.
CONT….
 These strategies include health education
and health promotion programs designed to
foster healthier lifestyles and environmental
health programs designed to improve
environmental quality.
CONT….
 Specific examples of primary prevention
measures include immunization against
communicable diseases; public health
education about good nutrition, exercise,
stress management, and individual
responsibility for health; chlorination and
filtration of public water supplies, fissure
sealents etc.
SECONDARY LEVEL OF
PREVENTION:
 Secondary prevention attempts to reduce the
number of existing cases in a population and,
therefore, is most appropriately aimed those
in the stage of presymptomatic disease or
the early stage of clinical disease.
 Secondary prevention focuses on early
detection and swift treatment of disease.
CONT…..
 Its purpose is to cure disease, slow its
progression, or reduce its impact on
individuals or communities.
 A common approach to secondary prevention
is screening for disease, such as the
noninvasive computerized test for the early
detection of heart disease.
CONT….
 Examples of secondary prevention methods
include treatment of hypertension to prevent
complications.
 Fillings of cavities to stop the progression of
lesions at an early stage.
TERTIARY LEVEL OF
PREVENTION:
 Tertiary prevention tries to limit disability
and improve functioning following disease or
its complications, often through
rehabilitation.
 Tertiary Prevention strategies involve both
therapeutic and rehabilitative measures once
disease is firmly established.
CONT….
 examples include improving functioning of
stroke patients through rehabilitation by
occupational and physical therapy, nursing
care, speech therapy, counseling, and so
forth, and treating those suffering from
complications of diseases such as meningitis,
multiple sclerosis, or Parkinson’s disease.
CONT…
 Placement of Implants , bridges & removable
prosthesis in pts. Who lost their teeth due to
trauma or dental caries.
SPECIFIC PROTECTION:
 Primary prevention may be accomplished by

measures designed to promote general

health and well-being, and quality of life of
people or by specific protective measures.
o Specific protection can be achieved by:

A. Immunization and seroprophylaxis.

B. chemoprophylaxis
CONT….
C. Use of specific nutrients or
supplementations.

D. Protection against occupational hazards.

E. Safety of drugs and foods.

F. Control of environmental hazards,

e.g. air pollution

ESSENTIAL ELEMENTS OF PHC:
1. Education on health problems and how to
prevent and control them.

2. Development of effective food supply and

proper nutrition.

3. Maternal and child healthcare, including

family planning.
CONT….
4. Adequate and safe water supply and basic
sanitation.

5. Immunization against major infectious

diseases.

6. Local endemic diseases control.

7. Appropriate treatment of common diseases

and injuries.

8. Provision of essential basic medication.

KEY CONCEPTS IN PHC
PLANNING:
 PHC Planning is a critical process which
involves certain components, designed to
make it successful by utilizing minimum
community resources.
 The basic requirements for sound PHC is

8 A’s & the 3 C’s.

CONT…
 Appropriateness
 Availability
 Adequacy
 Accessibility
 Acceptability
 Affordability
CONT…
 Assessabilty
 Accountability
 Completeness
 Comprehensiveness
 continuity
!!!!!! THANK YOU !!!!!!