Dr. Nuha H. Mohammed

Specific Objectives At the end of this lecture you will be able to: Define PHC Specify its important strategies Enumerate main elements of PHC Determine the basic requirements for effective health services

Primary health care is commonly viewed as a first level of care or as the entry point to the health care system for consumers. It can also be taken to mean a particular approach to care which is concerned with continuing care, accessibility, community involvement and collaboration between sectors.

DIFFERENCE BETWEEN PRIMARY CARE AND PRIMARY HEALTH CARE The two terms are often inappropriately used interchangeably. We should first distinguish between Primary Care and Primary Health Care.

Primary care is a core component of primary health care, although it is more narrowly focused on illness treatment and rehabilitation. It describes a narrow concept of “family doctor-type” services delivered to individual patients

Primary Health Care is a broader concept that includes primary care services, health promotion and disease prevention, and also population-level public health functions.

This ideal model of health care was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata in 1978 (known as the "Alma Ata Declaration") and became a core concept of the World Health Organization's goal of Health for all.

The Alma Ata Conference defines Primary Health Care 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 by means of acceptable to them, through their full participation and at a cost that community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.

It forms an integral part of both the country’s health system, of which it is the central function and the main focus and of the overall social and economic development of the community. Actually primary health care

The ultimate goal of primary health care is better health for all.

STRATIGIES OF PRIMARY HEALTH CARE Equitable distribution Community participation Intersectoral coordination Appropriate technology Development of basic resources for health

Equitable distribution Health services must be shared equally by all people irrespective of their ability to pay and all must have access to health services.

2 . Community participation Individuals, families and all members of community should participate in PHC programs to promote their health. Incorporation of traditional medical system & encouragement of its positive aspect (like :herbal medical medicine, TBA, man who fix fractures & circumcision),with doctor, those people can be identified trained well in a manner that can contribute to PHC system according to their specific activity.

3. Intersectoral coordination Primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, food, industry, education, housing, public works, mass media, communication and others sectors.

4. Appropriate technology Appropriate technology has been defined as "technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford”.

5. Development of basic resources for health Development of basic health infrastructure. (Safe water supply, basic sanitation). Development of human resources for health, preparation of health workers, health visitors, & traditional birth attendance (TBA).

Primary Health Care  is different in each  community depending  upon:  Needs of the residents; Availability of health care providers; The communities geographic location; Proximity to other health care services in the area.

Essential Health Services in Primary Health Care (ELEMENTS) E – Education for Health L – Locally endemic disease control

E – Expanded program for immunization M – Maternal and Child Health including responsible parenthood

E – Essential drugs N – Nutrition

T – Treatment of communicable and non-communicable diseases S - Safe water and sanitation

Other elements can be added, according to the health needs of the community. Examples are: promotion of mental health, school health services and oral health services.

Whatever the components are, health education is central to all PHC programs in any community. We can see from the above that PHC services are not only promotive and preventive, but also curative and rehabilitative

Care of vulnerable groups Primary Health Care Preventive services Curative services Outpatient clinic (referral) General services Care of vulnerable groups Laboratory services Dispensary Health education Maternal &child health s. First aid and emergency services Monitoring of environment School health services Prev.&control of endemic diseases Geriatric health services Health office services Occupational health services

The Basic Requirements for PHC (the 8 A’s and the 3 C’s) Appropriateness Availability Adequacy Accessibility Acceptability Affordability Assessability Accountability Completeness Comprehensiveness Continuity

Appropriateness Whether the service is needed at all in relation to essential human needs, priorities and policies. The service has to be properly selected and carried out by trained personnel in the proper way.

Adequacy The service proportionate to requirement (Sufficient volume of care to meet the need and demand of a community) Affordability The cost should be within the means and resources of the individual and the country.

Accessibility Reachable, convenient services Geographic, economic, cultural accessibility Availability Availability of medical care means that care can be obtained whenever people need it.

Acceptability Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.

Assessability Assessebility means that medical care can be readily evaluated. Accountability Accountability implies the feasibility of regular review of financial records by certified public accountants.

Completeness Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.

Comprehensiveness Comprehensiveness of care means that care is provided for all types of health problems. Continuity Continuity of care requires that the management of a patient’s care over time be coordinated among providers.

Thank you