Community Health Nursing Primary Health Care

Learning out comes To discuss the ALMA ATA DECLARATION To describe the goals and targets of health for All To enumerate the Themes Leading to Alma Ata To define primary health care To discuss the objectives of PHC

Learning out comes To enlist the COMPONENTS OF PHC To discuss the Obstacles to the Implementation of PHC Strategy To identify Levels of Care To discuss the Primary health care To identify the PRINCIPLES OF PHC

ALMA ATA DECLARATION ‘The main goal of Governments and World Health Organization in the coming decades was be the attainment by all people of the world by the year 2000, a level of health that would permit them to lead a socially and economically productive life’

GOALS AND TARGETS OF health for All An increase in life expectancy and in the quality of life for all Improved quality in health between and within countries Access for all to sustainable health systems and services An initial set of targets will guide the implementation of the HFA policy and define priorities for action for the first two decades of the 21st century

Themes Leading to Alma Ata Changing theories of health & development: shift away from GNP as measure of development towards recognition of the need of social development Concerns about poverty & population control Increasing reliance upon alternative approaches to medical care model Success of CHWs & associated emphasis on community participation of interest in public health; tackling causes of ill health rather than symptoms

PRIMARY HEALTH CARE 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 the community and the country can afford…

Prevention of illnesses and accidents Disability limitation Objectives of primary health care Prevention of health hazards Early detection and treatment of illnesses Rehabilitation Prevention of illnesses and accidents Disability limitation

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 Occupational health services Health office services

Levels of Care Primary health care Secondary health care Tertiary health care

Con….. 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.

Cont…. Secondary health care Tertiary 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

LEVEL OF PHC 1-HOME LEVEL : Refer to the basic unit in any community : House hold Family member e.g.: mother or head of house Person from neighborhood Home visiting community worker

2-Communal level :- Activities at this level concern the health of whole community (village. town .group of village s) Common facilities or voluntary effort of community member

3-Health system First health facility level :- refer to the first level where trained health professional and facilities are available . First referral level :-there is two type of : Clinical referral system which include s the supervision of performances at lower level

The second is administrative referral system usually the district health office this level involved planning .management and support of activities related to health education ,information and disease control

PRINCIPLES OF PHC Health Prevention & Promotion Equity Appropriate Technology Community Participation Intersectoral Coordination Decentralization*

Equity “Countries developed national health policies stating equity as one of the objectives …. …. it meant a reallocation of limited resources, which led to taking away resources from the already over-funded services serving the urban The equity policy objective was therefore not fully implemented”

Community participation “although community participation has been argued as the core of PHC policies, it has largely remained problematic, calling for more review and definition … …Village health worker programmes in many countries have disintegrated” And then there were the TBAs ….

Appropriate technology Generic drugs Basic radiological units Donkey, bicycle, motorcycle ambulances (eRanger ambulance) “this challenge continues to grow especially as globalisation takes root and the health profession’s education, training and practice continues to be driven by the medical model instead of the health model”

Health sector reforms Rationalisation of MoH Decentralisation of planning, management and implementation of health services Introduction of new financing mechanisms Recognition of the role of the private sector, NGOs, and others

Health sector reforms “these initiatives were aimed to achieve greater access to services, improved efficiencies in resource utilisation … and improved quality of health services. Yet there has been no improvement in health systems performance. In fact evidence available shows that in many countries the health status of the people has worsened”

COMPONENTS OF PHC Education concerning prevailing health problems & the methods of preventing & controlling them Promotion of food supply and proper nutrition An adequate supply of safe water and basic sanitation MCH including FP Immunization against major infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Provision of essential drugs mental health.

8 Elements of Primary health care Safe water supply, basic sanitation Provision of essential drugs -Food supply - Proper nutrition Comprehensive maternal and child health care Health education Prevention and control of endemic diseases Immunization of children Treatment of common diseases Health promotion& prevention of health hazards Objectives of PHC: Early detection and treatment of illnesses

Obstacles to the Implementation of PHC Strategy Misinterpretation of the PHC Concept Misconception that PHC is a 2nd rate health care for the poor Selective PHC Strategies Resistance to Change Lack of political will Centralized Planning & Management Infrastructure

SELECTIVE PRIMARY HEALTH CARE PHC implies that if one cannot afford to offer universal coverage for even the most basic of health care, one could would offer treatment & preventive strategies for the few diseases identified as having the greatest threat to mortality, & which are amenable to prevention / cure at low cost.

Comprehensive PHC DISADVANTAGES ADVANTAGES More costly to implement Looks at total health care Involvement of community Covers all elements of PHC Ensures equitable distribution of resources Facilitates effective referral system Government goal DISADVANTAGES More costly to implement Takes long time to see impact Long time to process Lack of specialized treatment Expensive Inefficient referral system ???-- misuse

Selective PHC ADVANTAGES DISADVANTAGES Donor friendly Elimination of selected disease Easy to plan & implement Is focused & have more impact Easy to manage & measure output Require limited resources Improve quality of services DISADVANTAGES Disease rather than health oriented Doesn’t ensure equity Top down decision making Neglect other problems Leads to outbreak Resources (tight) might not be available for urgent needs (emergencies) Less community involvement– donor priority

PHC: FROM ALMA- ATA TO 21st CENTURY PHC as an approach has provided impetus and energy to progress towards HFA Some progress has been made in ensuring access to the original eight PHC elements PHC remains valid as the point of entry into a comprehensive health care system Intersect oral action for health has not been fully achieved Reorientation of health services and personnel to PHC principles remains elusive Community participation takes time and dedication by all

PHC in the 21st Century: Policy Objectives to Reinforce the PHC Approach Make health central to development and enhance prospects for intersect oral action Combat poverty as a reflection of PHCs concern for social justice Promote equity in access to health care Build partnerships to include families, communities and their organizations Reorient health systems towards promotion of health and prevention of disease

Acceptable PHC: provision of essential health care which is: Socially Accessible to all individuals Acceptable Scientifically Economically Appropriate technology Multi -Sectorial Community Participation Equitable Distribution Principles of Primary health care

Primary Health Care Reform Medical model Primary Health Care  Treatment  Health promotion  Illness  Health  Cure  Prevention, care, cure  Episodic care  Continuous care  Specific problems  Comprehensive care  Individual practitioners  Teams of practitioners  Health sector alone  Intersectoral collaboration  Professional dominance  Community participation  Passive reception  Joint responsibility

MDGS Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality Improve maternal health Combat HIV/AIDs, malaria, and other communicable diseases. Ensure environmental sustainability. Global partnership for development.

Role of CHN in primary health care In 1974 WHO executive board recommended way in which nursing could have critical impact on the urgent health problems throughout the world.

Recommendations are:- Reformulation of basic and post basic nursing education to prepare all nurses for CHN. Support of nursing in the national developmental plans. CHN to work in schools, and all kinds of setting.