1. Community Health Nursing
Primary Health Care

2. 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

3. 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

4. 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’

5. 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

6. 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

7. 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…

8. 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

9. 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

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

11. 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.

12. 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

13. 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

14. 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

15. 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

16. 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

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

18. 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”

19. 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 ….

20. 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”

21. 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

22. 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”

23. 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.

24. 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

25. 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

26. 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.

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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.

34. 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.

35. 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.