Lecture 9: PHC As a Strategy For HP Dr J. Sitali MPH 541 Lecture 9: PHC As a Strategy For HP Dr J. Sitali

Lecture Outline Introduction. PHC as defined at Alma Ata. Concepts and Philosophy of PHC. History and international protocol on PHC. PHC as a strategy for Health Promotion.

Introduction Foundations were set at Alma Ata. First level of contact with the healthcare system. Includes basic medical and curative services. Preferred concept in pursuit of HP Focuses on promoting health and preventing disease. Addresses the social, economic and environmental determinants of health. Empowers people to make decisions regarding their health. It is cardinal to attainment of equity in health.

PHC As Defined at Alma Ata 1. Reflects and evolves from the economic conditions and socio-cultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience.

PHC As Defined at Alma Ata 2. Addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly.

PHC As Defined at Alma Ata 3. Includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs.

PHC As Defined at Alma Ata 4. Involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors.

PHC As Defined at Alma Ata 5. Requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate.

PHC As Defined at Alma Ata 6. Should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need.

PHC As Defined at Alma Ata 7. Relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

Concepts and Philosophy of PHC Principles underpinning PHC: Accessibility (Universal coverage reforms) A continuing and organized supply of essential health services is available to all people with no unreasonable geographic or financial barriers. Universal access to care and coverage on the basis of need.

Concepts and Philosophy of PHC Principles underpinning PHC: Public Participation (stakeholder participation) Individuals and communities have the right and responsibility to be active partners in making decisions about their health care and the health of their communities. Community participation in defining and implementing health agendas.

Concepts and Philosophy of PHC Principles underpinning PHC: Health Promotion (leadership reforms) The process of enabling people to increase control over and to improve their health.

Concepts and Philosophy of PHC Principles underpinning PHC: Appropriate Technology (service delivery reforms) This includes methods of care, service delivery, procedures and equipment that are socially acceptable and affordable.

Concepts and Philosophy of PHC Principles underpinning PHC: Intersectoral Cooperation (public policy reforms) Commitment from all sectors (government, community and health) is essential for meaningful action on health determinants.

Concepts and Philosophy of PHC Note: The PHC concept is a strategy to provide access to comprehensive, effective health services for populations. High quality community oriented service that is cost effective, acceptable and accountable.

Core Activities for PHC Education concerning prevailing health problems and the methods of preventing and controlling them. Promotion of food supply and proper nutrition. An adequate supply of safe water and basic sanitation. Maternal and child health care, including family planning.

Core Activities for PHC Immunization against the major infectious diseases. Prevention and control of locally endemic diseases. Appropriate treatment of common diseases and injuries. Basic laboratory services and provision of essential drugs.

Core Activities for PHC Training of health guides, health workers and health assistants. Referral services.

History and International Protocol on PHC History of global-public health. International health organizations International health efforts. Demographic transition. Epidemiologic transition. Development of modern health services in resource limited settings.

History and International Protocol on PHC Decentralized health care pre – colonial era. Healthcare in the colonial era. Health services shaped by colonial powers Extension of institution based care post – colonial era. Institution based health care. PHC and health expenditure.

PHC and Health Promotion Role of health sector: Health sector has an essential role in health promotion and disease prevention. It requires reorientation of work, education and financing towards these levels of prevention.

PHC and Health Promotion The role of primary health care: PHC is an essential part of health care. Its main principles are equity, health promotion, disease prevention, community participation, appropriate health technology and multisectoral approach.

PHC and Change-Health Promotion PHC as a setting for fostering behavior change: Acceptability. Expertise. Partnerships. Community based. Impact on environment.

WHO Strategies of PHC Reducing excess mortality of poor marginalized populations. Reducing the leading risk factors to human health. Developing sustainable health systems. Developing an enabling policy and institutional environment.

Basic Requirements for PHC Appropriateness Assessability Accountability Affordability Availability Completeness Adequacy comprehensiveness Accessibility Continuity Affordability

Outcomes of PHC Improvements in areas such as childhood immunization coverage and access to safe water and sanitation. Setbacks to providing equitable access to essential health care world wide. Health system constraints including financial barriers and health worker shortages, combined with challenges such as HIV epidemic, have hampered progress towards achieving health for all.

The end!