1. Primary Health Care Dr. Sanjeev Gupta Asso.Professor Department of community medicine

2. Health Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity Fundamental human right Responsibility of state

3. Current criticism???? Current health care services are (a)Predominantly urban-oriented (b)Mostly curative in nature, and (c)Accessible mainly to a small part of the population.

4. Present concern??? Not only to reach the whole population with adequate health care services But to secure an acceptable level of Health for All, through the application of primary health care programmes.

5. Health care delivery??? (a) First, that health services should be organised to meet the needs of entire populations and not merely selected groups. Health services should cover the full range of preventive, curative and rehabilitation services. (b) Secondly, to provide health care to the vast majority of underserved rural people and urban poor is to develop effective "primary health care" services supported by an appropriate referral system.

6. Characteristics of health care Appropriateness (relevance): whether the service is needed at all in relation to essential human needs, priorities and policies. Comprehensiveness: whether there is an optimum mix of preventive, curative and promotional services. Adequacy : if the service is proportionate to requirement. Availability : ratio between the population of an administrative unit and the health facility. e.g., population per centre; doctor-population ratio);

7. Characteristics of health care Accessibility: this may be geographic accessibility, economic accessibility or cultural accessibility. Affordability: the cost of health care should be within the means of the individual and the state. Feasibility : operational efficiency of certain procedures, logistic support, manpower and material resources.

8. Health care v s Medical care Many people mistakenly believe that both are synonymous. Medical care is a subset of a health care system. Medical care - personal services that are provided directly by physicians or rendered as the result of physicians's instructions. Domiciliary care to resident hospital care. Health care- Embraces a multitude of "services provided to individuals or communities by agents of the health services or professions, for the purpose of promoting, maintaining, monitoring, or restoring health“

9. Levels of health care Primary Secondary Tertiary

10. Primary health care This is the first level of contact between the individual and the health system where "essential" health care (primary health care) is provided. A majority of prevailing health complaints and problems can be satisfactorily dealt with at this level. This level of care is closest to the people. In the Indian context, this care is provided by the primary health centres and their subcentres, with community participation.

11. Primary health care

12. Secondary health care Deal with more complex problems. Comprises essentially curative services and is provided by the district hospitals and community health centres. This level serves as the first referral level in the health system.

13. Tertiary health care This level offers super-specialist care. This care is provided by the regional/central level institutions. These institutions provide not only highly specialized care, but also planning and managerial skills and teaching for specialized staff. In addition, the tertiary level supports and complements the actions carried out at the primary level.

14. Comprehensive health care Basic health care Primary health care Health for All Changing concepts of Health care

15. Comprehensive health care First used by the Bhore Committee in 1946. Means provision of integrated preventive, curative and promotional health services from "womb to tomb" to every individual residing in a defined geographic area. This concept formed the basis of national health planning in India and led to the establishment of a network of primary health centres and sub-centres.

16. Comprehensive Health Care Criteria: 1.Provide adequate preventive, curative and promotive health services. 2.It should be as close to the beneficiaries as possible. 3.It has the widest cooperation between the people, the service and the profession. 4.It should be available to all irrespective of their ability to pay. 5.Look after specifically the vulnerable and weaker sections of the community. 6.Create and maintain a healthy environment both in homes as well as working places.

17. Basic Health Care Definition : Network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of competent professional and auxiliary personnel to perform these functions. The change in terminology from comprehensive to basic health services did not affect materially the quality or content. The handicaps or drawbacks of the basic health services are those shared by the comprehensive health care services  Lack of community participation,  Lack of intersectoral coordination and  Dissociation from the socio-economic aspects of health.

18. Primary health care The concept of primary health care- Alma-Ata, USSR 1978. Definition " Primary health care is an essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford" "Health by the people" and "placing people's health in people's hands“ The primary health care Social equity, nation-wide coverage, self-reliance, intersectoral coordination, and people's involvement in the planning and implementation of health programmes in pursuit of common health goals.

19. Primary Health Care Equitable distribution Community participation Intersectoral coordination Appropriate technology Provision of essential drugs Treatment of common diseases P& C of locally endemic diseases Safe water and basic sanitation Food supply Health Education Immunization Maternal and child health care & FP Primary Health Care 4 Principles & 8 elements

20. Principles of primary health care Equitable distribution : Health services must be shared equally by all people irrespective of their ability to pay, and all (rich or poor, urban or rural) must have access to health services. Primary health care aims to redress this imbalance by shifting the centre of gravity of the health care system from cities (where three-quarters of the health budget is spent) to the rural areas (where three­quarters of the people live) Bringing these services as nearer to people's homes as possible.

21. Principles of primary health care Community participation Health care cannot be achieved without the involvement of the local community. There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance of health services, besides maximum reliance on local resources such as manpower, money and materials. It is now considered that "health guides" and “trained dais” are an essential feature of primary health care in India. They have been greatly influenced by experience in China where community participation in the form of bare-foot doctors took place on an unprecedented scale.

22. Principles of primary health care 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, animal husbandry, food, industry, education, housing, public works, communication and others sectors. To achieve such cooperation, countries may have to review their administrative system, reallocate their resources and introduce suitable legislation to ensure that coordination can take place. This requires strong political will to translate values into action.

23. Principles of primary health care Appropriate technology The term "appropriate" is emphasized because in some countries, large, luxurious hospitals that are totally inappropriate to the local needs, are built, which absorb a major part of the national health budget, effectively blocking any improvement in general health services. This also applies to using costly equipment, procedures and techniques when cheaper, scientifically valid and acceptable ones are available. eg:- oral rehydration fluid, standpipes which are socially acceptable, and financially more feasible than house-to- house connections.

24. Elements of primary health care Alma-Ata Declaration has outlined 8 essential components of primary health care. I.Education concerning prevailing health problems and the methods of preventing and controlling them. II.Promotion of food supply and proper nutrition. III.An adequate supply of safe water and basic sanitation. IV.Maternal and child health care, including family planning. V.Immunization against major infectious diseases. VI.Prevention and control of locally endemic diseases. VII.Appropriate treatment of common diseases and injuries. VIII.Provision of essential drugs.

25. Health for All This goal has come to be popularly known as "Health for All by the year 2000" (HFA). Attainment by all the people of the world of a level of health that will enable every individual to lead a socially and economically productive life- by 2000 AD. The background to this "new" philosophy was *The unacceptably low levels of health status in the rural poor *The gross disparities in health between the rich and poor, urban and rural population. The essential principle of HFA is Equity in health.

26. Voluntary Health Sector in India

27. Framework: Introduction Definition of voluntary sector Functions of voluntary sector Strengths of voluntary sector Weakness of voluntary sector Role of voluntary health sector Examples &Their role

28. Voluntarism: Voluntarism is a phenomenon of ancient Indian society, where people shared skills, expertise, services, resources and knowledge among the members of communities living together. In the present era, voluntarism manifests through organizations,associations, organized structures such as Community Based Organizations, VoluntaryOrganizations (VOs), NonGovernmentOrganizations(NGOs).

29. Volunatary organization:  non-governmental,  autonomous,  non- profit making organization  supported mainly by voluntary contributions in cash and kind from the general public or certain segments of the public,  specialized to carry out a number of functions related to development, aid and emergency relief.

30. Functions of Voluntary organization Supplementing the work of Govt agencies Pioneering Education Demonstration Guarding the work of Govt agencies Advancing health legislation

31. Examples: VHAI(Voluntary Health Association of India) SEARCH(Society for Education,Action &Research in Community Health) CRY(Child Relief &You) Indian Red Cross Society Hind Kusht Nivaran Sangh Tuberculosis Association of India The Kasturba Memorial Fund