1. Primary Health Care / Family Medicine System Global Trend and in K. S
Primary Health Care / Family Medicine System Global Trend and in K.S.A.

3. OBJECTIVES: By the end of this session the Students should be able to:
Discuss the global trend in health care system
History of health Care system in the Kingdom
Identify the PHC principles, components, types of services, and requirements
Distinguish between PHC, PC and Family Medicine
Demonstrates awareness of the general structure of the health care system in Saudi Arabia
Identify the home care services provided to the population

4. Case
Jamila 55 years old Saudi lady, presented with history of low back pain, irregular uterine bleeding and tiredness of four weeks duration.
She was diagnosed earlier to have IBS. She claimed that she has files in many hospitals.
She request that to be referred to a specialist for further investigations of her problems.

5. Discussion How we can help this lady?
To which specialty of care, this lady to be referred?

6. Global Trend
Health care System

7. The Shifting Face of Health Care
Aging of the population
From acute to chronic disease
From institutions to networks of care
From hospital to community
From a single professional, generally a physician, to teams of health care professionals
Expectations/knowledge/involvement of patients, families, communities

8. A Global Consensus
Primary Care is THE foundation of a sustainable health care system
Evidence that health systems with very strong primary care are effective and efficient
Starfield 2005
Kringos 2013
Franks P, Fiscella K. J Fam Pract 1998
Macinko et al, Health Serv Res 2003
Ramono et al. JAMA Intern Med.
Shi et al, J Epidemiol Community Health 2004;

9. Where are the patients?
Green LA et al. N Engl J Med 2001;344: Results of a Reanalysis of the Monthly Prevalence of Illness in the Community and the Roles of Various Sources of Health Care.

10. Family Medicine: A Constant Evolution Canadian Prospective
From solo to shared MD practices
1990’s- a specialty; all GPs are family medicine trained in accredited programs
2000- From shared-office MD practices to group interdisciplinary practices
2005-A government and university priority
2016-The Family Medicine Groups (medical home in Quebec) as a Key Integrating Factor

11. Family Medicine / Primary Care
A doctor-patient trusting relationship with continuity of care based on each patient having «their» physician and clinical team and each physician having a defined patient population by registering patients to their Family Physician

12. History: Health Care Services
1926 PHC Taif and Makka
1928 health and emergency services directorate
1931 Ministry of interior (department of health)
1950 establishment of ministry of health (MOH) and hospitals

13. What is Primary Health Care? How would you define Primary Health Care?

14. Primary Health Care
Primary health care has been defined by the World Health Organization (WHO, 1978) as:
Essential 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 country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination.

15. الرعاية الصحية الأولية(منظمة الصحة العالمية)
هي إتاحة الرعاية الصحية الأساسية للجميع
بتكلفة يستطيع البلد والمجتمع تحملها
باستخدام وسائل عملية سليمة من الناحية العلمية
ومقبولة من وجهة النظر الاجتماعية
لكل فرد من أفراد المجتمع
وينبغي إشراك المجتمع
وإشراك القطاعات الأخرى ذات العلاقة

16. Primary Health Care:
It forms an integral part both of the country’s health system.
It is the first level of contact of individuals, the family, and the community with the national health system.
Constitutes the first element of a continuing health care process.

17. Levels of Health Care Primary health care Secondary health care
Tertiary health care

18. 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.

19. Secondary health care More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1st referral level
Example:
King Salman Hospital
Iman Hospital
Prince Mohammad Bin Abdulaziz Hospital

20. Tertiary health care Offers super-specialist care
Provided by regional/central level institution.
Provide training programs
Example:
KKESH
KFSHRC

21. Primary health care
In accordance with Alma-ata (1978) declaration Saudi Arabia decides to adopt PHC approach in 1980
Alm-ata declaration PHC, WORLD HEALTH ORGANIZATION, GENEVA; 1978

22. Principles for PHC PHC based on the following FIVE principles :
Social equity
Nation-wide coverage
Self-reliance
Inter-sectorial coordination
People’s involvement in the planning and implementation of health programs

23. Rehabilitative services
Primary Health Care addresses the main health problems in the community through FOUR types of services:
Promotive,
Preventive,
Curative and
Rehabilitative services

24. Promotion: food supply and proper nutrition
TEN components of Primary Health Care
Education: Common health problems and the methods of preventing and controlling them
Promotion: food supply and proper nutrition
Adequate supply of safe water and basic sanitation
Maternal and child health care, including family planning
Immunization against the major infectious diseases

25. 6. Prevention and control of locally endemic diseases
Components of Primary Health Care (cont)
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Basic laboratory services and provision of essential drugs
9. Training of health guides, health workers and health assistants
10. Referral services

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

27. 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.

28. Adequacy The service proportionate to requirement.
Sufficient volume of care to meet the need and demand of a community

29. Affordability
The cost should be within the means and resources of the individual and the country.

30. Accessibility Reachable, convenient services
Geographic, economic, cultural accessibility

31. 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.

32. Availability
Availability of medical care means that care can be obtained whenever people need it.

33. Assessability
Assessebility means that medical care can be readily evaluated.

34. Accountability
Accountability implies the feasibility of regular review of financial records by certified public accountants.

35. 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.

36. Comprehensiveness
Comprehensiveness of care means that care is provided for all types of health problems.

37. Continuity
Continuity of care requires that the management of a patient’s care over time be coordinated among providers.

38. The current Status of PHC as per Saudi Ministry of Health:
33% of PHC centers are equipped with X rays.
72% of PHC centers are equipped with labs. CBC, ESR, INR, HbA1c, Lipid. TSH.
27 patients/physician/day,
3155 GPs, 1729 with FM training.
Board certified FM (<1%).

39. Think, Pair
&
Share

40. Primary care?
Primary health care?
Family medicine?

41. Primary Care:
is “that level of a health service system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented)
care over time, provides care for all but very uncommon or unusual conditions, and coordinates or integrates care provided elsewhere by others.”
L.K. Muldoon, W.E. Hogg, M. Levitt ; Primary care (PC) and primary health are (PHC): What is the difference? Canadian Journal of Public Health , September/October 2006, Vol.97, No.5,

42. Primary health care
refers to an approach to health and a spectrum of services beyond the traditional health care system. It includes all services that play a part in health, such as income, housing, education, and environment.
Primary care is the element within primary health care that focuses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury.
L.K. Muldoon, W.E. Hogg, M. Levitt ; Primary care (PC) and primary health are (PHC): What is the difference? Canadian Journal of Public Health , September/October 2006, Vol.97, No.5,

43. Family medicine
is just one of the primary care specialties, the others being general internal medicine, general pediatrics and, in some cases, ob-gyn (obstetrics/gynecology).
Family medicine training, however, is the only primary care specialty to offer care for the whole family, irrespective of age or gender. Family medicine also includes broader training in areas such as obstetrics, gynecology, orthopedics, surgery and psychiatry, which is not included in most of the other primary care specialties.

44. Health care system in Saudi Arabia

46. Kingdom of Saudia Arabia National e-Health Strategy: The New PHC Systems
The Ministry of Health (MOH) aims to improve health care in the Kingdom of Saudi Arabia by improving its equability, standards, availability and quality all over the Kingdom.
To realize this vision, the MOH has developed a business strategy and 5 year plan, and has positioned e-Health as a primary transformation agent and enabler.
MOH worked with national and international advisors and IBM, and has developed an e-Health Strategy and 5 years Roadmap to enable the vision.

47. Home Health care (HHC) Definition:
It is an important service to help aging patients get their medical treatment at home without the hassles of traveling to hospitals or clinics.
Prior to 2010, there were five well-established government-sponsored HHC programs at:
King Faisal Specialist Hospital in Alqassim,
King Fahad National Guard Hospital in Riyadh,
Military hospital in Riyadh, and
King Khalid National Guards Hospital in Jeddah.

48. Home Health care
The Ministry of Health mobilized a new fleet of 189 vehicles for this program
There are more than 700 health officials who are divided into 246 teams working in the field in all parts of the Kingdom,” they are linked to 169 hospitals to attend to the health needs of patients confined to their homes
Each medical team comprises a doctor, a nurse, technicians, physiotherapists and social workers to offer counseling to patients and their relatives
News and views "Saudi Arabia - Home care program benefits over 15,000 patients", International Journal of Health Care Quality Assurance, (2012) Vol. 25 Iss: 7,

49. To Summarize Primary care is an approach that:
Focuses on the person not the disease, considers all determinants of health
Integrates care when there is more than one problem
Forms the basis for other levels of health systems
Addresses most important problems in the community by promotive, preventive, curative, and rehabilitative services
Organizes deployment of resources aiming at promoting and maintaining health.

50. Thank you