1. Primary Health Care In Health Care System
Dr.Tauseef Ismail

2. Primary Health Care
Often abbreviated as PHC was a new approach to health care that came into existence following an International conference in Alma Ata in 1978 organized by WHO and UNICEF.
Primary Health Care was accepted by the member countries of WHO as the key to achieving the goal of Health for All.

3. Health For All 2000 (WHO, 1981)
The main social target of governments and of WHO should be the attainment by all the people of the world by the year 2000 of a level of health which would permit them to lead a socially and economically productive life.

4. Medical care versus Health care
Medical care: personal services provided by physicians
Health care: services provided to individuals or communities by health service professionals for purpose of
Promoting
Maintaining
Restoring health

5. Primary Health Care
The 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 country can afford to maintain at each stage of their development, in the spirit of self-reliance and self-determination”

6. Elements of primary health care
Health education
Promotion of food supply and proper nutrition
Safe water supply
Maternal and child care including family planning
Immunization against major infectious diseases
Prevention of endemic diseases
Appropriate treatment of common diseases and injuries.
Provision of essential drugs

7. Principles of PHC Equity Community Participation
Intersect oral Approach
Appropriate Methods/ technology
Health Promotion and Prevention

8. Equity
Services should be physically, socially, and financially accessible to everyone. People with similar needs should have equal access to similar health services. To ensure equal access, the distribution of resources and coverage of primary health care services should be greatest in those areas with the greatest need.

9. Community Participation
In addition to the health sector, families and communities need to get actively involved in taking care of their own health. Communities should participate in the following:
Creating and preserving a healthy environment
Maintaining preventive and promotive health activities
Sharing information about their needs and wants with higher authorities
Implementing health care priorities and managing clinics and hospitals

10. Inter-Sectoral Approach
PHC requires a co-ordinated effort with other health-related sectors whose activities impact on health e.g., agriculture, water and sanitation, transportation, education, etc. This is necessary to achieve social and economic development of a population.

11. Appropriate Methods
Care-givers should be trained to deliver services using the most appropriate and cost-effective methods and equipment for their level of care.
Note: Appropriate technology does not necessarily mean low technology.

13. Health Promotion and Prevention
Promotive — addresses basic causes of ill-health at the level of society.
Preventive — reduces the incidence of disease by addressing the immediate and underlying causes at the individual level.
Curative — reduces the prevalence of disease by stopping the progression of disease among the sick.
Rehabilitative — reduces the long-term effects or complications of a health problem.

15. Planning Primary Health Care System
Guidelines in PHC Planning
Community assessment
Prioritization of health problems
Assessment of felt needs of the community
Full filling the community needs
Setting goals for health improvement

16. Translating Primary Health Care
PHC is based on the fact that most health problems can easily be handled outside the hospitals. Therefore, to provide the best possible care for the greatest number of people, certain health care functions should be transferred to lower levels in the PHC pyramid.

18. Because resources for health care are always limited, health planners should first focus on strengthening health centres and medical posts rather than referral hospitals. Providing basic level health care at health centres and health posts or dispensaries is more cost-effective, whereas services at referral hospitals are more costly since they are delivered by personnel with more advanced training

20. Implementation of PHC Plans and General Principles
Program should be cost effective that is to obtain benefits with investment of scarce resources.
Establish partnership with community.
Motivate the community to constitute a Health Committee for implementation and periodic evaluation.

21. Constraints in PHC Managerial Deficiencies Service Delivery Failure
Community Causes

22. Managerial Deficiencies
Lack of trained managers
Lack of a selection and training criteria for managers
Lack of proper performance evaluation of health managers
Lack of motivation leading to professional and financial corruption

23. Service Delivery Failure
Accessibility problems
Utilization Failure
Efficiency Problems

24. Accessibility Issues
25-30 % of PHC facilities have been ill-planned and are usually out of reach of the rural community where logistics problems is as big issue as is poverty.
Such facilities are a big problem for non-resident PHC staff, which further augments the problem, and promotes quackery in such areas.

25. Utilization Failure
Since its inception, PHC has been promoted as an alternative for curative care. This image has been promoted by professional as well as political forces.
The result is that the concept of PHC has been buried and PHC has been synonymously taken as 2nd degree medical care for the poor.

26. Contd…..
PHC has been down looked upon resulting in the vacuum being filled by virtually non-committed untrained staff, which has offered a parallel system of tertiary care in PHC facilities at minimal or no cost.
Lack of training and proper monitoring/ check and balance on the PHC staff.

27. Contd… Not being a government priority
Lack of Quality of Care yardsticks for Primary Health Care.
No active research in this field.
Government one step forward, two steps backward approach to PHC, resulting in lack of consistency in various PHC programs.

28. Efficiency Problems
Lack of standardized management protocols for common PHC problems
Lack of clear cut policy, regulatory and organizational mechanisms resulting in haphazard experimentation.

29. Community Causes
Community participation has been virtually non-existent in PHC.
Gap in Community and Public sector has widened the bridge.
Health education has been given a backseat in PHC.
Low literacy levels and economic deprivation has forced people to shift entire responsibility of their health on state shoulders.

30. Ways to move ahead
Health has to be linked with education and poverty alleviation
PHC has to be redefined in Government books.
Managerial competencies needs to be developed through intensive training and very strict monitoring

31. Contd…
Ongoing PHC training for all PHC staff with proper monitoring and evaluation and made be must for all promotions in PHC.
Financial investment in PHC needs to be increased with help of donors.
Health should further be de-centralized with involvement of community and mechanism be made for partly community funding of PHC.

32. Head of Primary Care Center
After finishing postgraduate studies, all of a sudden you found your self in the position of primary care center, what are the first steps you would like to take?

33. Management of primary care center
Analyzing health situation
Population (catchment area)
Statistics
Area Epidemiology
Medical facilities
Manpower
Training facilities
Attitude and beliefs of population

34. Establishment of objectives and goals
At all levels
Long term
Short term
Putting in mind resources
Assessment of resources
Manpower
Money
Skills
Knowledge
Materials
Fixing priorities

35. Detailed covering all aspects Well defined cost and time
Write up your plan
Detailed covering all aspects
Well defined cost and time
Programming and implementation
Fix responsibility for every person to achieve goals
For implementation
Define task
Involve selection , training, motivation, manpower
Organization and communication

36. Assessment of achievement of the stated goals
Monitoring
Its continuous process of observation, recording, and reporting on activities thus it involves keeping activities on the track and correction of any deviation
Evaluation
Assessment of achievement of the stated goals
Adequacy
Efficiency
Acceptance