1. Concept of Primary Health Care
LECTURE 4+5
Primary Health Care Systems
NUR 473-Lecture 4+5
Concept of Primary Health Care

2. outlines The current health care system.
LECTURE 4+5
outlines
The current health care system.
Trends affecting the health care system.
Definition of primary care & primary health care.
The PHC workforce.
Primary health care movement.
DECLARATION OF ALMA-ATA
Principles of Primary Health Care
Eight essential elements of PHC.
Aims of primary health care
Applying three levels of preventive care.
PRIMARY HEALTH CARE IN SA
Health For All

3. LECTURE 4+5
Objectives
After completion of this lecture the students should be able to:
- Describe three trends that are affecting health care.
- Describe five trends that affecting the health care system.
- Define primary care & primary health care.
- Identify the PHC workforce.
- Discuss primary health care movement.
- Discuss eight essential elements of PHC.
- Applying three levels of preventive care.

4. The current health care system
LECTURE 4+5
The current health care system
Health Care system can take credit for improving the life span of people through advances in medical technology, science, and the pharmaceutical industry in relation with the issues related to cost, quality and access to health care

5. Three trends that affecting health care:
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Three trends that affecting health care:
Cost
Access
Quality

6. Trends affecting the health care system:
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Trends affecting the health care system:
Demographic trends
Social trends
Economic trends
Health workforce trends
Technology trends

7. Primary health care (PHC)
LECTURE 4+5
Primary health care (PHC)
The PHC movement officially began in
Is essential health care; based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and self-determination (WHO & UNICEF, 1978).
The setting for primary health care is within all communities of country and permeates all aspects of society.

8. LECTURE 4+5
The PHC workforce:
Team members include many professionals such as generalist and public health physician, nurses, dentists, pharmacists, optometrists, nutritionists, community outreach workers, mental health counselors, and other allied health professionals, and community members are considered to the team.

9. LECTURE 4+5
The PHC encourage:
Self-care and self management in the health and social welfare aspects of daily life.
People are educated to use their knowledge, attitudes, and skills in activities that improve health for themselves, their families, and their neighbors.
The desired outcome from the PHC strategy is individual, family and community self reliance and competence.

10. Principles of Primary Health Care
LECTURE 4+5
Principles of Primary Health Care
Equitable distribution
Health services should be shared or distributed equally to all areas irrespective of city (urban/village (rural), rich/poor, caste/ color etc
Accessibility - People should have reasonable access to essential health services with no financial or geographical barriers.

11. Principles of Primary Health Care
LECTURE 4+5
Principles of Primary Health Care
Community participation
Involving individual, family and community in promotion of their own health is an essential aspect of PHC.
The public should be encouraged to participate in planning and making decisions about their own health care.

12. Principles of Primary Health Care
LECTURE 4+5
Principles of Primary Health Care
Inter-sectoral coordination
Alone, health sector or department can not work out for the benefit of the community health. E.g. Agricultural, animal husbandry, food, industry, education, housing, public works, communication. To get all of these sectors to work for the common goal like health care system strong political involvement is needed.
Professionals from various sectors, including the health sector, work independently with community members to promote the health of the community.

13. Principles of Primary Health Care
LECTURE 4+5
Principles of Primary Health Care
Appropriate technology:
The meaning of the term “Appropriate technology" is :
Scientifically sound
Adaptable to local needs and acceptable to those who uses
Maintained by people
Resources that community and country can afford
Focus on prevention
The focus of care should be on prevention rather than cure

14. LECTURE 4+5
Elements/ essential components of primary health care (WHO & UNICEF, 1978)
Education concerning prevailing health problems and 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
Provision of essential drugs

15. PHC – element No.1 Health education
LECTURE 4+5
PHC – element No.1 Health education
Education for promotion of health and prevention of disease is an essential factor mentioned in Alma-Ata declaration
The individual should decide to be healthily or not , to accept health measures and to create a healthily environment .

16. PHC – element No.2 Promotion of food supply and proper nutrition
LECTURE 4+5
PHC – element No.2 Promotion of food supply and proper nutrition
Nutrition is a basic factor influencing the quality of human life.
Under nutrition is still one of the greatest health hazards. Child and maternal malnutrition is widespread.
Community health workers should be responsible for the promotion of better nutrition.
Correction of faulty feeding practices and prevention infectious diseases which are nutrition – related , eg. Diarrhea

17. LECTURE 4+5
PHC – element No.3 An adequate supply of safe water and basic sanitation
The main objectives of this PHC elements are to prevent diseases and improve the quality of life and well-being of the population by promoting personal and community hygiene
Ensuring the availability of safe water supply and sanitation facilities through self reliant, community action and also by associating water supply and sanitation with other health and/or development programs

18. LECTURE 4+5
PHC – element No.4 Maternal and child health care, including family planning
Maternal and child health care (MCH/FP) as part of PHC aims at promoting and protecting the health of children and women of childbearing age
So that all children have the possibility for healthily growth and development
and so that reproductive life of women is compatible with a state of health and well being

19. LECTURE 4+5
PHC – element No.4 Maternal and child health care, including family planning
MCH/FP (Maternal and Child Health/Family Planning) care includes at five main functions
Antenatal care
Delivery care
Post natal care
Child care
Family planning care

20. PHC – element No.5 Immunization against the major infectious diseases
LECTURE 4+5
PHC – element No.5 Immunization against the major infectious diseases
Immunization programs seeks to reduce morbidity and mortality by providing immunization against the major killers of children.
In the developing world, priority is usually given to the following diseases:
Diphtheria, Whooping cough, Tetanus
Measles, Rubella, Poliomyelitis
Tuberculosis, Hepatitis B
Tetanus immunization for pregnant mothers

21. PHC – element No.6 Prevention and control of locally endemic diseases
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PHC – element No.6 Prevention and control of locally endemic diseases
Malaria
Malaria remains one of the most important widespread endemic diseases. There are about million cases annually
The objectives may range from reduction of mortality in some areas to full-scale country wide malaria eradication

22. PHC – element No.6 Prevention and control of locally endemic diseases
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PHC – element No.6 Prevention and control of locally endemic diseases
Hypertension
High blood pressure is another health problem and form 8 – 18 % of adults in most countries both developed and developing, have pressures above 160mm/Hg systolic and 95mm/Hg diastolic.
The long term objectives are;
-To prevent hypertension if possible
-To reduce the mortality and morbidity due the
consequences of high blood pressure

23. Diagnosis of diarrheal disease Provision of appropriate treatment
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PHC – element No.7: Appropriate treatment of common diseases and injuries
Diarrheal disease:
Prevention of diarrheal morbidity and mortality is a vital part of national strategies for PHC. Diarrheal disease control itself includes at least main functions, namely:
Diagnosis of diarrheal disease
Provision of appropriate treatment
Management of outbreaks of diarrheal diseases and its prevention

24. Accidents are among the highest causes of death in most countries
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PHC – element No.7: Appropriate treatment of common diseases and injuries
Accidents are among the highest causes of death in most countries
The aims, therefore must be not only to provide first aid on the spot and adequate treatment at the appropriate level of care, but also to prevent the occur of similar accidents in the future and to provide program for active rehabilitation of disabled persons, children as well as adults
Three types of home accidents have been chosen as examples; Cuts, Burn, and Poisoning

25. PHC – element No.8 Provision of essential drug
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PHC – element No.8 Provision of essential drug
The provision of essential drugs aims at making these drugs available to the users of the health systems at all levels of PHC, all over the country, at all times by instituting an efficient system of drug acquisition, storage, distribution and utilization

26. Aims of primary health care
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Aims of primary health care
Promotion of health
Prevention of diseases
(primary, secondary and tertiary levels)

27. Aims of primary health care
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Aims of primary health care
Promotion of health
Action related to lifestyles and choices that maintain or enhance a populations health
(WHO) "Any combination of educational, organizational, economic, and environmental supports for behavior and conditions of living conductive to health".
Health promotion includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness. Nursing, in particular, has a social mandate for engaging in health promotion.

28. Aims of primary health care
LECTURE 4+5
Aims of primary health care
Promotion of health
The goal of health promotion is to raise levels of wellness for individuals, families, populations, and communities.
Community health efforts accomplish this goal through a three-pronged effort to:
1. Increase the span of healthy life for all citizens
2. Reduce health disparities among population groups
3. Achieve access to preventive services for everyone

29. Aims of primary health care
LECTURE 4+5
Aims of primary health care
Promotion of health
Health promotion programs and activities include many forms of health education—for example,
Physical activity and fitness.
Nutrition.
Tobacco use.
Teaching the dangers of alcohol and drug use.
Family planning
Mental health and mental disorders
Violent and abusive behavior
Educational and community-based programs

30. Aims of primary health care
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Aims of primary health care
Prevention of diseases
Nursing care oriented to health promotion, wellness and illness prevention can be understood in terms of health activities on primary, secondary and tertiary levels.
Prevention means anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment

31. Aims of primary health care
LECTURE 4+5
Aims of primary health care
Prevention of diseases-Primary Prevention
Any effort done before or to prevent the problem to occur.
Primary prevention obviates the occurrence of a health problem; it includes measures taken to keep illness or injuries from occurring. It is applied to a generally healthy population and precedes disease or dysfunction.
It can be provided to an individuals or to general population, or it can focus on individuals at risk for developing specific diseases. Wellness activities are synonymous with the activities identified for primary prevention.

32. Aims of primary health care
LECTURE 4+5
Aims of primary health care
Prevention of diseases-Primary Prevention
Primary prevention includes Health promotion activities such as:
Health education
Good standard for nutrition adjusted to developmental phases of life
Attention of personality development
Provision of adequate housing and recreation , as well as agreeable working condition
Marriage (genetic ) counseling
Genetic screening
Periodic selective examinations

33. Aims of primary health care
LECTURE 4+5
Aims of primary health care
Prevention of diseases-Primary Prevention
Specific protection activities in order to improving the general health of individuals, families and communities, activities such as:
Use of specific immunization
Attention to personal hygiene
Use of environmental sanitation
Protection against occupation hazards
Protection from accidents
Use of specific nutrients
Protection form carcinogens
Avoidance of allergen

34. Aims of primary health care
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Aims of primary health care
Prevention of diseases-Secondary Prevention
It focuses on individuals who are experiencing health problems or illness and who are at risk for developing complications or worsening conditions.

35. Aims of primary health care
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Aims of primary health care
Prevention of diseases-Secondary Prevention
Early diagnosis and prompt treatment:
Involves efforts to detect and treat existing health problems at the earliest possible stage when disease or impairment already exist.
Hypertension and cholesterol screening programs in many communities help to identify high-risk individuals and encourage early treatment to prevent heart attacks or stroke.
Other examples are teaching breast and testicular self-examination, encouraging regular mammograms and Pap smears for early detection of possible cancer

36. Aims of primary health care
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Aims of primary health care
Prevention of diseases-Secondary Prevention
Disability limitation
Secondary prevention attempts to discover a health problem at a point when intervention may lead to its control or eradication.
This is the goal behind testing of water and soil samples for contaminants and hazardous chemicals in the field of community environmental health.
It also prompts community health nurses to watch for early signs of child abuse in a family, emotional disturbances in a group of alcohol and drug abuse among adolescents

37. Aims of primary health care
LECTURE 4+5
Aims of primary health care
Prevention of diseases- tertiary Prevention
Involves efforts to reduce disability and, as much as possible, restore function.
This focuses on helping people manage complicated, long-term health problems such as diabetes, heart disease, cancer and chronic musculoskeletal pain. The goals include preventing further physical deterioration and maximizing quality of life. For example:
cardiac or stroke rehabilitation programs
chronic pain management programs
patient support groups

38. PRIMARY HEALTH CARE IN Saudi Arabia
LECTURE 4+5
PRIMARY HEALTH CARE IN Saudi Arabia
Primary health care (PHC) is defined by the World Health Organization (WHO) as essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost the community and the country can afford
Saudi Arabia started implementing this approach in 1980 by the Ministry of Health (MOH).

39. PRIMARY HEALTH CARE IN Saudi Arabia
LECTURE 4+5
PRIMARY HEALTH CARE IN Saudi Arabia
The MOH provides primary health care (PHC) services through a network of health care centers throughout the kingdom.
It also adopts the referral system which provides curative care for all members of society from the level of general practitioners at health centers to advanced technology specialist curative services through a broad base of general and specialist hospitals

40. LECTURE 4+5
Health For All
In 1977, it was decide in the world health assembly to lunch a movement known as "health for all by the year 2000".
The fundamental principle of HFA strategy is equity , that is an equal health status for people and countries, ensured by an equitable distribution of health resources.
The member countries of WHO at the World Health Assembly defined health for all as:
Attainment of a level of health that will enable every individual to lead as socially and economically productive life

41. LECTURE 4+5
Health For All
In 1981, after identifying the goal of HFA and the PHC strategy for realizing that goal, the WHO established global indictors for monitoring and evaluating the achievement of HFA.
These indicators are grouped into four categories.
Health Policies
Social and Economic Development
Provision of Health Care
Health Status.

42. LECTURE 4+5
Health Indicator
A health indicator is a characteristic of an individual, population, or environment which is subject to measurement (directly or indirectly) and can be used to describe one or more aspects of the health of an individual or population (quality, quantity and time). (WHO, 1998)

43. Health Indicator Health policy indicators
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Health Indicator
Health policy indicators
Policy commitment to Health for all (HFA)
Resource allocation
Degree if equity of distribution of health resources
Community involvement attaining HFA.

44. Health Indicator Social and Economic Development Rate of population
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Health Indicator
Social and Economic Development
Rate of population
Income distribution
Gross national product
Work condition
Adult literacy rate
Housing
Food availability.

45. Health Indicator Provision of Health Care Coverage by PHC
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Health Indicator
Provision of Health Care
Coverage by PHC
Coverage by referral system.

46. Health Indicator Health Status
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Health Indicator
Health Status
Nutritional status &psychological development
Infant mortality rate
Child mortality rate
Life expectancy at birth or at other specific age
Maternal mortality rate.

47. General Indicator-related definitions
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General Indicator-related definitions
Proportion: The relation of a subgroup to the entire group; that is the subgroup divided by the entire group.
Rate: The frequency of events in a population during a specified time period (usually a year) divided by the population ‘at risk’ of the event occurring during that time period.
Or a rate is: A statistical measures expressing the proportion of persons with a given health problem among a population at risk.

48. General Indicator-related definitions
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General Indicator-related definitions
Ratio: The relation of one population subgroup to the total population or to another subgroup; that is, one subgroup divided by another. 
Which is simply the comparison of one number with another
A ratio: is often used to compare one at-risk population with another.
The number of females: The number of males

49. General Indicator-related definitions
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General Indicator-related definitions
Incidence and Prevalence Rates
Incidence: Refers to the rate at which a specific disease develops in a population.
An incidence rate is the number of new cases of an illness or injury that occurs in a specific time.
Prevalence: The number of cases in a defined population at a specified point in time.
Prevalence: measures all of the existing cases at a given point of time.
Prevalence includes the incidence (new cases) plus all of the existing cases.

50. General Indicator-related definitions
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General Indicator-related definitions
Life expectancy at birth: The average number of additional years a person could expect to live if current mortality trends were to continue for the rest of that person’s life.
Maternal mortality ratio: The number of women who die as a result of childbearing or within 42 days of termination of pregnancy in one year, per live births during that year.