Primary health care

PRIMARY HEALTH

CARE

LEVELS OF HEALTH CARE:

PRIMARY HEALTH CARE.

SECONDARY HEALTH CARE.

TERITIARY HEALTH CARE.

DEFINITIONS“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 every stage of their development in the spirit of self-determination.” Declaration of Alma Ata

DEFINITIONS“Essential health care made universally accessible to individuals and acceptable to them through their full participation and cost of the community and country can afford.” WHO

EVOLUTION OF PRIMARY HEALTH CARE: in post-independent era in 1947,

when the bhore committee brought its recommendations.

To provide comprehensive health services to the people in rural areas through the network of primary health centres.

A short term plan was formulated.

ALMA ATA DECLARATION 1978 launched primary health care RECOMMENDATIONS OF ALMA ATA CONFERENCE: to incorporate and strengthen the

primary health care with other sectors. The health services should be

comprehensive. community participation and

appropriate technology.

ALMA ATA DECLARATION

strengthen and support primary health care through various sectors.

maximum care to the special risk groups.

Training. proper use of resources. continuous supply of drugs and proper

managerial process, includes planning, organizing, monitoring and evaluation of health services.

HEALTH FOR ALL:2000 AD

health for all is ‘ the attainment of a level of health that will enable every individual to lead a socially and economically productive life.’

WHO

HEALTH FOR ALLSPECIFIC GOALS TO BE ACHIEVED BY 2000 AD : Reduction of infant mortality from the level of

125 to below 80. To raise the expectation of life at birth from the

level of 52 years to 64 years. To reduce the crude death rate from the level of

14 per 1000 population to 9 per 1000 population.

To reduce the crude bith rate from the level of 33 per 1000 population to 21 per 1000 population.

To achieve a net reproduction rate of one

HFA-2000 ADEvaluation of HFA [1979-2006]: Insufficient political commitment. Failure to achieve equity in access to all PHC. The continuing low status of women. Slow socio economic development. Unbalanced distribution of resources. Wide spread inequality of health promotion

efforts. Weak health information systems and lack of

baseline data. Pollution, poor food safety and lack of water

supply and sanitation.

HFA

Rapid demographic and epidemiological change.

Inappropriate use and allocation of resources for high cost of technology.

Natural and man-made disasters. Misinterpretation of the PHC concept. Misconception that PHC is the 2nd rate

of health care for the poor. Lack of political will. Centralized planning and management.

NATIONAL HEALTH POLICYPriorities:

Nutrition. Prevention of food adulteration and quality of drugs. Water supply and sanitation. Environment protection.

NATIONAL HEALTH POLICY

Immunization programmes. Maternal and child health services. School health programmes. Occupational health services

NATIONAL HEALTH POLICY-GOALS To establish one HSC for every 5000 [3000

for hilly areas]. To establish one PHC for every 30,000

population. To establish one CHC for every 1,00000

population. To train village health guides selected by

the community for 1,000 population in each village.

To train TBAs in each village. Training of various categories of field

functionaries

GOALS SET AND ACHIEVED BY NATIONAL HEALTH POLICY-1983

IMRPNMRCDRMMRUFMRLIFE

EXPECTANCY MALE

FEMALELBW

6033 92

10 

6464

10%

70468.74

9.4 

62.463.426%

Indicator Goals by 2000

Achieved by 2000

CBRCPRNBR

Growth rateFamily size

AN careTT pregnant

DPTOPVBCGFully

immunized

2160%

11.22.3

100%100%85%85%85%85%

26.146.2%1.451.933.1

67.2% 83%87%92%82%56%

Indicator Goal by 2000

Achieved by 2000

NHP 2002 –TO BE ACHIEVED BY YEAR 2015

Eradicate polio and yaws -2005

Eliminate leprosy -2005

Eliminate Kala- azar -2010

Eliminate filariasis -2015

Zero level growth of HIV/AIDS -2007

Decreasing mortality of TB by 50% -2010

NHP 2002 –TO BE ACHIEVED BY YEAR 2015 Decreasing malaria and other vector borne disease -2010 Decreasing prevalence of blindness

0.5% -2010 Increasing utilization of public health

service from 20% to 75% -2010 Decreasing IMR to 30/1000 and MMR

100/1lakh -2010

NATIONAL RURAL HEALTH MISSION 5th april, 2005 for a period of 7

years. main aim of NRHM is to provide

accessible, affordable, accountable, effective and reliable primary health care, and bridging gap in rural health care through creation of a cadre of Accredited social health activist.

The goals to be achieved by NRHM: NATIONAL LEVEL: Infant mortality rate reduced to

30/1000 live births. Maternal mortality ratio reduced to

100/100000. Total fertility rate reduced to 2.1. Malaria mortality rate reduction- 50%

by 2010. Kala-azar mortality reduction-100%

by 2010.

Filaria rate reduction-70% by 2010. Cataract operation: increasing to 46 lakhs

per year by 2012. Leprosy prevalence rate: reduce from

1.8/10000 in 2005 to less than 1/10000 thereafter.

Tuberculosis DOTS services: maintain 85% cure rate through entire mission period.

Upgrading community health centers to public health standards.

Increase utilization of first referral units from less than 20% to 75%.

Engaging 250000 female ASHA in 10 states.

AT COMMUNITY LEVEL:

Provide drug . Health day at anganwadi . Availability of generic drugs . Good hospital care. Improved access to universal

immunization. Improved facilities for institutional

delivery. Provision of household toilets. Improved outreach services

HEALTHY PEOPLE-2020

GOALS

Elimination of preventable disease, disability, injury and premature death.

Achievement of health equality. Elimination of health disparities. Creation of social and physical

environment that will promote good health and healthy development and behaviour at every stage of life.

targets to be achieved by the year 2020 are: Decease infant mortality rate below 60. To increase the expectation of life from

52 years to 64 years. To decrease the crude death rate from

14/1000 population to 9/1000 population.

To achieve a net reproduction rate of 1. To provide water to the entire

population

ELEMENTS E- Education

L- Locally endemic disease control

E- expanded programme immunization.

M- Maternal and child health

E- Environment sanitation

N- Nutritional services

T- Treatment of minor ailments.

S- School health services

EXTENDED ELEMENTS Expanded options of immunization.

Reproductive health needs. Provision of essential technologies for health.

Prevention and control of non- communicable diseases.

Food safety and provision of selected food supplements

PRINCIPLES Equity in health care

Available for all. Available to all. Available by all. Affordable by all

Community involvement:

Focus on prevention

Appropriate technology: Scientifically sound. Acceptable. Compatible. adaptable. Understandable

Multi-sectorial approach

STRATEGIES OF PRIMARY HEALTH CARE

Accessibility, Availability, Affordability and Acceptability of Health Services

Health services delivered where the people are

one community health worker per 10-20 households

Use of traditional medicines

Provision of quality, basic and essential health services

Training.Attitudes, knowledge and skills

developed.Regular monitoring and periodic

evaluation.

Community Participation Awareness on health and health-

related issues. Planning, implementation, monitoring

and evaluation done through small group meetings

Selection of community health workers

Formation of health committees. Establishment of a community health

organization. Mass health campaigns and mobilization

Self-reliance Community generates support for

health programs. Use of local resources Training of community in leadership

and management skills. Incorporation of income generating

projects, cooperatives and small scale industries.

Recognition of interrelationship of health and development

Convergence of health, food, nutrition, water, sanitation and population services.

Integration of PHC into national, regional, provincial, municipal development plans.

Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services.

Establishment of an effective health referral system.

Social Mobilization Establishment of an effective

health referral system.Multi-sectoral and interdisciplinary

linkage. Information, education,

communication Collaboration between government

and non-governmental organizations.

Decentralization Reallocation of budgetary

resources.Reorientation of health

professional and PHC.Advocacy for political and support

from the national leadership down.

PRIMARY HEALTH CARE MODEL

Health services

Health services

nutrition

environment

economic

politics

Education & communication

PRIMARY HEALTH CARE STATUS IN

INDIA Village level:

Village health guidesLocal daisAnganwadi workersASHA

Sub-centre level

Maternal health care. Counseling and appropriate Adolescent

health care. Assistance to school health services. Promotion of sanitation. Field visits. Community need assessment. Curative services. Training. Implementation of national health programmes

Primary health center level ACTIVITES include: Medical care. MCH including family planning. Safe water supply and basic sanitation. Prevention and control of locally endemic

diseases. Collection and reporting of vital statistics. Education about health. National health programmes. Referral services. Training of health guides, health workers, local dais and health assistants. Basic laboratory services.

Requirements for a sound PHCAppropriateness.Availability.Adequacy.Accessibility.Acceptability.Affordability.Assessability.Accountability.Completeness.Comprehensiveness.Continuity

Community health centre level Care of routine and emergency. 24 hour delivery services. Essential and emergency obstetric care. Full range of family planning services. Safe abortion services. Newborn care. Routine and emergency care of sick

children. foreign body removal, tracheostomy etc Implementation of national health

programmes.

CURRENT TRENDS Combining country efforts and policy instruments with global reach

Integrated service delivery models

Financing universal coverage Human resources for health Medicines Infrastructure and technology Health governance

EXISTING WEAKNESS IN IMPLEMENTATION OF PRIMARY

HEALTH CARE Minimal policy and

organizational commitment Poorly defined functions Poor selection: Deficiencies in training and

continuing education Lack of support and supervision Uncertain working conditions

EXISTING WEAKNESS IN IMPLEMENTATION OF PRIMARY

HEALTH CARE Undetermined cost and sources

of finance Lack of monitoring and

evaluation Lack of transport facilities Insecurity of female staff Inadequate supply of drugs and

stationeries Medical officers are not

interested to work in rural areas

ISSUES AND CHALLENGES OF PHC IN INDIA

Inadequate human resources Failure to deliver universally Failure to deliver effectively Poor leadership, public regard, and

professional status Funding models that are unresponsive fail to ensure treatments are effectively

distributed and universally available for common serious acute diseases

Lack of effective information systems

CHALLENGES:

the changing environment Advances in health and Technology

Lack of health personnel The double burden of disease

ROLE OF NURSE IN PRIMARY HEALTH CARE

Collaborator

Advisor:

Consultant

Advocate:

Preventor of illness

ROLE OF NURSE IN PRIMARY HEALTH CARE

Promotor of health Care provider Team leader Participant: Observer Manager Potentiator