Community Health Nursing Topic 2 Handouts: Primary Health Care

TOPIC INTRODUCTION

Primary Health Care

Primary health care is a whole-of-society approach to health and well-being centered on the needs
and preferences of individuals, families and communities. It addresses the broader determinants
of health and focuses on the comprehensive and interrelated aspects of physical, mental and social
health and wellbeing (WHO, 2019). However, its core foundation started more than 4 decades ago
as Primary Health Care was a 1978 health care initiative held in Alma Ata Russia by the World
Health Organization. It recognizes the need for a concerted effort among nations to address health
inequities all over the world and thus created the concept of Health for All (an initial view of what
we know now as Universal Health Care). That Alma Ata Conference capitalized and highlighted
that there are social determinants to health and that health must be viewed using the context of
each countries and strengthen primary, basic health services for all.

CONCEPT DISCUSSION 1 - PHC as a Universal Health Care Strategy

As per World Health Organization, Primary Health Care is the community’s first and main
point of contact with the health system. PHC focuses about helping people to live the
healthiest lives possible and, when they need health care, providing the right care, at the right
time, right in their communities. Strong PHC can address the vast majority of people’s health
needs throughout their lives, from preventing and treating illness, to managing chronic health
conditions, to delivering essential health services like vaccinations and reproductive,
maternal, newborn and child health care.

WHO stated further that by addressing the vast majority of people’s health needs across a
lifetime – from womb to tomb. PHC is among the most cost-effective approaches we have to
drive better health outcomes and improved quality of services while contributing to reduce
inequities in health along the life course. Health systems built on strong primary health care
empower individuals and communities, respond to day-to-day needs and foster trust in health
workers. In times of crisis, strong PHC boosts resilience and enables a faster, more effective
response. When we invest in primary health care, we build the foundation of an effective,
efficient and equitable health system and accelerate progress towards universal health
coverage. This makes strengthening PHC in every community and country both a moral and
strategic imperative – Universal Health Care strategy. It is the best – and most affordable –
way to get health systems to work. In the larger perspective, the call to again put health equality
on the international political agenda. A move towards universal health coverage was promoted
as the core strategy for tackling inequalities.

The vision of the Alma-Ata Declaration and the original PHC concepts still hold true up until
now, even as the world embraces a new call to action - the Sustainable Development Goals,
which set aims for the year 2030. SDG3, “Ensure healthy lives and promote wellbeing for all
at all ages,” echoes the bold target of “Health for All by the Year 2000” established way back
in 1978. The world have missed that target, but with much progress, development and lessons
learned, the accumulated knowledge, experience, and social capital propelled the countries to

1|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

rethink and reinvent its interventions with the aim of strengthening PHC as a critical strategy
to advancing to Universal Health for all.

CONCEPT DISCUSSION 2 – Definition of Primary Health Care

WHO/UNICEF (1978) has defined Primary Health Care as 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 can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination. PHC is an approach to health
beyond the traditional health care system that focuses on health equity-producing social policy.

This ideal model of health care was adopted in the declaration of the International Conference
on Primary Health Care held in Alma Ata in 1978 (known as the "Alma Ata Declaration"), and
became a core concept of the World Health Organization's goal of Health for all. The Alma-
Ata Conference mobilized a “Primary Health Care movement” of professionals and
institutions, governments and civil society organizations, researchers and grassroots
organizations that undertook to tackle the “politically, socially and economically
unacceptable” health inequalities in all countries.

Primary health care is rooted in a commitment to social justice and equity and in the recognition
of the fundamental right to the highest attainable standard of health, as echoed in Article 25 of
the Universal Declaration on Human Rights: “Everyone has the right to a standard of living
adequate for the health and wellbeing of himself and of his family, including food, clothing,
housing and medical care and necessary social services […]”.

The concept of primary health care has been repeatedly reinterpreted and redefined. In some
contexts, it has referred to the provision of ambulatory or first-level of personal health care
services. In other contexts, primary health care has been understood as a set of priority health
interventions for low-income populations (also called selective primary health care). Others
have understood primary health care as an essential component of human development,
focusing on the economic, social and political aspects.

WHO has developed a cohesive definition based on three components:

1. meeting people’s health needs through comprehensive promotive, protective,

preventive, curative, rehabilitative, and palliative care throughout the life course,
strategically prioritizing key health care services aimed at individuals and families
through primary care and the population through public health functions as the central
elements of integrated health services;

2|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

2. systematically addressing the broader determinants of health (including social,

economic, environmental, as well as people’s characteristics and behaviours) through
evidence-informed public policies and actions across all sectors; and
3. empowering individuals, families, and communities to optimize their health, as
advocates for policies that promote and protect health and well-being, as co-developers
of health and social services, and as self-carers and caregivers to others.

CONCEPT DISCUSSION 3 - Brief History of Primary Health Care

The International Conference on Primary Health Care, held in Alma Ata, Kazakhstan in 1978
gathered health decision makers and prime movers from around the world and produced a
landmark declaration that defined primary health care (PHC) as health care which is “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 in the spirit of self-reliance and self-determination” and committed a global
effort to achieve “health for all by the year 2000.”

Remarkably, this definition was influenced by health situations in China, Eastern Europe,
Sub-Saharan Africa, South Asia, Southeast Asia, and Latin America, which had been
encapsulated as a public health strategy through various assemblies organized by the World
Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in the 1970s.
However, the implementation of the Alma Ata Declaration faced political and economic
challenges, which paved the way for more pressing global health challenges that led to an
emphasis on disease-specific health interventions, termed as “selective primary health care.”
Eventually, mounting evidence on socioeconomic and political factors contributory to the
persistence of poor health outcomes, collectively termed as the social determinants of health,
has propelled the World Health Organization (WHO) to revisit PHC as a paradigm for
addressing health issues at a global scale, initially doing so in 1988 as it reflected on the
prospects of achieving the Declaration’s stated goal of “Health For All” by 2000.

As the Declaration reached its deadline in 2000, a renewal of commitments was advocated
during the 2000 People’s Health Assembly held in Dhaka, Bangladesh, where health
advocacy groups from all over the world gathered to reexamine the Declaration’s level of
accomplishment. This assembly then led to a “Health Care for All” declaration penned in
2001 by representatives of member states of the European Union and some African countries.
Thus, in 2008, 30 years after the Alma Ata Declaration, the WHO attempted to provide an
updated context to the original PHC definition by entitling its annual World Health Report
(WHR) as “Primary Health Care – Now More Than Ever,” which balanced its ongoing focus
on disease-specific programs with recommendations for reform in public policy, leadership,
service delivery and universal coverage. WHO has since advocated for a “health in all
policies” approach which recognizes the contribution and accountability of non-health sectors,
such as agriculture and public works, towards addressing health needs and improving health
outcomes.

3|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

This approach adopted during the 2013 Global Conference on Health Promotion in Helsinki,
Finland, specifically encourages policy makers to reflect on the “health implications of
decisions,” while considering the social determinants of health. Nonetheless, just as how
WHO revisited PHC by reviewing its historical and socioeconomic contexts, implementing
this renewal of commitment to PHC in the Philippines would likewise require insightful
consideration of how it was advocated and implemented in past decades. Since PHC is
dependent on the concepts of social acceptability and community participation, it is likewise
necessary to assess whether the proposed reforms of the renewed PHC approach are
applicable to the Philippine situation.

There is also a need to analyze how PHC can aid in addressing current health challenges, by
considering how it influenced strategies developed in the past, especially at the community
level. Analyzing these developments using a community-oriented lens is critical since the
Philippine health care system relies on its most basic units, the barangay health stations and
health centers, in addressing the health needs of millions of Filipinos. Thus it is critical to note
and understand how primary health care evolved in the Philippines and how community
health programs in the Philippines were shaped by the PHC approach.

CONCEPT DISCUSSION 4 - Key Concepts of Primary Health Care

PHC Goal:
Health for all Filipinos and Health in the Hands of the People by the year 2020.

PHC Concept:
Based on the definition and rundown of brief history, PHC was characterized by
partnership and focused on empowerment of the people. It includes the full
participation and active involvement of the community towards the development
of self-reliant people that is capable of achieving an acceptable level of health and
well-being.

PHC Legal Basis:

o The 30th World Health Assembly (May 1977) adopted a resolution which decided
that the main social target of governments and of WHO should be the attainment
by all the people of the world by the year 2000 a level of health that will permit
them to lead a socially and economically productive life.

o World Health Organization’s Alma Ata (Russia) Conference - the First

International Conference on Primary Health Care held September 6-12,1978. It
was held in Almaty (formerly Alma-Ata), Kazakhstan (formerly Kazakh Soviet
Socialist Republic) which rectify the provisions of unifying health systems
through primary health care initiative

o The Philippine government through the Letter of Instruction (LOI) 949 Signed on
October 19, 1979 by President Ferdinand E. Marcos mandated the then Ministry

4|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

of Health to adopt PHC as an approach towards design, development, and

implementation of programs which focus health development at the community
level – Health in the Hands of the People by 2020

Rationale in Adopting PHC:

• Magnitude of Health Problems
• Inadequate and unequal distribution of health resources among and within nations
• Increasing cost of medical care worldwide
• Isolation of health care activities from other development activities

5 Key Elements to achieve the Goal of “Health for All”

1. Reducing exclusion and social disparities in health (universal coverage)
2. Organizing health services around people’s need and expectations (health service
reforms)
3. Integrating health into all sectors (public policy reforms)
4. Pursuing collaborative models of policy dialogue (leadership reforms)
5. Increasing stakeholder’s participation

PHC ELEMENTS DAM!!!

E: Education, Information, Advocacy on Health
L: Local / Endemic Diseases Treatment

E: Expanded Program on Immunization

M: Maternal and Child Health
E: Essential Drugs Provisions
N: Nutrition
T: Treatment and Control of Diseases (Cd/Non-Cd)
S: Safe Water/ Sanitation and Environment

D: Dental Health
A: Accessible Health Care / Access to Appropriate Health Facilities
M: Mental Health

5|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

CONCEPT DISCUSSION 5 - Key Principles/ Pillars of Primary Health Care

Four (4) A’s of PHC (Characteristics)

• Accessibility – refers to the physical distance of a health facility or the travel time
required for people to get the needed or desired health services from a health care
facility. This requires the existence of a facility within reasonable distance from the
catchment population or the people it is meant to serve. As per WHO for a health care
facility to be considered accessible, they must be within 30 minutes from the
communities.

• Affordability – is not only in consideration of the individual or family’s capacity to

pay for basic health services. Particularly, for public health services, it is also a matter
of whether the community or government can afford these services. WHO considers in
determining affordability of health care is the out of pocket expenses of health care –
usually the actual costs to the family for health services, less any health insurance
coverage.

• Acceptability/ Appropriateness of health services – means the health care facility

offered acceptable/ appropriate health services that is in consonance with the prevailing
culture and traditions of the population/ community

• Availability – is a question whether the basic health services required/ needed by the
people are offered/ available in the health care facilities or is provided on a regular,
organized, and reliable manner

Pillars of PHC Implementation: SCAN!!!

S: Support Mechanisms in Place
Resources for essential health services come from three major entities: the
people, the government and private (NGO’s, socio civic or faith
organizations), thus elevating health to a comprehensive and sustained
national effort involving all stakeholders through social mobilization. PHC
should enhance people’s participation in health governance. From efficient
utilization of resources from the three (3) major sectors, a multisectoral
approach is necessary. Multisectoral approach are cooperation,
communication, and collaboration within and among various sectors to
attend to health and disease outcomes considering multiple interrelated
factors.

C: Community Participation (Active)

6|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

Community participation is the heart and soul of primary health care

whereas the health in the hands of the people brings the government
closest to the people. It necessitates a process of capacity building of
communities and organization to plan, implement and evaluate health
programs at their levels. Health is achieved through self-reliance and self-
determination, and that individuals, families and communities are NOT
considered as a recipient of care, but active participants in achieving their
health goals – Health in the Hands of the People.

Self-reliance: Through community participation and cohesiveness of

people’s organization they can generate support for health care through
social mobilization, networking, and mobilization of local resources.

Active Participation: means that people should be knowledgeable about

their own health problems and should identify the needs for their solution
or reduction and draw out plans of action according to the priority and the
resources available, organize and implement the programs and monitor
and control their progress, and periodically evaluate for getting the
feedback and do reprogramming (Roy, 1986).

People are the center, object, and subject of development. Thus, the
success of any undertaking that aims at serving the people is dependent on
people’s participation at all levels of decision-making; planning,
implementing, monitoring, and evaluating. Any undertaking must also be
based on the people’s needs and problems (PCF, 1990)

Partnership between the community and the health agencies in the provision
of quality of life. Providing linkages between the government and the non-
government organization and people’s organization
A: Appropriate Technology (Use of)
Using appropriate technology will make services and resources required for
their delivery, effective, affordable, accessible, and culturally acceptable.
People’s technology or indigenous technology are also use as a reference to
appropriate technology.

Criteria of Appropriate Health Technology

Safety: This means that the technology results in minimalist risk to the user
and that the intended positive outcomes of the use of technology far
outweigh its unintended negative effects. For example, the pertussis vaccine
(a component of DPT which is administered as part of the Expanded
Program on Immunization) is not recommended to be given to a child who
is 7 years or older because at this age, the vaccine is already more hazardous
than the disease itself

7|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

Effectiveness: The technology should accomplish what it is meant to

accomplish. For example, medicinal plants endorsed by DOH have been
tested and have been clinically proven to have medicinal value in relief or
treatment of ailments
Affordability: Measures foe health promotion and disease prevention are
cost-effective in comparison to treatment of diseases. Prevalent childhood
conditions, such as cough and colds, diarrhea and fever often require home
management only, these cost-effective interventions require an educated
community.
Simplicity: the technology that requires readily available simple materials
and that involves a simpler process in its use can be more easily adopted by
the people in the community when and where applicable. For example, oral
rehydration for management of diarrhea is a simple technology that can be
administered at home.

Acceptability: Technology is effective only when it is used by those who

need it. Thus, culture is an important consideration in determining the
appropriateness of a technology. In addition, education regarding a
particular technology is essential for its adoption.
Feasibility and Reliability: The technology must be easy to apply
considering the people’s natural settings like the home school, workplace
and community. Supplies must be constantly available, for example,
compared to chest X-ray, sputum examination is feasible in more areas

Ecological Effects: Effects on ecology are an important consideration in

choosing or rejecting a particular technology. For example, DOH
Administrative Order No. 21 S2008 mandated the gradual phase out of
mercury in all Philippine health care facilities and institutions
Potential to contribute to individual and community development:
Appropriate technology promotes self-sufficiency on the part of those using
it.

N: Networking and Linkages (Intra-Inter Sectoral)

One concrete example for networking and linkages is the Essential

National Health Research (ENHR) is an integrated strategy for organizing
and managing research using intersectoral, multi-disciplinary and
scientific approach to health programming and delivery.

8|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

Multisectoral approach: as health and disease are outcomes of multiple

interrelated factor, PHC requires communication, cooperation and
collaboration within and among various sectors. This is exemplified through
intrasectoral and intersectoral linkages:

• Intrasectoral linkages: refer to communication, cooperation, and

collaboration within the health sector: among the members of the health
team and among health agencies. This is exemplified by the team
approach utilized by the personnel of a health center in dealing with
health conditions and problems
The two-way referral system, another illustration of intrasectoral
linages, is necessary so that clients get the needed and desired care.
Example: a pregnant woman who had a prenatal check-up in the Brgy.
Health Station or Rural health Unit (RHU) has been identified as high
risk. She would be referred to appropriate hospital for childbirth. In this
case, a more competent care should be ensured, and available health
resources should be utilized. In the context of two-way referral system,
after childbirth the same mother should be referred back to the referring
BHS or rural health unit for follow-up home care, a type o service that
hospital usually do not provide – for the continuity of care.

• Intersectoral Linkages: encompass the communication, cooperation,

and collaboration between the health sector and other sectors of the
society like education, public works, agriculture, and the local
government units. This is necessary as health was established to be
multi-factorial and multi-level approach as it is not solely determined
by one factor – hence the social determinants to health.
One example for intersectoral linkages is that of the Rabies Prevention
and Control Program. It requires collaborative effort among the
Department of Health (DOH), Department of Agriculture (DA),
Department of Education (DepEd) and the local government unit
(LGUs). The DOH provides the immunization for victims of animal
bites, the DA provides outreach rabies immunization for dogs, while
DepEd and LGUs are in charge of information campaign in schools and
communities.

CONCEPT DISCUSSION 6 – Equitable Distribution of Health Resources

Equitable Distribution of Health Resources: PHC advocates for care that is community
-based and preventive in orientation. It calls for an inventory and analysis of health

9|Page
Community Health Nursing Topic 2 Handouts: Primary Health Care

resources, facilities, and manpower. One approach that greatly affect equitable distribution
of health resources were that of Decentralization of government functions.

This ensures empowerment of the Local Government Units to manage and lead their way
in governance at their locality including that of provisions and management of health
services. This empowerment can only be facilitated if the administrative structure provides
local level political structures with more substantive responsibilities for development
initiators. This also facilities proper allocation of budgetary resources.
On the other hand, the Department of Health spearheaded two programs that ensure the
equitable distribution of health manpower to the rural areas, these programs are:
1. Doctor to the Barrios (DTTB) Program: this is the deployment of doctors to
municipalities that are without doctors. DTTB volunteers are fielded to manage the
RHU or health centers in underserved, unserved, economically depressed fifth-
sixth class municipalities for 2 years, they also have the option of being
permanently absorbed by the municipality. This program was the feature story on
the film Mulanay- Sapusod ng Dagat.
2. Registered Nurses Health Enhancement and Local Service (RN Heals) – it is a
training and deployment program for unemployed nurses. RN Heals volunteers in
underserved, unserved, economically depressed municipalities for 1 year, to
address the inadequate nursing workforce in rural communities and health facilities.
It also provides the nurses valuable training to enhance both their clinical and
preventive management competencies.

CONCEPT DISCUSSION 7 - Traditional and Alternative Health Care

This concept discussion were directly lifted from Department of Health website
(https://riitmc.doh.gov.ph/health-guide/#ert_pane1-2).

Traditional medicine has been practiced since ancient times in every culture throughout
the world and has been an integral part of human evolution and development. The
evolution of Philippine traditional medicine is an interesting study that is influenced by
religion, mysticism, magic, superstition, folkloric herbalism and western medicine.

Philippine’s common traditional medicine practitioners include the following:

• Hilot or Manghihilot acts as a midwife, a chiropractor or massage therapist to

promote health and healing
• Tawas or Mangtatawas, this practitioner uses alum, candles, smoke, paper, eggs
and other mediums to diagnose the cause of illness associated by prayers and
incanteations

10 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

• Albularyo, a general practitioner who uses a combination of healing modalities

that may include prayers, incantations, mysticism and herbalism. Albularyos
claim to draw healing powers from a supernatural source (shamanism)
• Medico, a general practitioner similar to an albularyo but integrates western
medicine to promote healing.
• Faith Healers, a practitioner who claims divine power bestowed by the Holy
Spirit or God. A patient is required to have faith and believe in divine powers to
effect healing

These traditional medical practitioners covers a wide spectrum of practices and differs
from one another. Even in this modern times where information and advanced science
has greatly progressed, traditional medicine still enjoys a large following most especially
in rural areas.

In recognition of the deep-seated practice of traditional medicine as an alternative

modality for treating and preventing diseases in the Philippines, the Department of Health
(DOH) through its former Secretary Juan M. Flavier launched the Traditional Medicine
Program in 1992. This program aims to promote an effective and safe use of traditional
medicine.

Then President Fidel V. Ramos appreciated the importance of the traditional medicine
program and signed into law Republic Act 8423 (R.A. 8423), otherwise known as
the Traditional and Alternative Medicine Act (TAMA) of 1997. This gave rise to the
creation of Philippine Institute of Traditional and Alternative Health Care
(PITAHC)which is tasked to promote and advocates the use of traditional and alternative
health care modalities through scientific research and product development.

Since then the Philippine Department of Health (DOH) through its “Traditional Health
Program” has endorsed 10 medicinal plants to be used as herbal medicine in Philippines
due to its health benefits.

The following are the 10 Medicinal Plants in the Philippines endorsed by DOH:

1. Akapulko (Cassia alata) – a medicinal plant called “ringworm bush or schrub”

and “acapulco” in English, this Philippine herbal medicine is used to treat tinea
infections, insect bites, ringworms, eczema, scabies, and itchiness.
2. Ampalaya (Momordica charantia) – common names include “bitter melon” or
“bitter gourd ” in English. This Philippine herbal medicine has been found to be
effective in the treatment of diabetes (diabetes mellitus), hemofrhoids, coughs,
burns and scalds, and being studied for anti-cancer properties.
3. Bawang (Allium sativum) – common name in english is “Garlic”. Bawang is a
used in Philippine herbal medicine to treat infection with antibacterial,
antiinflammatory, anti-cancer and anti-hypertensive properties. It is widely used
to reduce cholesterol level in blood.
4. Bayabas (Psidium guajava) – “Guava” in English. A Philippine herbal medicine
used as antiseptic, anti-inflammatory, anti-spasmodic, antioxidant

11 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

hepatoprotective, anti-allergy, antimicrobial, anti-plasmodial, anti-cough,

antidiabetic, and antigenotoxic in folkloric medicine.
5. Lagundi (Vitex negundo) – known as “5-leaved chaste tree” in english is used in
Philippine herbal medicine to treat cough, colds and fever. It is also used as a
relief for asthma & pharyngitis, rheumatism, dyspepsia, boils, and diarrhea.
6. Niyog-niyogan (Quisqualis indica L.) – is a vine known as “Chinese honey
suckle”. This Philippine herbal medicine is used to eliminate intestinal parasites.
7. Sambong (Blumea balsamifera) – English name: “Ngai camphor or Blumea
camphor” is a Philippine herbal medicine used to treatkidney stones, wounds and
cuts, rheumatism, anti-diarrhea, anti-spasms, colds and coughs and hypertension
8. Tsaang Gubat (Ehretia microphylla Lam.) – English:” Wild tea” is a Philippine
herbal medicine taken as tea to treat skin allergies including eczema, scabies and
itchiness wounds in childbirth
9. Ulasimang Bato|Pansit-Pansitan (Peperomia pellucida) – is a Phillipine herbal
medicine known for its effectivity in treating arthritis and gout.
10. Yerba Buena (Clinopodium douglasii) – commonly known as Peppermint, is
used in Philippine herbal medicine as analgesic to relive body aches and pain due
to rheumatism and gout. It is also used to treat coughs, colds, and insect bites.

Types of Herbal Medicine

Medicinal plants can be used by anyone, for example as part of a salad, an herbal tea or
supplement. Many herbalists, both professional and amateur, often grow or wildcraft their
own herbs. Making your own herbal medicine preparation is not only fun but can be cost-
effective. In using the above-mentioned herbal medicines, some may require some degree
of skill, you have to use your own judgement if you decide to use one. Below is a list of
general ways on how to prepare your own herbal medicine. The list is not all inclusive
and you have to see individual articles for the herb you use so that you will know how to
prepare them.

Herbal Teas
There are two methods of making herbal teas, infusion, and decoction. Infusion is
steeping lighter parts of the plant (leaves, flowers, light stems) in boiled water for
several minutes (10-15 minutes). Decoction is boiling tougher parts, such as roots
or bark for a longer period of time (20minutes). Herbal teas are often used as a
home remedy, and as an alternative to tea and coffee.

As a general rule unless recommended by an herbalist, Prepare 1 teaspoon of

dried herb for every 1 cup of water. Let it steep in boiling water for 10 to 20
minutes. Strain the herbs out and drink 3 to 4 times a day.

Herbal Tinctures

12 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

Steeping a medicinal plant in alcohol extracts the alcohol-soluble principles into a

liquid form that can be stored for long periods. Herbalists may mix several herbal
tinctures to form an individualized prescription for each patient. Plant tinctures
are also the basis for many homeopathic medicines.

To prepare your herbal tincture you will need:

1. 8 ounces of finely cut dried herbs

2. 1 large glass jar that can hold 4 cups of liquid
3. 2 cups of vodka

Instructions:
Put the dried herb into a large, glass jar and pour in equal amount of liquid,
making sure the herbs are completely covered (this is very important). Store
the jar in a cool, dark place for at least two weeks, preferably 4. Make sure to
shake the mixture every day. When ready to use, filter the mixture using a
cheesecloth bag, coffee filter, or fine cloth, capturing the tincture liquid below
in another container. Store the tincture in clean, dark glass containers, out of
the sun. If stored properly the tincture will be preserved for two or more years.
Vinegar tinctures should be refrigerated.

Note: A drop of tincture is equal to 1 tsp of herb juice.

For Vinegar Tinctures, use 1 ounce of herb per 5 ounces of vinegar.

Fluid Extracts. Fluid extracts are stronger than herbal tinctures and can be made
with alcohol or glycerin.

Herbal Poultices. Poultices are a solid, vegetable fat-based mixture used

externally. They have the shortest life span of any herbal remedy and must be
made fresh for every use.

Powdered Herbs and Tablets. Herbs that are dried and (sometimes) certain parts
are separated out then diced to powder fine consistency. Powered matter can then
be compressed or put in an empty pill coating to form a tablet.

Herbal Creams and Ointments. An ointment usually is mixed with beeswax (or
something similar) to make it more applicable to outside the body, such as on a
cut or scrape.

Essential Oils. Extraction of volatile liquid plant materials and other aromatic
compounds from plants gives essential oils. These plant oils may be used
internally in some forms of herbal medicine as well as in aromatherapy and
generally for their perfume, although their medicinal use as a natural treatment
(alternative medicine) has proved highly efficacious in the treatment of headache
and muscle pain, joint pain and certain skin diseases.

13 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

Herbal Supplements. Herbal supplements tend to be commercial products in

tablet or capsule form manufactured and marketed by the health food industry for
sale in retail outlets to the general public, although there are some types that are
sold only to healthcare practitioners for prescription. Herbal supplements are
often standardized to contain stated levels of active phytochemicals. Some
herbalists may not agree with the standardization of active ingredients, preferring
instead to use the whole plant.

As per HopkinsMedicine.Org many different areas make up the practice of complementary and
alternative medicine (CAM). As many parts of one field may overlap with the parts of another
field. For example, acupuncture is also used in conventional medicine. In the U.S., CAM is used
by about 38% of adults and 12% of children. Examples of CAM include:

• TRADITIONAL ALTERNATIVE MEDICINE. This field includes the more

mainstream and accepted forms of therapy, such as acupuncture, homeopathy, and
Oriental practices. These therapies have been practiced for centuries worldwide. In the
Philippines and worldwide traditional alternative medicine may include:
o Acupuncture - a system of integrative medicine that involves pricking the skin or
tissues with needles, used to alleviate pain and to treat various physical, mental,
and emotional conditions. Originating in ancient China, acupuncture is now
widely practiced in the West.
o Acupressure - an alternative medicine technique similar in principle to
acupuncture. ... In treatment, physical pressure is applied to acupuncture points
with the aim of clearing blockages in these meridians. Pressure may be applied by
hand, by elbow, or with various devices.
o Naturopathy - a system of alternative medicine based on the theory that diseases
can be successfully treated or prevented without the use of drugs, by techniques
such as control of diet, exercise, and massage.
o Ayurveda - the traditional Hindu system of medicine, which is based on the idea
of balance in bodily systems and uses diet, herbal treatment, and yogic breathing.
o Homeopathy - a system of medical practice that treats a disease especially by the
administration of minute doses of a remedy that would in larger amounts produce
in healthy persons symptoms similar to those of the disease.
o Chinese or Oriental medicine - an ancient medical system that takes a deep
understanding of the laws and patterns of nature and applies them to the human
body.

• BODY. Touch has been used in medicine since the early days of medical care. Healing
by touch is based on the idea that illness or injury in one area of the body can affect all
parts of the body. If, with manual manipulation, the other parts can be brought back to
optimum health, the body can fully focus on healing at the site of injury or illness. Body

14 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

techniques are often combined with those of the mind. Examples of body therapies
include:
o Chiropractic and osteopathic medicine - represent another nonsurgical
treatment option for patients with back pain. Chiropractors and osteopathic
doctors may decrease low back pain by mobilizing joints in the lumbar spine
though manipulations (commonly referred to as "adjustments").
o Massage - is the scientific manipulation of the soft tissues of the body for the
purpose of normalizing those tissues and consists of manual techniques that
include applying fixed or movable pressure, holding, and/or causing movement of
or to the body.
o Reflexology - is a type of massage that involves applying different amounts of
pressure to the feet, hands, and ears. It's based on a theory that these body parts
are connected to certain organs and body systems. People who practice this
technique are called reflexologists
o Body movement therapies - refers to a broad range of Eastern and Western
movement approaches used to promote physical, mental, emotional, and spiritual
well-being. Some forms of movement therapy that combine deep-tissue
manipulation and postural correction with movement education are also known as
bodywork therapies.
o Tai chi - also called tai chi chuan, is a noncompetitive, self-paced system of
gentle physical exercise and stretching. Each posture flows into the next without
pause, ensuring that your body is in constant motion.
o Yoga - is a type of therapy that uses yoga postures, breathing exercises,
meditation, and guided imagery to improve mental and physical health. Modern
yoga therapy covers a broad range of therapeutic modalities, incorporating
elements from both physical therapy and psychotherapy.
o Pranic Healing - is a highly developed and tested system of energy treatment that
uses prana to balance, harmonize and transform the body's energy processes.
Prana is the Sanskrit word that means life-force. This invisible bio-energy or vital
energy keeps the body alive and maintains good health.

• DIET AND HERBS. Over the centuries, man has gone from a simple diet consisting of
meats, fruits, vegetables, and grains, to a diet that often consists of foods rich in fats, oils,
and complex carbohydrates. Nutritional excess and deficiency have become problems in
today's society, both leading to certain chronic diseases. Many dietary and herbal
approaches attempt to balance the body's nutritional well-being. Dietary and herbal
approaches may include:
o Dietary supplements - is a manufactured product intended to supplement the diet
when taken by mouth as a pill, capsule, tablet, or liquid. A supplement can
provide nutrients either extracted from food sources or synthetic, individually or
in combination, in order to increase the quantity of their consumption
o Herbal medicine - (also herbalism) is the study of pharmacognosy and the use of
medicinal plants. Plants have been the basis for medical treatments through much

15 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

of human. Paraherbalism is the pseudoscientific use of extracts of plant or animal

origin as supposed medicines or health-promoting agents.
o Nutrition/diet - The study of the dietary requirements of the body and of the
amounts of water, carbohydrates, fats, proteins, vitamins, minerals and fibre
needed for the maintenance of health.

• EXTERNAL ENERGY. Some people believe external energies from objects or other
sources directly affect a person's health. An example of external energy therapy is:
o Electromagnetic therapy - electromagnetic field therapy refers to therapy
involving the use of magnets or electromagnets. Types include
Bioelectromagnetics, the study of how electromagnetic fields interact with and
influence biological processes.
o Reiki - is a form of alternative medicine called energy healing. Reiki practitioners
use a technique called palm healing or hands-on healing through which a
"universal energy" is said to be transferred through the palms of the practitioner to
the patient in order to encourage emotional or physical healing.
o Qigong - or chi gung is a centuries-old system of coordinated body-posture.
Clinical research on qigong for its potential benefit in treating disease has been
inconclusive. circulating through the body; though a more general definition is
universal energy, including heat, light, and electromagnetic energy

• MIND. Even standard or conventional medicine recognizes the power of the connection
between mind and body. Studies have found that people heal better if they have good
emotional and mental health. Therapies using the mind may include:
o Meditation - is “a method of relaxation and consciousness expansion by focusing
on a mantra or a keyword, sound, or image while eliminating outside stimuli from
one's awareness” (Mosby's Medical Dictionary, 2009). The duration of a
meditation practice is as short as one minute to several hours
o Biofeedback - Biofeedback is a technique you can use to learn to control some of
your body's functions, such as your heart rate. During biofeedback, you're
connected to electrical sensors that help you receive information about your body
o Hypnosis - also referred to as hypnotherapy or hypnotic suggestion, is a trance-
like state in which you have heightened focus and concentration. Hypnosis is
usually done with the help of a therapist using verbal repetition and mental
images.

• SENSES. Some people believe the senses, touch, sight, hearing, smell, and taste, can
affect overall health. Examples of therapies incorporating the senses include:
o Art, dance, and music - are a significant part of complementary medicine in the
twenty-first century. ... The arts therapies also contribute significantly to the

16 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

humanization and comfort of modern health care institutions by relieving stress,

anxiety, and pain of patients and caregivers.
o Visualization and guided imagery - techniques offer yet another avenue for
stress reduction. These techniques involve the systematic practice of creating a
detailed mental image of an attractive and peaceful setting or environment.
o Aromatherapy - is based on the usage of aromatic materials, including essential
oils, and other aroma compounds, with claims for improving psychological or
physical well-being. It is offered as a complementary therapy or as a form of
alternative medicine, the first meaning alongside standard treatments, the second
instead of conventional, evidence-based treatments

CONCEPT DISCUSSION 8 - Primary Health Care Versus Primary Care

Primary Health Care is a strategy for the delivery of health programs. It should not be confused
with that of the primary care includes health promotion, disease prevention, health
maintenance, counseling, patient education and diagnosis and treatment of acute and chronic
illnesses in a variety of health care setting like offices, inpatient, critical care, long term care
and home care. (facility-based health care setting). Primary care is managed and performed
by a personal physician often collaborating with other health professionals and utilizing
consultation and referral as appropriate.

POINT OF COMPARISON PRIMARY HEALTH CARE PRIMARY CARE

Focus Client Family and Community Individual

Promotive and Preventive Curative provided by Health
Focus Of Care through Community Professionals
Participation
Community centered, Health Worker Driven
Decision Making Process consultative participative
Self-reliance/ Self Help Reliance on Health Professional
Outcome to regain/restore health

Rural Based satellite Clinics, Urban-based, hospital and

Setting For Services CHC and Health Stations/ Posts clinics

Development and Preventive Absence of Disease

Goal Care

17 | P a g e
Community Health Nursing Topic 2 Handouts: Primary Health Care

ACTIVITY 12: SYNTHESIS

Primary Health Care is a philosophy and a strategy for health empowerment, should capitalizes on
the realization of the Health in Hands of the People. The health that is directed by community
health governance and thus, its autonomy should be understood more than that of the devolution
of power and local administration in LGU’s; but that of taking advantage of governance with the
contextual understanding of the community (and its people) about their own health situation, and
eventually achieving health security – through community participation and collective governance
– in Primary Health Care management. Moreover, as the community people were empowered to
plan and work for their own health development – this may constitute in building a deep sense of
community ownership, thus, adds up to their capability and freedom to do and to be – guaranteeing
not only basic health services but that of the basic human rights to health, participation and equity
in access to resources and basic quality development and social services to education, health care,
among others.

18 | P a g e