PRIMARY HEALTH CARE

(PHC)

LECTURER:
IMELDA O. PAMINTUAN, RN, MAN
PRIMARY HEALTH CARE
Primary Health Care is “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”
(WHO/UNICEF 1978, in Stanhope and Lancaster 1992: 172).
Brief History of PHC

oIt was 1977 when the United Nations (UN) thru the World Health
Organization launched “ Health for all by the Year 2000” as a global
agenda to be pursued to fully realize the dream of attaining the full
potential of peoples around the world in both social and economic
terms.

oThe Adoption of PHC as key strategy to achieve the global agenda

ensued as stated in the Alma Ata Declaration.
Brief History of PHC

oThis declaration adopted by the member states of the UN in

September 1978 aims to implement worldwide system reform
focusing on accessibility of healthcare for all population groups.

oIn our country, PHC was implemented thru Letter of Instruction 949
(1979) from then President Marcos who underscored the need to
promote health development In Rural areas and to integrate health
in all government activities.
Brief History of PHC
oPrimary Health Care is defined 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 and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination (WHO,
2008).

oIt forms an integral part of both of the country’s health system, of which
it is the central function and main focus, and of overall social and
economic development of the community.
Brief History of PHC

oIt is the first level of contact of individuals, the family and

community with the national health system bringing health care as
close as possible to where people live and work, and constitutes the
first element of a continuing health care process. (WHO, 1981)

oAccessible healthcare is the first step in making PHC a reality.

Core Values of PHC

Social
Justice

Respect for
human Dignity Equity
and Human Rights

Self-
Solidarity
reliance
Alma-ata Declaration
oAffordable healthcare flows from the Alma-ata’s declaration
specifically highlighting that reform for healthcare systems across the
globe should be within the context of financial realities of
governments.
Essential Health Services in PHC
The Alma-Ata conference outlined 8 essential components of primary health care.

Education and information 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
Essential Health Services in PHC
The Alma-Ata conference outlined 8 essential components of primary health care.

Immunization against major infectious diseases.

Prevention and control of locally endemic

diseases

Appropriate treatment of common diseases and

injuries

Provision of essential drugs

From Alma-ata to Astana: Leaving no one behind in the
quest for health
o40 years from Inception of PHC in 1978, WHO converged last October
2018 in Astana, Kazakhstan to affirm the declaration of Alma-ata that
health is a fundamental right of all people and that all should be afforded
equitable healthcare access.

o“Strengthening primary health care (PHC) is the most inclusive, effective

and efficient approach to enhance people’s physical and mental health, as
well as social well-being, and that PHC is a cornerstone of sustainable
health system for Universal Health Coverage (UHC) and health-related
Sustainable Development Goals” (WHO, 2018)
The following are the Key points of Astana Declaration:
1. Health is the key element to achieving global peace, security and
development.
2. All people should enjoy the highest level of wellness without any
distinction and access to promotive, preventive, curative,
rehabilitative, and palliative healthcare should be provided to all.
3. Persistent inequalities in health among all countries especially
among the poor is socially, politically, and ethically unacceptable
4. The fight against the relentless increase in the number of people
dying from non communicable diseases.
The following are the Key points of Astana Declaration:
5. Multisectoral action and engagement of all stakeholders in health will
be pursued to make significant strides in achieving health reforms.
6. Strengthen implementation of PHC to avoid fragmentation and to
ensure a resilient, gender sensitive, people centered healthcare
delivery system in all countries.
7. Rally all governments of the world and other organizations to work
together for full implementation of UHC
8. Empower communities through capacity building activities and
promote health literacy among all population groups beyond borders.
Legal Basis

Letter of Instruction (LOI) 949 signed on October 19,1979 by then

President Ferdinand E. Marcos – One year after the First
International Conference on Primary Health Care which was held in
Alma Ata, USSR on September 6-12 1978, sponsored by the WHO
and UNICEF
Concept of Primary Health Care
Bringing Healthcare closer to people is a Key Feature of Primary
Health Care (PHC).

This is a total approach in ensuring peoples’ health by fostering

active community participation and establishing partnerships among
all sectors of society in working for better health.
Primary Health Care (PHC)

Is an over-all approach to
providing people access to
basic healthcare and
ultimately improve health of
communities.
 It calls for collective efforts among all
Dimensions of Primary stakeholders in society and gives premium
Health Care to people empowerment in health thru
their own efforts.
This approach has
three dimensions:
1. Goal
2. Strategy
3. Philosophy
Dimensions of Primary Health Care
GOAL
• PHC seeks to ensure that all people regardless of age, sex, creed, religion,
ideology, and race are provided access to basic health services.

STRATEGY
• Promotes collaboration among all sectors in society and values
partnership between pubic and private organizations

PHILOSOPHY
• Guides Public Health Practitioners to rally communities to assume responsibility
for their health and to involve themselves in issues affecting their health.
Traditional Cornerstones/Pillars of PHC
Active Community Participation
Inter and Intra-sectoral Linkages
Use of Appropriate Technology
Support System Made Available
Elements of PHC
According to WHO Technical Series on PHC (2018)

Three (3) Main Elements define PHC:

1. Primary care essential public health functions as the core of
integrated services
2. Multisectoral policy and actions
3. Empowered people and communities.
Healthcare should be characterized by 5 A’s namely:
ACCESSIBLE

AVAILABLE

AFFORDABLE

ACCEPTABLE

APPROPRIATE
10 Essential Public Health Services
1. Monitor health status to identify and solve community health
problems.
2. Diagnose and investigate health problems and health hazards in
the community.
3. Inform, educate, and empower people about health issues.
4. Mobilize community partnerships and action to identify and solve
health problems.
5. Develop policies and plans that support individual and community
health efforts.
10 Essential Public Health Services
6. Enforce laws and regulations that protect health and ensure
safety.
7. Link people to needed personal health services and assure the
provision of health care when otherwise unavailable.
8. Assure competent public and personal health care workforce.
9. Evaluate effectiveness, accessibility and quality of personal and
population-based health services.
10.Research for new insights and innovative solutions to health
problems.
Determinants of success for PHC
1. Knowledge and Capacity Building
2. Human Resources for Health
3. Financing
4. Technology
Criteria for appropriate health technology
1. Effective – it delivers the intended benefits or purpose
2. Safe – It assures users that no harm will result
3. Affordable – the cost of technology will not be a burden
4. Sustainable – is of utility to the population
5. Acceptable – is in harmony with community norms and culture
PRINCIPLES OF PRIMARY HEALTH CARE
1. Equitable distribution.
2. Community participation.
3. Intersectoral coordination.
4. Appropriate technology.
5. Focus on Prevention
Equitable distribution
The first key principle in the primary health care strategy is equity or equitable
distribution of health services.
Health services must be shared equally by all people irrespective of their ability
to pay, and all must have access to health services.
At present health services are mainly concentrated in the major towns and
cities resulting in inequality of care to the people in rural areas.
The worst hit are the poor and the needy and vulnerable groups of the
population in rural areas and urban slums. This has been termed as social
injustice.
Community participation
Health of the people is not just the responsibility of central and state
government alone.
Involvement of people in the development process voluntarily and willingly is
vital component of primary health care.
There must be a continuing effort to secure meaningful involvement of the
community in planning, implementing & maintenance of health services,
besides maximum reliance on local resources such as manpower, money &
materials.
Intersectoral Coordination
There is an increasing realization of the fact that the components of primary
health care cannot be provided by the health sector alone.
The declaration of Alma-Ata states, primary health care involves in addition to
the health sector, all related sectors and aspects of national and community
development, in particular agriculture, food, industry, education, housing, public
works, communication and other sectors”.
This requires strong political will to translate values into action, an important
element in intersectoral approach is planning – planning with other sectors to
avoid unnecessary duplication of activities.
Appropriate technology
Appropriate technology has been defined as “technology that is scientifically
sound, adaptable to local needs, & acceptable to those who apply it & for those
whom it is used & that can be maintained by the people themselves in keeping
with the principles of self reliance with the resources the community & country
can afford.
The term appropriate is emphasized because in some countries luxurious
hospitals that are totally inappropriate to the local needs, are built, which
absorb a major part of the national health budget, effectively blocking many
improvement in general health services.
Focus on Prevention
Prevention is the core strategy of primary health care.
Community health nurses focus on health promotion and health maintenance
activities for which they engage in primary ,secondary and tertiary level of
preventive care activities.
LEVELS OF PREVENTION
Levels of Disease Prevention

PREVENTION
The management of those factors that could lead to disease so as
to prevent the occurrence of disease.

GOAL:
To maintain optimal health by preventing disease
Three (3) Levels of Prevention
Primary
PRIMORDIAL
Prevention
PRIMARY
Secondary
SECONDARY
Prevention

TERTIARY
Tertiary
Prevention
Primordial Prevention
It is the prevention of emergence of risk factors in population, in
which they have not yet appeared.

Interventions:
oHealth education
Individual HE
Mass HE
Primordial Prevention Strategy
The primordial prevention strategy is applied to reduce
the development of risk factors before their appearance.

Adequate attention is given to prevent chronic disease.

The main action in primordial prevention is providing health

education and awareness to people on how to live a healthy lifestyle.
For example, Primordial prevention focuses on a healthy lifestyle, it educates on
taking nutritious food, avoiding smoking alcohol, exercising regularly etc.

Examples of primordial prevention are:

1. Avoiding smoking, alcohol and drugs
2. Taking healthy nutritious food
3. Regular exercise
4. Making major changes in lifestyle like taking adequate sleep.
Primary Prevention
Primary prevention can be defined as action taken prior to the onset
of disease, which removes the possibility that a disease will ever
occur,

STRATEGY:
oPopulation (mass) strategy
oHigh risk strategy
Interventions:
oGeneral health promotion:

Health Education
Environmental modification
Nutritional interventions
Lifestyle and Behavioural changes
oSpecific protection

Immunization (BCG ,DPT, MMR Vaccine)

Chemoprophylaxis ( tetracycline for cholera, dapsone for leprosy ,
chloroquinine for malaria)
Use of specific nutrients (vitamin A for children, iron and folic acid
for pregnant mothers)
oSpecific protection:

 Protection against accidents (use of helmet , seatbelt etc.)

 Protection against occupational hazards
 Avoidance of allergens
 Protection from air pollution
Primary Prevention
Primary prevention is the action taken to prevent the development of disease. It
removes the possibility of the occurrence of disease. In this, action is taken
before the onset of illness.

Primary prevention based on the “positive health” concept, It encourages

achievement and maintenance of the health of every individual and enables him
to lead a socially and economically productive life.

Primary prevention executed through two ways i.e. health

promotion and specific protection.
Health Promotion
Health promotion is the process of adoption of healthy behaviour and a positive
attitude for maintaining a healthy lifestyle.

Health promotional activities are environmental modification, health education,

nutritional intervention, lifestyle and behavioural changes.

Difference between primordial prevention and primary prevention: Primordial

prevention prevents the development of risk factors and Primary prevention
modifies existing risk factors and prevents them to become a disease.
Approaches for Primary Prevention

WHO recommends two approaches for primary intervention and

prevention of chronic diseases, are:

a) Population strategy
b) High-risk strategy.
a)Population strategy
As the name says, population strategy covers the whole population or mass
irrespective of individual risk levels.
For example: A mass of the population will be made aware of the effectiveness
of behavioural and lifestyle changes for the risk of cardiovascular disease.

b)High-risk strategy
This strategy identifies high-risk people by screening and other clinical methods.
Special education and attention are provided to these group.
Secondary Prevention
The action which halts the progress of a disease at its incipient stage
and prevent complications.

oIntervention:
Early detection.
Prompt treatment.
oOBJECTIVES

Complete cure and prevent the progression

of disease process.
To prevent the spreads of disease by curing
all the known cases.
To prevent the complications and sequel of
disease.
To shorten the period of disability.
Secondary Prevention
oIt is the action taken to stop the progress of the disease at the initial
stage and prevent complication.

oSecondary prevention is the step taken to stop the disease process and
restore health by seeking out unrecognised disease and treating it before
it reaches the irreversible pathological stage.

oThis prevention is taken up by early diagnosis and screening. Early

diagnosis recognises the disease at early stages and help to provide
adequate treatment.
Tertiary Prevention

All measures available to reduce or limit impairment and disabilities,

minimize suffering caused by existing departures from good health
and to promote the patient adjustment irremediable conditions.
Interventions:

oDisability limitation
oRehabilitation
 DISEASE

IMPAIRMENT

DISABILITY

HANDICAP
Rehabilitation
The action of restoring someone to health or normal life through
training and therapy after imprisonment, addiction, or illness.

Medical rehabilitation
Vocational rehabilitation
Social rehabilitation
Psychological rehabilitation
Tertiary Prevention
It came into action when disease advances beyond early stages.

Tertiary prevention is defined as “all the measures taken to reduce, limit,

impairment, disability and promote patient adjustment to the current situation.”

This stage aims at disability limitation and rehabilitation.

Disability is the prevention of the transition of the disease process from

impairment. Despite taking measures, if any type of disability occurs,
rehabilitation is required to retain the individuals highest level of functioning.
Universal Health Coverage/Care (UHC)
Universal Health Coverage/Care (UHC)
All people having access to quality health services without suffering
the financial hardship associated with paying for care.

oAll people (population coverage)

oHaving access to quality health services (service coverage)
oWithout suffering financial associated with paying for care
(financial risk protection)
Universal Health Care and Its Aim
Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP), is
the “provision to every Filipino of the highest possible quality of health care that
is accessible, efficient, equitably distributed, adequately funded, fairly financed,
and appropriately used by an informed and empowered public”.

The Aquino administration puts it as the availability and accessibility of health

services and necessities for all Filipinos.

It is a government mandate aiming to ensure that every Filipino shall receive

affordable and quality health benefits. This involves providing adequate
resources – health human resources, health facilities, and health financing.
UHC’s Three Thrusts
To attain UHC, three strategic thrusts are to be pursued, namely:
1. Financial risk protection through expansion in enrollment and
benefit delivery of the National Health Insurance Program (NHIP);
2. Improved access to quality hospitals and health care facilities; and
3. Attainment of health-related Millennium Development Goals
(MDGs).
Financial Risk Protection
Protection from the financial impacts of health care is attained by making any
Filipino eligible to enroll, to know their entitlements and responsibilities, to avail
of health services, and to be reimbursed by PhilHealth with regard to health care
expenditures.
PhilHealth operations are to be redirected towards enhancing national and
regional health insurance system. The NHIP enrollment shall be rapidly expanded
to improve population coverage.

The availment of outpatient and inpatient services shall be intensively promoted.

Moreover, the use of information technology shall be maximized to speed up
PhilHealth claims processing.
Improved Access to Quality Hospitals and Health Care
Facilities
Improved access to quality hospitals and health facilities shall be achieved in a number
of creative approaches.

First, the quality of government-owned and operated hospitals and health facilities is to
be upgraded to accommodate larger capacity, to attend to all types of emergencies, and
to handle non-communicable diseases.

The Health Facility Enhancement Program (HFEP) shall provide funds to improve
facility preparedness for trauma and other emergencies.

The aim of HFEP was to upgrade 20% of DOH-retained hospitals, 46% of provincial
hospitals, 46% of district hospitals, and 51% of rural health units (RHUs) by end of 2011
Financial efforts shall be provided to allow immediate rehabilitation and
construction of critical health facilities.

In addition to that, treatment packs for hypertension and diabetes shall be

obtained and distributed to RHUs.

The DOH licensure and PhilHealth accreditation for hospitals and health facilities
shall be streamlined and unified.
Attainment of Health-related MDGs
Further efforts and additional resources are to be applied on public health
programs to reduce maternal and child mortality, morbidity and mortality from
Tuberculosis and Malaria, and incidence of HIV/AIDS.

Localities shall be prepared for the emerging disease trends, as well as the
prevention and control of non-communicable diseases.

The organization of Community Health Teams (CHTs) in each priority population

area is one way to achieve health-related MDGs.
CHTs are groups of volunteers, who will assist families with their health needs, provide health
information, and facilitate communication with other health providers.

RNheals nurses will be trained to become trainers and supervisors to coordinate with
community-level workers and CHTs. By the end of 2011, it is targeted that there will be 20,000
CHTs and 10,000 RNheals.

Another effort will be the provision of necessary services using the life cycle approach. These
services include family planning, ante-natal care, delivery in health facilities, newborn care, and
the Garantisadong Pambata package.
Better coordination among government agencies, such as DOH, DepEd, DSWD, and DILG, would
also be essential for the achievement of these MDGs.