Primary Health Notes Care 2019

Primary Health Care (Lecture three)
Primary healthcare (PHC) refers to "essential health care" that is based on

"scientifically sound and socially acceptable methods and technology, which
make universal health care accessible to all individuals and families in a community.
It is through their full participation and at a cost that the community and the country can
afford to maintain at every stage of their development in the spirit of self-reliance and
self-determination".
In other words, PHC is an approach to health beyond the traditional health care
system that focuses on health equity-producing social policy. PHC includes all areas
that play a role in health, such as access to health services, environment and
lifestyle. Thus, primary healthcare and public health measures, taken together, may be
considered as the cornerstones of universal health system.
The Back Ground
This ideal model of healthcare was adopted in the declaration of the International
Conference on Primary Health Care held in Alma Ata, Kazakhstan 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.
There were many factors that inspired PHC; a prominent example is the Barefoot
Doctors of China.
Goal and Principle of Primary Health Care
The ultimate goal of primary healthcare is the attainment of better health services for all.
It is for this reason that the World Health Organization (WHO), has identified five key
elements to achieving this goal:
 reducing exclusion and social disparities in health (universal coverage reforms);

 organizing health services around people's needs and expectations (service delivery
reforms);
 integrating health into all sectors (public policy reforms);
 pursuing collaborative models of policy dialogue (leadership reforms); and
 Increasing stakeholder participation.
Behind these elements lies a series of basic principles identified in the Alma Ata
Declaration that should be formulated in national policies in order to launch and sustain
PHC as part of a comprehensive health system and in coordination with other sectors:[1]
 Equitable distribution of health care – according to this principle, primary care and
other services to meet the main health problems in a community must be provided
equally to all individuals irrespective of their gender, age, caste, color, urban/rural
location and social class.
 Community participation – in order to make the fullest use of local, national and
other available resources. Community participation was considered sustainable due
to its grass roots nature and emphasis on self-sufficiency, as opposed to targeted
(or vertical) approaches dependent on international development assistance.[4]
 Health workforce development – comprehensive healthcare relies on an adequate
number and distribution of trained physicians, nurses, allied health
professions, community health workers and others working as a health team and
supported at the local and referral levels.
 Use of appropriate technology – medical technology should be provided that is
accessible, affordable, feasible and culturally acceptable to the community.
Examples of appropriate technology include refrigerators for cold vaccine storage.
Less appropriate examples of medical technology could include, in many settings,
body scanners or heart-lung machines, which benefit only a small minority
concentrated in urban areas. They are generally not accessible to the poor, but draw
a large share of resources.
 Multi-sectional approach – recognition that health cannot be improved by
intervention within just the formal health sector; other sectors are equally important
in promoting the health and self-reliance of communities. These sectors include, at
least: agriculture (e.g. food security); education; communication (e.g. concerning
prevailing health problems and the methods of preventing and controlling them);
housing; public works (e.g. ensuring an adequate supply of safe water and basic
sanitation); rural development; industry; community organizations
(including Panchayats or local governments, voluntary organizations, etc.).
In sum, PHC recognizes that healthcare is not a short-lived intervention, but an ongoing
process of improving people's lives and alleviating the underlying socioeconomic
conditions that contribute to poor health. The principles link health, development, and
advocating political interventions rather than passive acceptance of economic
conditions.
Primary Health Care Approach

The primary health care approach has seen significant gains in health where applied
even when adverse economic and political conditions prevail.[10]
Although the declaration made at the Alma-Ata conference deemed to be convincing
and plausible in specifying goals to PHC and achieving more effective strategies, it
generated numerous criticisms and reactions worldwide. Many argued the declaration
did not have clear targets, was too broad, and was not attainable because of the costs
and aid needed. As a result, PHC approaches have evolved in different contexts to
account for disparities in resources and local priority health problems; this is
alternatively called the Selective Primary Health Care (SPHC) approach.
Selective PHC
After the year 1978 Alma Ata Conference, the Rockefeller Foundation held a
conference in 1979 at its Bellagio conference center in Italy to address several
concerns. Here, the idea of Selective Primary Health Care was introduced as a strategy
to complement comprehensive PHC. It was based on a paper by Julia Walsh and
Kenneth S. Warren entitled “Selective Primary Health Care, an Interim Strategy for
Disease Control in Developing Countries”. This new framework advocated a more
economically feasible approach to PHC by only targeting specific areas of health, and
choosing the most effective treatment plan in terms of cost and effectiveness. One of
the foremost examples of SPHC is "GOBI" (growth monitoring, oral rehydration,
breastfeeding, and immunization), focusing on combating the main diseases in
developing nations.
GOBI and GOBI-FFF
GOBI is a strategy consisting of (and an acronym for) four low-cost, high impact,
knowledge mediated measures introduced as key to halving child mortality by James P.
Grant at UNICEF in 1983. The measure are:
 Growth monitoring: the monitoring of how much infants grow within a period, with
the goal to understand needs for better early nutrition.[4]
 Oral rehydration therapy: to combat dehydration associated with diarrhea.
 Breastfeeding
 Immunization
Three additional measure were introduced to the strategy later (though food
supplementation had been used by UNICEF since its inception in 1946), leading to the
acronym GOBI-FFF.
 Family planning (birth spacing)

 Female education
 Food supplementation: for example, iron and folic acid fortification/supplementation
to prevent deficiencies in pregnant women.
These strategies focus on severe population health problems in certain developing
countries, where a few diseases are responsible for high rates of infant and child
mortality. Health care planning is used to see which diseases require most attention
and, subsequently, which intervention can be most effectively applied as part of primary
care in a least-cost method. The targets and effects of selective PHC are specific and
measurable. The approach aims to prevent most health and nutrition problems before
they begin:
PHC and population aging (lecture three)
Given global demographic trends, with the numbers of people age 60 and over
expected to double by 2025, PHC approaches have taken into account the need for
countries to address the consequences of population ageing. In particular, in the future
the majority of older people will be living in developing countries that are often the least
prepared to confront the challenges of rapidly ageing societies, including high risk of
having at least one chronic non-communicable disease, such
as diabetes and osteoporosis. According to WHO, dealing with this increasing burden
requires health promotion and disease prevention intervention at the community level as
well as disease management strategies within health care systems
Primary care ethics is the study of the everyday decisions that primary care clinicians
make, such as: how long to spend with a particular patient, how to reconcile their own
values and those of their patients, when and where to refer or investigate, how to
respect confidentiality when dealing with patients, relatives and third parties. All these
decisions involve values as well as facts and are therefore ethical issues. These issues
may also involve other workers in primary healthcare, such as receptionists and
managers.
What are the roles of a primary health care nurse?
A model of the roles of nurses is that their work may cover:
 Health promotion
 Illness prevention
 Antenatal and postnatal care
 Child and family health nursing
 Treatment and care of sick people
 Rehabilitation and palliation
 Community development
 Population and public health
 Education and research
 Policy development and advocacy

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Primary Health Care (Lecture three)

Primary healthcare (PHC) refers to "essential health care" that is based on

 reducing exclusion and social disparities in health (universal coverage reforms);

Primary Health Care Approach

 Family planning (birth spacing)

A model of the roles of nurses is that their work may cover:

 Antenatal and postnatal care

 Child and family health nursing

 Treatment and care of sick people

 Rehabilitation and palliation

 Population and public health

 Education and research

 Policy development and advocacy

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