PRIMARY HEALTH CARE

Historical Background
In the 1977 World Health Assembly, the government of Kenya along with other member states of WHO,
endorsed the worldwide social objective of “The attainment by all people of the world by the year 2000
of a level of health that will permit them to lead a socially and economically productive life” (WHO,
1977).

However, many countries in the developing world recognised the fact that it was not possible in the
foreseeable future for them to achieve this worldwide social objective. This was because many lacked
the resources required to develop and run health services. They needed to adopt a strategy that allowed
them to use the available resources to give some benefit to everyone and provide special attention to
those at high risk. So, the member governments endorsed the Primary Health Care strategy for the
provision of health services for all.

The strategy for the implementation of PHC was adopted by the Kenyan government to provide health
services to its population, majority (80%) of who live in the rural areas.

The Definition of Primary Health Care

In 1978, the Alma Ata international conference on primary health care 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 and country can afford to
maintain at every stage of their development in the spirit of self-reliance and self-determination.”

In that definition, we hope you noted the following key statements which identify PHC as essential
health care. These are:

 PHC is universally, accessible to individuals and families in the community;

 PHC is socially acceptable to all; meaning that the health care is appropriate and adequate in quality
to satisfy the health needs of people, and is provided by methods acceptable to them within their
social cultural norms;
 PHC is affordable, that is, whatever methods of payment used, the services should be at a price the
community can afford;
 PHC promotes full participation of individual, families and communities;
 PHC is appropriate technology i.e. the use of methods and technology which use locally available
supplies and equipments.

The Concept of Primary Health Care

The concept of PHC can be described as ideas about the implementation of health care for all.PHC has
the following characteristics easily identified using the following 5 A’s:

 Accessible That is, the services are geographically, financially and culturally within easy
reach to the whole community.

 Acceptable The quality of health services offered are appropriate, adequate, and able to
satisfy the health needs of people; and are provided by methods which are
within their social cultural norms.

 Affordable That the services are provided at a cost that the community can afford.

 Available The health structures and services are easily available to the community
members and they also help them to assume responsibility in promoting their
own health.

 Appropriate Technology: Utilizing existing methods, techniques, and resources within the
community.

Table 1 below gives further explanation of the PHC concept based on the definition and discussion we
have had so far.

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Table 1: The Seven Pillars of PHC.

ASPECT DEFINITION COMMENT

Health System Primary Health Care The first elements of a continuing health care
process, sustained by integrated, functional
and mutually support referral systems
leading to the progressive improvement of
the comprehensive health care for all and
giving priority to those in most need.
Priority Essential health problems Addresses main health care problems in the
community providing promotive, preventive,
curative and rehabilitative services
Science Practical, scientifically sound Based on application of the relevant results
of social, biomedical and health services
research
Culture Socially acceptable methods Reflects and evolves from the economic
and technology conditions and socio-cultural and political
characteristics of the country and
communities
Equity Made universally accessible to  The attainment of health care for all
individuals and families peoples of the world by the year 2000 and
beyond of the level of health that would
permit them to lead socially and
economically productive lives.
 The existing gross inequality in the health
status of the people particularly between
developing countries as well as within
countries is politically, socially and
economically unacceptable.
Participatory Through their full participation The people have the right and duty to
participate individually and collectively in
the planning and implementation of health
care

Sustainability At a cost that the community To exercise political will to mobilize the
can afford to maintain at every country’s resources and to use available
stage of their development in external resources rationally.
the spirit of self-reliance and
self-determination

In summary, we can say that Primary Health Care is a strategy of health care delivery which creates a
partnership between the consumer of the health services and health care professionals. They both
actively participate in the achievement of the common goal of improved health.

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Key players in implementation of PHC:
 government,
 non-governmental organizations,
 primary health care workers/Community health workers
 Community members.

Fundamentals of PHC
Fundamentals of PHC are basic rules or beliefs that are essential to the existence, development or
success of the Primary Health Care concept.

The following are the fundamentals of PHC:

1. PHC reflects and evolves from the economic conditions and socio-cultural and political
characteristics of the country and the communities; and is based on the application of the
relevant results of social, biomedical and health services research and public health experience.

2. PHC addresses the main health problems in the community, providing promotive, preventive,
curative and rehabilitative services accordingly.

3. PHC includes, at least: education concerning prevailing health problems and the methods of
preventing and controlling them; an adequate supply of safe water and basic sanitation; maternal
and child care including family planning; immunization against the major infectious diseases;
prevention and control of locally endemic diseases; appropriate treatment of common diseases
and injuries and provision of essential drugs.

4. PHC involves, in addition to the health sector, all in particular agriculture, animal husbandry,
food industry, education, housing, public works, communication and other sectors. It demands
the coordinated efforts of all these sectors.

5. PHC requires and promotes maximum community and individual self- reliance and participation
in the planning, organization, operation and control of health services, making fullest use of

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 local, national and other available resources. Through appropriate education the communities
themselves are empowered to participate.

6. PHC should be sustained by integral, functional and mutually supportive referral systems leading
to the progressive improvement of comprehensive health care for all, and giving priority to those
most in need.

7. At local and referral levels, PHC relies on health workers, including physicians, nurses,
midwives, auxiliaries and community workers as applicable, as well as traditional practitioners
as needed who are suitably trained both socially and technically, to work as a health team and to
respond to the expressed health needs of the community.

Elements of PHC

In the Alma Ata conference of 1978, eight essential elements of PHC were identified. However,
individual countries were given the liberty to add any other elements that were of public health concern
and relevant to their own country. Kenya has added 6 other elements.

The PHC elements listed at the Alma-Ata Declaration were as follows:

1. Education concerning prevailing health problems and the methods of preventing and
controlling them.

2. Local disease control

3. Expanded programme on immunization

4. Maternal and child health care and family planning

5. Essential drug supply

6. Nutrition and adequate food supply

7. Treatment and prevention of common diseases and injuries.

8. Safe water supply and good sanitation.

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The Kenyan government has added more elements to the ones we have just discussed. These are:

1. Mental Health
2. Dental Health
3. Community based rehabilitation
4. Malaria Control
5. STI and HIV/AIDS prevention and control.

Health Education

Health education is education that is intended to have a direct or indirect positive impact on health. It is
a process of dialogue with individual, family and or community members to find out appropriate
responses to health problems as well as empower them with the knowledge and insights they need to
understand how their behaviour affects their health. Health education today has extended its scope
beyond disease prevention and control to health promotion. It gives individuals and communities the
incentive to promote the conditions that maintain good health.

Therefore as you can see, health education is an integral part of all health services and all health
personnel including yourself have an important role to play in organizing appropriate health educational
programmes at all levels in the community.

Promotion of food supply and proper nutrition

As you are well aware, nutritional deficiency states are particularly noticeable among pregnant and
lactating mothers, infants and children. This may be due to the prevailing cultural or economic factors in
the community. As a community health nurse, it is your responsibility to take appropriate measures to
prevent and treat diarrhoea diseases, parasitic intestinal infestations and other diseases which lead to
nutritional deficiency states. It is also your responsibility to support health promotional measures such as
child spacing, nutrition education, kitchen garden and food hygiene. In co-ordination with other sectors,
you should also encourage community members to increase agricultural output by growing more foods,
prevent post-harvest spoilage through construction of simple food stores, and to keep poultry and dairy
cattle.

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Water supply and basic sanitation
Safe water and sanitation services are an essential component of preventing the occurrence of many
communicable diseases and yet they are not available to a greater section of the population. Most water
borne diseases that are prevalent in the community can be prevented if communities gain access to safe
water and adopt proper refuse and faeces disposal.
So under this element, effort are made to bring together the different actors from related sectors to
survey and identify sources of safe water and carry out proper analysis of the water. At the same time,
community health workers should educate community members how to protect these water sources (e.g.
wells and springs) from contamination, how to construct latrines, compositing facilities and soakage
pits.

Maternal and Child Health/Family Planning (MCH/FP)

Children make up one-half of the community and their mothers another fifth and in turn their health care
forms the greater part of community health. Also, mothers and children run a great risk of injury and
disease because their lives are concerned with beginnings and growth. MCH/FP services are therefore
aimed at promoting the health of mothers and children by reducing maternal and child mortality rates
and enabling women of childbearing age to get the desired number of pregnancies and at the right
interval. MCH/FP care has the following four main functions:
 Antenatal care
 Intranatal care
 Prenatal care
 Postnatal care
 Family planning services

Since 1980, the issue of family planning has gained momentum and highlighted as an issue that was
formally regarded as unimportant. In response, the government established the National Council for
Population and Development to coordinate all population and family planning activities with particular
emphasis on motivation aspect of the program. It also set up the service component of the family
planning program within the Ministry of Health. Also, NGOs such as FPAK, CHAK, and the Catholic
Secretariat (supports only natural family planning) play an important role in both motivation and service
provision.

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The practice of family planning is an old African tradition. What is new is the variety of methods which
have been introduced to prevent or delay pregnancy.

Immunisation
Kenya has for some time now implemented immunization activities through the Kenya Expanded
Programme on Immunization (KEPI). Immunization is a very effective means of primary prevention
against certain endemic and epidemic diseases. Health workers have been trained on how to motivate
and encourage mothers to bring their children for immunisation as well as how to identify suspected
cases of immunizable disease, i.e. measles, poliomyelitis and neonatal tetanus, using standardized case
definition (disease surveillance).
Local disease control
There are many endemic diseases in this country, some of which are confined to particular areas. An
endemic disease is a disease or infectious agent that is constantly present within a given community,
geographical area or population all the time”. It includes holo endemic and hyper endemic diseases.
A holo endemic disease is one for which a high prevalent level of infection begins early in life and
affects most of the child population, leading to a state of equilibrium such that the adult population
shows evidence of the disease much less commonly than do children (malaria in many communities is a
holo endemic disease).
A hyper endemic disease is one that is constantly present at a high incidence and/or prevalence rate and
affects all groups equally. (A Dictionary of Epidemiology,1997).

Examples of endemic diseases in this country include the following:

 Malaria
 Schistosomiasis
 Filariasis
 Hookworm
 Trachoma
 Onchocerciasis

Malaria Control

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Each district in Kenya is required to determine the endemicity of malaria, plan and implement an
appropriate control strategy. The other factor to be considered is the objective of control activities. Four
levels of control are possible as described below.

Level 1
The objective is to prevent malaria mortality and hence the control strategy is to make chemotherapy
available as close as possible to every family.

Level 2
The objective is to control mortality and morbidity due to malaria. The control strategy here involves
chemotherapy as close to each family as possible and chemoprophylaxis with simple anti - mosquito
measures.

Level 3
The objective is to control malaria mortality, morbidity and prevalence. This requires chemotherapy and
chemoprophylaxis with effective mosquito control measures.

Level 4
The objective here is to eradicate malaria completely.

Given the economic situation in Kenya the health infrastructure and complexity of the logistical demand
of the methods of control mentioned above, the first priority of malaria control for us has to be that of
mortality and morbidity particularly in areas of unstable malaria.

Treatment and prevention of common diseases and injuries

Curative care is important in its own right as it provides a powerful mechanism for teaching preventive
and promotive care.

Supply of Essential Drugs

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Essential drugs are basic drugs used to treat minor ailments or conditions at the dispensary and health
centre levels.

Kenya has been a pioneer in the establishment of an effective drugs kit system which regularly delivers
drugs to health units. Community pharmacies have also been established in remote rural areas to
improve access to drugs by the rural and remote communities. As a community health nurse you have a
major responsibility of ensuring that patients have access to essential drugs and know how to manage
their drug regimens for optimal effect.

Mental Health
Before we proceed, can you remember how we defined the term “health” in Module 1? Jog your
memory by doing the following activity.

We defined health as: “… a state of complete physical, psychological, spiritual and social well-being
and not merely absence of disease or infirmity” (WHO, 1948)

So, mental health services should not be viewed in isolation but as an integral part of the other services
that are required to achieve the complete health of individuals, families and communities. Therefore
health workers should:

 Be oriented to look at mental health as part and parcel of PHC.

 Promote good mental health practices through health education of the family and
community in order to create awareness.
 Provide facilities in all health institutions and service delivery points for education,
detection, treatment or referral of mental health problems.

Dental Health
Dental health is a strategy of care focusing on the promotive and preventive care of the teeth and oral
cavity that basically includes oral health and dental hygiene. I am sure from your experience you are
aware that dental diseases are one of the most widespread diseases in our communities that are often
easily overlooked and yet they are largely preventable. The ministry of health has established fully
fledged dental care units in all health facilities to help improve dental health services.

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Community Based Rehabilitation
Many developing countries such as Kenya included this element in order to give special attention to the
management and prevention of disabilities arising from congenital defects, chronic non-communicable
diseases such as cancers, and accidental injuries.
Rehabilitation services are now being integrated at all levels of health care delivery including at the
family and community level.

HIV/AIDS Prevention
The Kenyan government has set out technical and ethical approaches aimed at meeting the challenges
presented by the HIV/AIDS pandemic. These include:

 Adequate and equitable provision of health care to the growing numbers of HIV infected persons;
 Treatment of other sexual transmitted diseases that increase peoples biological vulnerability to HIV
infection;
 Reduction of women’s vulnerability to HIV infection by improving their health, education, legal
status and economic prospects;
 Reduction of vulnerability of MTCT of HIV infection by introducing PMTCT services
 A supportive socio-economic environment for HIV/AIDS prevention.

The PHC approach emphasises the need to involve individuals, family members, and community
members in the prevention and control of HIV/AIDS.

Principles of Primary Health Care

In the implementation of the Primary Health Care elements which we have just discussed, a number of
principles are involved. Although the details vary from country to country each principle must be
considered during the implementation of PHC.

A principle is a law, rule or basic belief that has a major influence on the way in which something is
done (an inevitable consequence of something). It is also defined as a basic generalization that is
accepted as true and that can be used as a basis for reasoning or conduct. Therefore, the five basic

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principles of PHC that act as rules or guidelines in governing the implementation of PHC activities
include:

 Equity;
 Manpower development;
 Community participation;
 Appropriate technology;
 Multi-sectoral approach.

Equitable Distribution
Equity is the fair and reasonable distribution of available resources to all individuals and families in
order to meet their fundamental and basic needs. This principle should be taken into account when
deciding on the location of new health facilities, outreach service points, or during introduction of new
health programmes, especially those that require payment for services.

Manpower Development
We know that primary health care aims at mobilizing the human potential of the entire community by
making use of available resources. This principle facilitates the identification and deployment of the
necessary health personnel as well as the training and development of new categories of health workers
to serve the community.

Community Participation
Community participation is the process by which individuals, families and communities assume
responsibility in promoting their own health and welfare. This PHC principle underlines the importance
of full community participation, especially in health decision-making. Community members and health
providers need to work together in partnership to seek solutions to the complex health problems faced by
many communities today.

Appropriate Technology
Appropriate technology is that which is scientifically or practically sound and adaptable to the local
needs, and which the community can afford to maintain at every stage of their development in the spirit

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of self-reliance and self-determination. It includes issues of costs and affordability of services, type of
equipments and their pattern of distribution throughout the community.

Multi-Sectoral Approach
Evidence clearly indicates that the health sector can not achieve much of its activities (disease
prevention, treatment, care and rehabilitation) in isolation. It must work in close collaboration with
other sectors in the community in order to succeed in promoting the community’s self-reliance. The
support of other inter-related departments in other government ministries will greatly enhance the
efficiency and output of the health activities being implemented by the Ministry of Health.
Often, the health sector works in collaboration with the following sectors:
 Agriculture
 Water and sanitation
 Animal husbandry
 Education
 Housing
 Public works
 Transport and communication
 Roads and housing
 Reclamation, development of arid and semi arid wastelands
 Non governmental organization etc

These sectors need to co-ordinate their plans and activities in order to contribute towards the health of
the community and avoid conflicts or duplication of efforts.

In brief, this is what you need to remember about the principles of PHC.

 Every individual has a right to a high quality of life

 The community must be allowed to take charge of the resources available from both within and
outside their environment. This empowers them to be more responsible and accountable for their
quality of life.
 There should be equitable distribution of resources among the community members so that they can
meet their fundamental and basic needs.

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IMPLEMENTATION OF PHC ELEMENTS

An overview of health services in Kenya before implementation of PHC

Since Kenya became independent in 1963, our government has all along demonstrated its responsibility
towards the provision of quality health services for its people. In its various manifestos and development
plans, the government has identified health as one of the basic needs and an essential precondition for
the overall economic development and social progress of this country.
The major milestones achieved by our government in health care development are captured in the
following chronology of events.

 In 1965 the government introduced free medical treatment in government medical facilities in line
with the policy guidelines of the KANU Manifesto.

 In 1967 the National family planning programme was started.

 In 1970 the central government took over the running of health services from local councils.

 In 1971 - 1972, a joint GOK/WHO mission formulated the proposal for the improvement of rural
health services in the country and the establishment six Rural Health Training Centres. This was
with an effort to provide adequate health coverage to the rural population.
Rural health demonstration centres in Kenya.- Karurumo Rural Training Centre.
- Chuluaimbo Rural Training Centre.
- Mbale Rural Training Centre.
- Maragua Rural Training Centre.
- Misoriet Rural Training Centre.
- Mosoriot Rural Training Centre
- Tiwi Rural Training Centre.

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 In 1984 a Community-based Health Care unit was subsequently set up within the integrated Rural
Health and family planning project.

Indeed, the concept of community participation in development activities is not new in Kenya. You will
remember the introduction of the ‘Harambee motto’ (self-help) that encouraged people to pull their
resources and participate in the development of healthcare and education. People’s efforts were directed
towards construction of physical facilities like classrooms and wards, with the hope that the government
would take over their management. Similarly, community participation is an important cornerstone of
the PHC strategy. The PHC strategy relies on the abounding spirit of self-help among community
members and endeavours to empower them to improve their health.

Major health policies guiding current health development plan

The steady development of PHC has necessitated a continuous review of existing policies in the health
sector.
Policies which has guided the development of PHC in Kenya.
 The district focus for Rural Development strategy
 Increasing coverage and accessibility of health services in rural areas
 Consolidating urban and rural and curative, preventive and Promotive services.
 Intersectoral collaboration

The district focus for rural development strategy

This policy was introduced by the government in July 1985 to decentralize decision making to the grass
roots and turn the district into a centre for the planning and implementation of government projects.

As a result of this strategy, the management capability of health personnel at the district level has
strengthened thus reducing many challenges which they experienced before. Problems that were
resolved by the introduction of the district focus strategy include:
 Facilities management
 Drug supplies
 Transport

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  Maintenance of equipment

The role of the District Health Management Teams has been strengthened in line with district focus for
rural development strategy.

Increasing coverage and accessibility of health services in rural area.

It was realized that development of the rural health infrastructure had lagged behind because of financial
constraints. Yet experience had shown that preventive and promotive health programmes were more cost
effective if adequately supported. So the government made a deliberate effort to redirect capital from
major capital projects to small-scale projects at the district and sub-district levels. Effort was also made
to support preventive and promotive health programmes and further investment in the rural health
infrastructure by improving service delivery methods and increasing the number and quality of trained
health manpower.

Consolidating urban/rural and curative, preventive and promotive services.

Here emphasis was put on training of all health cadres in preventive and promotive methods. Personnel
located at hospitals and other static facilities were encouraged to include health education as a routine
component of PHC.

Intersectoral collaboration
Intersectoral collaboration means working together with other line sectors (from inter-related ministries)
whose activities have a direct influence on health. Health is too important to be responsibility of the
health sector alone. Other sectors whose activities have a direct influence on health include ministries of
agriculture, water, housing, culture and social services, and so on.

The current development plan has set out the following policies to guide health development:

 Increasing emphasis on MCH/FP services in order to reduce morbidity, mortality and fertility rates;
 Strengthening ministry of health management capabilities with an emphasis on the district level;
 Increasing inter-ministerial coordination;

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 Increasing alternative financing mechanism for health care.

These major policy guidelines show the explicit direction which the health delivery services in Kenya
have taken. For instance, there has been a clear shift from the earlier policy which provided free medical
services to the one that introduced cost sharing. The development of the Community Based Health Care
(CBHC) approach as a basic component of PHC is another important milestone. This approach
emphasizes community participation in environmental health activities, prevention of diseases,
establishment of community health funds and income generating activities.

The Alma Ata conference set as its target “Health for All by the Year 2000. Since then the Ministry of
Health has reviewed and revised its strategies to follow the primary health care guidelines. Through the
implementation of the policies we have just discussed, it has organized a number of healthcare activities
within communities according to their needs and conditions.

The year 2000 which was set as the target for the achievement of health for all came and passed. Even
ten years later we have not achieved health for all. For this target to be met, we need to change a
number of things that continue to come in the way. These are:

 A change in the attitude of health personnel and the community

 A change in the motivation of both health workers and the community
 Greater inter-sectoral collaboration
 Political will
 Equitable redistribution of the available resources
 More appropriate and affordable health technology

The following rational steps needs to be adopted in order to effect the necessary changes at the
community and location level.

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 Training and retraining of health personnel, the community and community leaders using
appropriate methodology and exposure of health personnel to the communities;
 Strengthening intersectoral collaboration at the community level;
 Greater commitment of our political leadership to the concepts of Primary Health Care;
 Intensification of community involvement and existing community initiatives for health and
development through increased awareness;
 Extension of the existing health services infrastructure in support of PHC to remote areas through
outreach programmes or creation of new health units.

As we adopt these steps, it is important to ensure that we give priority to the underserved areas. This
can be achieved through proper
 coordination of funding agencies,
 making effective use of committees at all levels and
 improvement of monitoring and evaluation.

Implementation of PHC elements at different levels of health care provision

The levels of health care provision in Kenya:
 Family level
 Community level
 District level
 Provincial/National level

Family Level

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The family is the basic unit of any social organization in a community. Being the basic unit in a
community, the family is therefore the nucleus and main focus of each essential element of PHC. The
following is a description of how each element is implemented at the family level.

 Education
The family does not only provide its members with food, clothing and shelter. It also gives its members
basic education in the form of language, beliefs and customs. Families have a strong influence on what
each member does. Thus, when we educate families on how to promote their health and prevent disease
we impact positively on the health of the entire community. Education for the promotion of health and
the prevention of diseases is most effective in the home environment because the family provides an
ideal atmosphere for effective teaching. Demonstrations can be done in the home setting with the active
participation of all family members.

 Nutrition and food supply

Good nutrition is a basic component of the healthy growth and development of each family member. In
order to strengthen food and nutrition activities at the family level, you need to teach the members about
good food and nutrition practices including appropriate methods of growing and storing food.

 Water and sanitation

You should motivate the family to start the “three pots” system where applicable. You should also train
them how to protect springs and well; how to construct and use latrines; simple personal hygiene
measures such as handwashing; and the use of rain-roof catchments to harvest water. Figure 7 below
illustrates a simple method of purifying water using the three pot method of storage.

 Maternal and child health and family planning

As you well know, certain traditional practices in the family towards pregnancy, labour and puerperium
can impact positively or negatively on the health of a mother and child. It is your responsibility to
encourage good practices and discourage harmful ones. Families need to be educated on the importance
of antenatal care, immunization and family planning. This can be done through community health
workers and opinion leaders such as, teachers, religious leaders, social workers. We can also use model
families in the community to reinforce our teachings.

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 Immunization
It is the responsibility of families to take their children for immunization. Your role as a health worker
is to educate them on all the items on the growth card, the need for immunization and how it works.
With the assistance of TBAs and CHWs, you should also assess and refer children in the homes for
immunization.

 Control of Endemic Disease (Malaria)

The main objective is to control mortality particularly in stable malaria areas. The role of the family here
is to identify the nearest source of anti malarial treatment; determine the dosage for the treatment of
various age groups in the family; manage fever by tepid sponging and know when to take the patient to
the nearest health facility; continue feeding the sick person as normally as possible; determine where
and when to seek help; recognize and use simple protection methods such as mosquito treated nets;
ensure family members at risk of dying from malaria receive chemoprophylaxis; and clear bushes and
stagnant water around the dwelling.

If the family implemented these simple measures, they would considerably reduce mortality due to
endemic diseases.

 Treatment of Common Conditions

Common conditions are diseases which tend to occur very often in the family. They include:
 Malnutrition
 Anaemia
 Malaria
 Diarrhoeal diseases
 Respiratory tract infections
 Worm infestation
 Schistosomiasis
 Scabies
 Conjunctivitis

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 Otitis media

The role of the family here is to recognize the signs and symptoms of these conditions and seek help
from the nearest health facility. In addition it is their responsibility to ensure the prescribed treatment is
taken correctly and to fully support the patient until they fully recover. They should also understand the
causes of these diseases and take the necessary measures to prevent them.

 Mental Health
The role of the family in the implementation of the mental health element is to: recognize and accept
that mental health problems are like any other disease; seek help as soon as abnormal behaviour is
detected among any of the family members; adopt practices that promote good mental health, such as
breast feeding and family support in times of crisis; avoid behaviour and practices that contribute to poor
mental health such as over permissiveness and rejection of their young ones.

 Dental care
The family plays a very important role in the implementation of dental health care element. This is
because the family is able to reinforce habits that lead to healthy teeth and gums, such as the use of local
tooth sticks; eating of indigenous foods, regular dental checkups and avoiding consumption of large
amounts of refined sugar.

 Community based rehabilitation

Family members should be educated and sensitised by CHWS on how they can reduce disability in the
community. They should take their children for immunization to prevent diseases like polio; attend
antenatal clinics for early detection and management of those with complicated pregnancies; participate
in the care of members with rehabilitative needs; and seek support from organizations whenever
necessary

HIV/Aids/TB Prevention
Since families have a very strong influence on what each member does, they can achieve a lot in
HIV/AIDS/TB prevention by encourage single sex partners; talk openly to their children on the
importance prevention of HIV/AIDS; nursing their members with HIV/AIDS at home and referring

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appropriately for medical care; advocating the use of condoms; and accept family members with
HIV/AIDS and help them to socialize and interact in the community.

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Location and Divisional Level

These two levels will be referred to as the community level in the following discussion.

 Education

As we discussed earlier individuals and communities can protect themselves against diseases and
improve their health if they are well informed. Thus the role of the community here is to seek
information and education from health care providers on how they can improve their health and also
accept to change negative habits and customs which are harmful to their health.

 Nutrition and Food Supply

The activities at this level include: supervision of the CHWs by health committees; identification of high
risk individuals and groups; providing relevant information to the District Development Committees
(DDCs); and providing food security, promoting better food production, storage and marketing.

 Water and sanitation

The role of the community in the implementation of this element is to: work closely with the Public
Health Technician to protect and improve sources of clean water; promote the construction and use of
VIP latrines in the community, and identify leaders to represent them in village health committees where
issues of water sanitation are discussed.

 Maternal, Child Health and Family Planning

Since health workers are members of the local communities, they should train, support and supervise
traditional birth attendants who manage pregnancy and labour in most rural communities. They should
ensure availability of contraceptives and create awareness on the need to fully utilise the MCH/FP
services available in the community.

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 Immunization

The role of the community in the implementation of this element is to ensure that they take all the
children for immunisation. Health workers at the community level should ensure that there is a constant
supply of vaccines and that the cold chain is well maintained. Immunization should be provided on a
daily basis at all health service delivery points and should be integrated with other MCH/FP services.
Health workers should also train and supervise CHWs and provide outreach and mobile services where
there are no statistic facilities.

 Control of endemic diseases (malaria)

The role of the dispensary and health centre is to support the malaria control activities at the community
level. The type of support given depends on the local situation and the objectives of the malaria control
strategy.
The following are the activities we undertake to control endemic diseases at the community level:

 Training supervision and follow up of CHWs and any other field staff;
 Ensuring constant supply of drugs and other supplies required by the community;
 Keeping records of clinical cases, parasitological cases, treatments and results of treatment given
at this level;
 Compiling reports from CHWs/TBAs and providing them with feedback;
 Passing on information to the next level on frequency of malaria diagnosis and clinical results of
treatment;
 House alternative drugs for those who need it.
 Setting out the criterion for referral and how to deal with emergencies due to malaria.

 Treatment of Common Condition

The role of the CHWs should be strengthened so that they can diagnose these conditions and refer or
treat them early before complications set in. The health centre or dispensary should train and monitor
CHWs; maintain records and reports of activities as well as forward them to higher levels. They should
also ensure that field staff including shop keepers are well informed and equipped with necessary
supplies, such as ORS.

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 Essential drugs
At the community level, the health centres are responsible for technical supervision of the use of drugs
by CHW. They should train them on rational use of drugs.

 Dental health
At this level, the role of health workers is providing health education to the other community members
on good dental health practices. Dispensary and health centre staff together with CHWs may require
training on simple procedures for treating dental diseases.

 Community Based Rehabilitation

At the community level health workers have been trained to cater for CBR services within PHC. Their
role here is to mobilise the community to adopt measures that promote good physical health and accept
people with disabilities. They should also train CHWs on how to identify and prevent disabilities; basic
techniques of disability rehabilitation at the community level; referral methods and integration
techniques of the disabled;

 HIV/AIDS, TB/STI Control

At the community level health workers should facilitate health promotion activities; carry out outreach
services including immunization and distribution of condoms; provide the correct treatment using
national guidelines; promote early diagnosis and treatment; support home based care givers; and
implement the HIV/AIDS and TB package.

The District Level

As we had discussed earlier, the district focus for rural development strategy was an important policy
shift in support of PHC. It provided new grounds for practical collaboration between the government
sectors and NGOs based at the district level.

The District Health Management Team is the main coordinator of PHC at the district level.

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 Health Education
At this level the DHMT is in-charge of health care services and activities. Their job is to coordinate and
integrate the various health programmes in the district as well as produce and distribute simple learning
materials to health facilities at the community level.

 Nutrition and Food Supply

Here the role of the DHMT is to ensure food security for the district, establish an early warning system
and analyse district nutrition surveillance data.

 Water and Sanitation

Here the DHMT works closely with the District Development Committee to evaluate coverage of safe
water supply. The DHMT also organises training for public health technicians in water systems,
maintenance and latrine construction; procures the necessary materials; and ensures coordination of
water and sanitation activities with other sectors and NGOs.

 Maternal and Child Health and Family Planning

The role of the DHMT in the implementation of this element is mainly training and continuing education
of health workers. They also monitor and evaluate MCH/FP activities in the district and share their
findings at the DDC meeting. The DDC also plays an import role through its sub-committee on family
planning and population. The DDC selects priority areas and allocates resources to ensure adequate
coverage. It also vets and clears all PHC activity sites within the district.

 Immunisation
The district is responsible for the distribution of supplies, evaluation of district immunization coverage,
and assisting the community level to maintain and repair their cold chain equipment

 Control of Endemic Diseases Especially Malaria

The role of the district level is to keep records and recognise outbreaks of endemic diseases and take the
appropriate action. They should also provide adequate and appropriate malaria diagnostic and
management referral backup as well as coordinate tests which measure the sensitivity of malaria
parasites to the drugs being used.

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 Treatment Of Common Conditions
The role of the district level in the implementation of this element is monitoring and training of health
workers in the field; recognising outbreaks and epidemics and taking appropriate action; production and
upgrading of operational manuals for use in communities; distribution of supplies; and the management
of referrals.

 Essential Drugs
The district level ensures delivery of drug kits to all units and is responsible for continuing education
and monitoring.

 Mental Health
It is the responsibility of the district level to ensure that the mental health policy is implemented in the
district. In addition, they provide training and continuing education of health workers in mental health;
provide transport for mobile community based mental health activities; maintain a register of mental
health activities at inpatient and outpatient levels; and regularly evaluate mental health activities in the
district.

 Dental Health
It is a government policy to have a dental unit and qualified dentist in every district hospital. Therefore
the district level acts as a major referral centre for the management of dental conditions beyond the
scope of the community health facilities. The district level also refers dental patients to the provincial
hospital where better equipment for dental x-ray and laboratory services for dentures are found.

 Community Based Rehabilitation.

Responsibility here is to integrate community based rehabilitation services with other health services in
the district.

Provincial/National Levels

The provincial/national level is the highest level in the hierarchy of PHC implementation. The
responsibility here is shared between the provincial teams and national programme managers. This is

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where policies are translated into strategies for implementation in the other levels we have mentioned. It
is also where the major referral hospitals are found. As such, the activities that they undertake in the
implementation of each PHC elements tend to be similar. To avoid repetition, we shall therefore list
them all together instead of grouping them under each element.

The role of the provincial/national level in the implementation of PHC elements includes the following:

 Provision of training and continuing education programmes for all health personnel;
 Development of mass media, using materials and language relevant to specific provinces and
districts.
 Preparation of health education material e.g. posters and pamphlets.
 Formulation of policy guidelines on food and nutrition, immunization, family planning, and the
management and control of diseases.
 Collaboration with other relevant ministries and NGOs
 Monitoring and evaluation of activities at the district level
 National and provincial disease surveillance and monitoring of drug resistance
 Participation in planning national immunization activities.
 Provision of logistical support i.e. financial, transport, material, and manpower.
 Ensuring steady supply of contraceptive, essential drugs, and other supplies;
 Coordination of donor assistance and technical expertise.
 Making provision for renovations and modernization of hospitals as referral and teaching hospitals
as well as introduction of psychiatric and dental units in provincial and district levels.
 Implementing strategies for promotion and propagation of good mental health practices.
 Ensuring implementation of HIV/AIDS policies, creating awareness and undertaking advocacy in
respective sectors.

RESPONSIBILITIES OF THE KEY IMPLEMENTERS OF PHC

The Community
As you already know, the community is the centre of focus in the implementation of primary health
care. Therefore its responsibilities include the following:

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 To recognize priority problems relating to health
 Decide on what needs to be done to overcome the problems
 Decide on what the community itself can do to solve the problems
 To organize and implement whatever they themselves can do either on their own or with the support
of governmental or non-governmental bodies.
 Monitor and evaluate activities as necessary.

The community meets these responsibilities through the following activities:

 Community participation
 Community awareness
 Community involvement.

Community participation
Community participation is defined as the process by which a community mobilizes its resources,
initiates and takes responsibility for its own development activities, and shares in decision making and
implementation of all other development programmes. The expected outcome of community
participation is the overall improvement of the community’s health status.

The emphasis on community participation represents an enormous change from former healthcare
approaches, which viewed the community as passive recipients of services planned and provided by
others.

Community Awareness
The community should be aware of its problems and the available resources, such as, manpower,
money, materials, ideas and time.

How can community awareness be achieved?:

Participation and involvement of the community in community diagnosis (self diagnosis) diagnosis that
act as a stimulus).

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 Through exposure of the community to another with successful development programmes and by
creating demand.

In addition Barazas, churches, schools and development groups play key roles in promoting awareness.

Creating awareness at the different levels of the community

At the division level, this is done through barazas or small groups, community elders, TBAs, Churches,
and women groups. In addition health workers brief the Division Development Committee who in turn
involve NGOs and local MP.

At location level, PHC awareness is created by the Location Development Committee, NGO’s,
politicians, and opinion leaders. This can be done through barazas, mobile clinics, church gatherings
women groups etc.

You need to appreciate that creating awareness is a dynamic and continuous process. All members of
the community are responsible for creating awareness. Although it takes time, it alerts people about their
health problems. Community participation and awareness is a starting point for problem identification,
which then requires community involvement for its solution.

Community Involvement

Community involvement entails active and willing participation of the community in planning,
management and evaluation of programmes which contribute to their well being. It can lead to the
creation of partnership between the establishment (government), other development agencies and the
community. It also contributes to the attainment of community responsibility and accountability over all
development programmes and thereby preventing a community from alienating itself from such
programmes. Participation and involvement leads to development of self reliance and helps a
community to develop social control over its own infrastructure.
The level at which any community participates in its own development process varies from place to
place. A number of factors could influence the degree of community involvement.

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Factors which influence the degree of community involvement
 A favourable political atmosphere.
 The educational status of the community (literacy may influence the speed at which full participation
and involvement is achieved).
 The community infrastructure (i.e., the communication network)
 Economic factors
 The level of intersectoral coordination at the community level
 Suppression of involvement and initiative by projects which create dependency.

The community should be involved in the following areas of PHC implementation:

 Setting of priorities: through self diagnosis, a community can identify its priorities and identify the
methods to solve them.

 Supervision: The community can play an important role in the supervision of CHWs through the
local health committees.

 Income generating projects: the community can engage in income generating projects, in order to
raise funds to initiate projects.

 Participation of the community in health services.

This is only practical in the following areas where the community can be involved:
- Liaising with health workers to help in problem solving
- Helping to improve environmental sanitation and water supply for the health unit
- Visiting the hospital to assess what assistance they can provide
- Helping with the construction of shelter for the patient’s waiting bay

 Development committees
These include;

 Village health committee

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  Sub-location development committee
 Location development committee
 Divisional development committee
 District development committee

The development committees at grassroots level such as village development committee are usually
concerned with planning, financing, implementing and evaluating projects. They are one of the visible
forms of community participation in the community.

The Government

The political and economic stability of the government has significantly contributed to the successful
development of PHC in Kenya. It has provided an enabling environment for re-orientation and change
towards greater community involvement and self reliance in health and health related matters.

As we saw in Section two of this unit, our government has also continuously reviewed and revised its
strategies in order to integrate the PHC strategy in our health care system. Existing policies have been
reviewed and new ones added in order to guide health development in this country.

In keeping with the government broad health policies, the following objectives have guided the
allocation of resources and programme development during the years:

 Strengthening in real terms the elements of PHC and their implementation;

 Encouraging widespread community participation and the mutual social responsibility of all
Kenyans in health and development through PHC;
 Increasing provision of preventive and promotive services and improving methods of early detection
and treatment of communicable and vector borne diseases with an emphasis on high risk groups;
 Increasing the number of health workers trained in preventive and promotive health methods (such
as, environmental, nutrition, maternal child health and family planning, communicable and vector
borne disease control etc);

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 Pursuing an intersectoral and multidisciplinary approach to health care at all levels with particular
emphasis on increasing inter-ministerial co-ordination in water, sanitation, education and nutrition
activities.
 Improving manpower development policies in order to increase the number of skilled manpower in
hospitals, health centres and dispensaries;
 Designing development projects which favour construction of smaller but more cost effective
facilities aimed at increasing coverage and accessibility of health services, i.e. health centers and
dispensaries;
 Selectively increasing the number of district and sub-district hospitals;
 Increasing basic and post-basic opportunities for all health workers;
 Strengthening the overall management (planning, implementation and evaluation) capability of the
Ministry of Health in the provinces and districts;
 Developing and strengthening logistics and the drug supply system;
 Improving and consolidating various components of the national health information system
(including data gathering, processing, analysis reporting and dissemination methods);
 Improving the facilities, management of out patient services and the quality of care for in-patient
services;
 Standardizing treatment and operational procedures in hospitals, health centres and dispensaries;
 Consolidating existing facilities with an emphasis on maintenance and rehabilitation.

Responsibilities of the Government at the National Level

The responsibilities of the government at the national level are to:
 Ensure a consistent policy and strategy base for Primary Health Care (PHC) activities throughout the
country;
 Be aware of the actions that should be taken to overcome these problems;
 Be aware of the resources available to address these problems from other sectors, NGOs, and
international sources;
 Ensure collaboration among the different government sectors in planning activities that have a
bearing on health;
 Ensure the co-ordination of inputs from both bilateral and multilateral sources in accordance with the
national plan for PHC development.

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A primary health care unit was established in the office of the Director of medical services (DMS). The
unit has a full-time coordinator with a team of professionals and support staff. The functions of the unit
are to:

 Provide overall co-ordination of PHC activities in the country;

 Review and evaluate PHC activities with a view to identify areas in need of strengthening;
 Provide technical and financial support for PHC activities;
 Promote intersect oral collaboration in PHC at all levels;
 Establish and maintain relevant guidelines for implementation of PHC;
 Establish training guidelines in collaboration with relevant institutions and NGOs;
 Liaise with WHO, UNICEF and other agencies on matters relating to PHC;
 Maintain a data base on PHC development and provide quarterly and annual reports of progress.

The various heads of departments in the Ministry of health have been given specific responsibilities in
the implementation of PHC elements. They meet regularly under the chairmanship of the Director of
Medical services to discuss progress and problems relating to each of the elements.

Responsibilities of the government at the Provincial Level

The responsibility of the government is to provide technical support in the planning and management of
PHC at the district level. The provincial health management team is responsible for all PHC activities.

Responsibilities of the government at the District Level

At the district level, the government’s responsibilities are as follows:

 Identifying the existing health problems in the district;

 Identifying what action needs to be taken reduce these problems;
 Identifying the resources available within the community, from other government sectors and NGOs,
to deal with the identified problems;
 Preparing plans to use the resources available in a coordinated manner to improve health;
 Providing technical support to PHC activities in the community;

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 Monitoring the implementation of the district plan both in terms of activities carried out by each of
the actors in the plan and their effect on the health.
The government has set up the District Development Committee (DDC) which is responsible for the
planning and coordination of all development works in the district, including PHC activities.
It is chaired by the District Commissioner and typically includes representatives from all government
ministries and departments located in the district plus important NGOs. It operates through
subcommittees of DDC known as District Health Committee charged with advising on various sectoral
activities. The other district team that is responsible for PHC implementation is the District Health
Management Team (DHMT). It was actually established to strengthen the implementation of PHC
activities in the district. The DHMT is responsible for the planning and implementation of all health
services in the district. It is a member of the DDC and provides technical advice to the DDC on health
matters. In order to ensure the full coordination of health services in the district, the DHMT works
closely through joint memberships. It delegates its responsibility of day-to-day management of PHC
development activities to the PHC CORE TEAM, which is made up of members of the health sector
staff. This team plays an important part in the implementation of PHC in the district, especially in the
area of training.

Responsibilities of the government at the Divisional Level

At the division level, the government implements PHC activities through the Division Development
Committee. This committee usually finds it useful to delegate this responsibility to a PHC coordinating
team. The team may be headed by a member of the health team in the division or any of the division
heads. The main responsibilities of the team are to plan PHC activities such as training; support the
community health workers; and maintain contact with village health development committees. In
addition, the team monitors the PHC activities carried out by other sectors in the division and provide
information to the Divisional Development Committee.

The Divisional Development Committee is made up of the following people:

 The district officer
 Divisional development heads
 Chiefs
 Political leaders
 Religious leaders

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  Women group leaders

Responsibilities of the government at the Community Level

In keeping with its policy of decentralisation and support for community based health care approaches,
the government has assisted communities to set up village health development committee. This
committee is selected by the members of the villages according to their own set up. The committee may
have a membership of six to twelve members, which is normally drawn from community groups or from
people with good organisational skills or a high educational level.

The main responsibilities of the village health development committee are to:
 assist with the identification of health problems in the community and setting of priorities;
 assist with the identification of community resources and coordinating them in planned activities
aimed at overcoming specific health problems;
 assist the community to select community health workers (CHWs) and to provide administrative
supervision of their work;
 Provide a channel of communication between the community and the health and development
committees at the division level;
 Assist with the monitoring of the health of the community;
 Initiate and participate in communal income generating activities.

The final key player in the implementation of PHC in Kenya is Non-Governmental Organisations
(NGOs)

Non-Governmental Organisations (NGOs)

NGOs have been actively involved in developing Community Based Health Care (CBHC) projects since
the mid 1970’s. Although collaboration between the Ministry of Health and NGO’s has so far been
good, it could be improved even more by creation of a joint coordinating committee. Indeed, it was
through such joint efforts with assistance from WHO and UNICEF that National Guidelines for the
implementation of PHC in Kenya were formulated.

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Many NGOs have on-going CBHC schemes. Some of the NGOs actively involved in CBHC
programmes include the following:
African Medical and Research Foundation (AMREF)
Aga khan health services
Christian Health Association of Kenya (CHAK)
Kenya Red Cross society
Action Aid – Kenya
Catholic Relief Services – Kenya
Family Planning Association of Kenya
Institute of Cultural Affairs
National Christian Churches of Kenya (NCCK)
The Undugu Society
World Vision.

PHC ACHIEVEMENTS, CHALLENGES AND WAY FORWARD

Achievements of PHC

When Kenya adopted the Alma Ata declaration of Health for All by the year 2000 and beyond, it
became committed to the integration of all health programmes necessary to bring everyone to a level of
health that would permit them to lead a socially and economically productive life. The following are
some of the achievements of PHC:

 PHC has won widespread acceptance among government ministries, NGOs and international
agencies. Formal commitment has been made to Health for All (HFA) by most countries, including
Kenya.

38
 PHC has had considerable influence in promoting a more equitable distribution of health resources
and in the development of new types of health workers in the country;
 There has been extensive expansion of coverage of several PHC elements;
 Epidemiologically, childhood diseases such as poliomyelitis, measles, tetanus, and pertussis have
decreased owing to the rapid expansion of immunization coverage. This decrease has contributed
significantly to the overall decline in infant and child mortality rate.
 PHC has led to encouraging achievements in the global targets for eradication and control of
selected diseases.
 PHC has made an important contribution to greater social justice and equity by reducing the gap
between those who have access to an appropriate level of health care and those who do not.

Challenges faced in PHC implementation

Although considerable progress has been made in the implementation of PHC our government has
continued to face a number of challenges. These include;
 The major causes of morbidity and mortality in Kenya still remains diseases and conditions that can
be easily prevented through immunization, improved personal hygiene and environmental
manipulation. For example, it has been documented that 36% of the under-five population die
before their fifth birthday due to preventable diseases and conditions. Diarrhoea alone account for
12.8% of under five deaths in Kenya while 12.2% are due to malaria. According to Kenya
Demographic and health surveys of 2003, one out of every nine children born in Kenya dies before
attaining their first birthday, while 40% of infant deaths occur during the first month of life.

 Curative services remain an expensive aspect of Kenya’s health care delivery accounting for about
70% of health budget. Most of these funds are held up in tertiary and secondary level facilities,
which are mainly located in urban areas. This situation has tended to impact negatively on the
allocation of resources thereby undermining the principle of equity in health delivery.

 There has been an increase in the burden of diseases due to emerging and re-emerging diseases, as
well as natural and human disasters. AIDS related illnesses such as pneumonia and TB have a

39
 national prevalence of nearly 10% and account for 14.2% of the burden of disease measured in terms
of life years lost.

 Studies have shown that 55% of Kenyans lack access to safe water and sanitation, a situation that
puts the population at risk of contracting diarrhoea and other communicable diseases. Air pollution,
poor waste management and poor food control measures have also been on the increase.

 Malaria and respiratory diseases combined account for almost 50% of all reported diagnosis in
public health facilities with diarrhoea increasing this to almost 60%.

 Maintenance of the present level of coverage achieved by many PHC programmes, such as KEPI,
has remained highly dependent on continued support from donors, thus raising concern about their
sustainability;

 Despite the five-tier system in health care delivery, there are no clear guidelines on the referral
procedures from one level to the other.

These challenges raised concern not only within the ministry but also among other key stakeholders in
the health sector. To address these concerns, the ministry of health held a series of consultative meetings
and workshops to try and reverse the deteriorating health situation in the country. A major outcome of
this consultative process was the National Health Sector Strategic Plan (NHSSP). This plan was
developed to address the constraints in the health sector and to adopt a sector-wide approach in their
resolution.

Aims of the NHSSP:

 To initiate appropriate structural, financial and organizational reforms.
 To reduce the burden of disease, particularly malaria, HIV/AIDS, and those diseases that are
preventable.

In addition, the plan seeks to:

 develop human and physical capacities,
 put in place cost effective interventions to combat diseases and ill health,

40
 and expand the coverage and accessibility of health services to the vulnerable groups.

In order to implement the reform agenda, a ministerial reform committee known as the Health Sector
Reform Committee was established. It was charged with the responsibility of implementing the reforms
and marketing the respective policies. The committee established guidelines and responsibilities of all
the levels of health provision in this country in the marketing and implementation of the reform policies
as follows;
MOH Headquarters
The role of the headquarters was restricted to policy formulation and development, strategic planning,
setting standards and regulating mechanisms. In addition, it was charged with the responsibility of
regulating and coordinating health training, coordinating donor activities, overseeing the implementation
of the reform process, and ensuring the equitable allocation of national health resources.
The Provincial Level
The role of this level was strengthened to supervise district projects, implement, enforce and maintain
health standards for services and infrastructure. The Provincial Health Management Teams were to be
equipped with the necessary tools and management skills and empowered to perform these activities.
This is in addition to assisting the districts in developing their respective plans and training activities.
District Level
Here the District Health Management Teams complemented by the District Health Management Boards
were to play a central role in implementing health reforms at district level. The specific roles of this tier
were to include:
 Preparing work plans
 Implementation and maintenance of district plans
 Provision of curative, rehabilitative, preventive and PHC services.
 Coordination and supervision of other health providers
 Enforcement of health standards
 Prioritisation of health problems.
 Collaboration with other sectors, donor agencies, NGOs and other partners in health and health
related activities
 The management of district based HMIS and the implementation of district specific health
reforms

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Local Institution Structure within the Communities
 Bamako initiatives
 Village Health Committees
 Community Health Workers
 Traditional practitioners
 Community leaders

These systems would be strengthened to enhance the participation of the households in health and health
related activities at the local level. To this end, local health campaigns would be organized and
conducted to control endemic diseases. In addition, the structure would further be empowered to manage
local health initiatives and funds.

The households were recognized as key community units in health care delivery. It is thus paramount
that their abilities to be developed to recognize ill health instantaneously and treat simple systems and
conditions. Under the NHSSP, this would gradually be developed by providing households with
adequate information and assisting them in deciding, obtaining and administering simple, safe and
effective medication. This was in addition to preparing them to provide basic health care and providing
them with sufficient knowledge and ability to refer serious conditions for further management.

Way Forward
There is no doubt that our government is committed to improving the country’s health status. It has
introduced policies and constantly reviewed and revised its strategies in order to implement PHC in this
country. However, there are a number of things we can do at our level to improve the implementation of
PHC. These are:

 Rational and effective use of resources such as drugs, time, and funds which are allocated to our
health facilities. One way of ensuring the rational use of drugs is , for example, by making the
correct clinical diagnosis and prescribing appropriately;
 Continuously updating our knowledge, skills, and attitudes to ensure that we are current in terms of
new diseases, treatment regimes, and government policies. For example, the management of malaria

42
 is continuously changing as the parasites become resistant to drugs. You need to keep updating
yourself on this;
 Advocating for policy change and good governance at all levels;
 Effective disease surveillance and reporting so that measures can be taken in good time;
 Implementing the primary health care elements at our level.

It is anticipated that if these four areas are addressed, the following benefits will accrue:

 An effective legal and regulatory framework for the provision of quality health services
 More equitable distribution of financial resources
 Better coordination of health services which are provided by the various stakeholders including
the MOH.

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