PRIMARY

HEALTH CARE IN
SOUTH AFRICA
PRESENTED BY V. NTSALU
2024
PHC: Lecture Outcomes

LEARNING OUTCOMES

On completion of this lecture students will be able to:

• Describe and explain the concept of primary health care (PHC)
• Explain the core norms and standards relating to PHC
• Use these norms and standards as a guide to measure the extent to which PHC
services in SA comply with policies and public expectations
• Understand and explain the role of the pharmacist in PHC
Overview of this lecture

What is health and Pre-requisites for Health systems and The right to health
wellness? health health care systems care

Historical
The Declaration of Significant development of
Definition of PHC
Alma-Ata principles of PHC modern PHC
systems

Patients’ rights and

Final points on PHC
responsibilities
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What is health?

“Health is a state of
complete physical, mental
WHO Definition adopted in
and social wellbeing, and
1948:
not merely the absence of
disease or infirmity.”
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What is health?

 Whilst this definition is still in use it has been criticized

 It has been seen by some unrealistic
 The word “complete” is too absolute
 With the increase of chronic diseases, anyone with a chronic disease is not healthy
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What is health?

The following additions were recommended (Ottawa Charter for Health Promotion, 1986):

Health is seen as a resource for everyday life, not the objective of living

Health is a positive concept emphasizing social, personal and physical resources /

capacities

To achieve health a person must be able to identify and realize aspirations to ① satisfy
needs and to ②change or cope with the environment.
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What is wellness?
 Achieving a balance of harmony between:
 Physical health
 Emotional (mental) health
 Sexual health
 Intellectual health
 Occupational health
 Social health
 Environmental health
 Spiritual health
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Pre-requisites for health
 Fundamental conditions and resources needed for health according to the Ottawa Charter for Health
Promotion, 1986
 Peace
 Shelter
 Education
 Food
 Income
 A stable eco-system
 Sustainable resources
 Social justice
 Equity
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Health systems & health care Systems

 A health system:
 All ① organisations,② institutions and ③ resources that produce actions whose
purpose is to improve health
 A health care system:
 ①Institutions,② people and ③ resources involved in delivering health care to the
individual
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The right to health care

 The Universal Declaration of Human Rights (UDHR), United Nations 1948

 Everyone “ has the right to a standard of living adequate for the health and well-being
of himself and his family, including food, clothing, housing and medical care and
necessary social services.”
 The Constitution of the Republic Of South Africa, 1996
Chapter 2 – The Bill of Rights
 “Everyone has the right of access to –
Health care services, including reproductive health care, sufficient food and water, and
social security, including, if they are unable to support themselves and their dependents,
appropriate social assistance.”
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The right to health care
 The right to health is more than just access to doctors, nurses and medicines
 People must be able to live under conditions that do not harm their health and
wellbeing
 Health is the responsibility of:
 The individual
 Society
 Government
 Employers
 The market
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Declaration of Alma-Ata, 1978
 The International Conference on Primary Health Care in Alma-Ata, September
1978
 Expressed the need for urgent action by all governments, all health and
development workers and the world community to protect and promote the health
of all people of the world
 Strongly reaffirmed that health, is a fundamental human right and that the
attainment of the highest possible level of health is a most important world-wide
social goal whose realization requires the action of many other social and
economic sectors in addition to the health sector.
 Primary health care is the key to attaining a level of health for all people by
2000 that will allow them to lead a socially and economic productive life.
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Declaration of Alma-Ata, 1978
 The conference defined primary health care as follows:
 Primary health care is essential health care
 It is based on practical, scientifically sound and socially acceptable methods and
technology
 It is universally accessible to individuals and families in the community through their
full participation
 It is at a cost that the community and country can afford to maintain in every stage of
their development to self-reliance and self-determination
 It is the first level of contact of individuals with the national health system
 It brings health care as close as possible to where people live and work
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Declaration of Alma-Ata, 1978
 Primary health care includes at least:
 Education about prevailing health problems
 Methods of preventing and controlling prevailing health problems
 Promotion of food supply and proper nutrition
 Adequate supply of safe water and basic sanitation
 Maternal and child health including family planning
 Immunization against major infectious diseases
 Prevention and control of locally endemic diseases
 Treatment of common diseases and injuries
 Provision of essential drugs
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Significant principles of PHC
1) Universal access to care and coverage on the basis of need
- no unreasonable geographic or financial barriers
2) Health promotion
-Involve health education, nutrition, sanitation
3) Community participation in defining and implementing health agendas
- society has the right and responsibility to be an active partner in making decisions with respect to health care
4) Appropriate technology and cost-effectiveness
- use of methods of care, service delivery, procedures and equipment that are socially acceptable and affordable
5) Inter-sectoral approaches to health
- commitment from various levels & departments of government as well as the community and the health sector
Declaration of Alma-Ata, 1978
PHC Service Delivery Reforms
Comprehensive services, patient education, food security and nutrition, water and sanitation,
maternal and child health, family planning, immunisation, endemic and common diseases, injuries,
essential drugs, co-ordinated, prioritise local health needs, suitably trained health workers working
in a team

PHC approach:
Inter-sectoral equity, social Community
collaboration justice, health as participation
a right
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Principles of PHC in a systems perspective

 A health system based on PHC will:

1) Build on the Alma-Ata principles of equity, universal access, community
participation and inter-sectoral approaches
2) Take into account the broader health issues of the population and reflect and re-
enforce public health functions
3) Create conditions for effective provision of services to poor and excluded groups
4) Organise integrated and seamless care that links prevention, acute care and
chronic care across all components of the health system
5) Continuously evaluate and strive to improve performance
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Services that PHC provides

 Preventative: prevention of illness and disease

 Promotive: health and wellness promotion
 Curative: treatment of illness, diseases and injuries (including the provision of
essential drugs)
 Rehabilitative: rehabilitation of patients

 The focus of PHC will be prevention and promotion

WORLD HEALTH REPORT 2008

SERVICE
DELIVERY
UNIVERSAL
REFORMS
COVERAGE
REFORMS To make health
systems people
To improve health
centred
equity

LEADERSHIP PUBLIC POLICIES

REFORMS REFORMS
To make health To promote and
authorities more protect the health of
reliable communities
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The SA National Patients’ Rights Charter : Patient Rights
 According to the National Patients' Rights Charter, every patient has the right to:
 A healthy and safe environment that will ensure their physical and mental health or well-being.
 Take part in deciding on matters affecting one's health.
 Proper emergency care at any health care facility.
 Treatment and rehabilitation.
 Special needs care, especially newborn infants, children, pregnant women, the aged, disabled
persons, patients with chronic pain, people living with HIV/AIDS.
 Counselling without discrimination, intimidation or violence on matters such as reproductive
health, cancer or HIV/AIDS.
 Affordable and effective care for people in the final stages of their lives.
 Friendly health care providers.
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The SA National Patients’ Rights Charter : Patient Rights
 Health information in their language of choice.
 Knowledge of health insurance and medical aid schemes.
 Choose their own health care provider or health facility.
 Be treated by a clearly identified health care provider.
 Confidentiality and privacy concerning health care issues and treatment.
 All information regarding their illnesses, treatment and the costs involved.
 Refuse treatment verbally or in writing.
 Be referred for a second opinion to a healthcare professional of their choice.
 Continuous care.
 Complain about health services, have their complaints investigated and to receive a full response.
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The SA National Patients’ Rights Charter : Patient
Responsibilities
 All patients need to:
 Take care of their health.
 Care for and protect the environment.
 Respect the rights of other patients and health providers.
 Use the health care system properly and not abuse it.
 Know his or her local health service and what they offer.
 Provide health care providers with the relevant and accurate information for diagnostic, treatment, rehabilitation or
counselling purposes.
 Advise the health care providers on his or her wishes regarding death.
 Comply with treatment or rehabilitation procedures.
 Ask about the related costs of the treatment and /or rehabilitation and arrange for payment.
 Take care of any health records they may have.
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Final general points on PHC
PHC is a community based and decentralized approach to health care that will allow
communities to lead socially and economically productive lives

The PHC mission is to put “people first”

PHC must be shaped around the life patterns of the population

PHC must meet the needs of the local community as well as being an integral part of
the national healthcare system

PHC must provide preventative, promotive, curative and rehabilitative services for the
individual, family and society