Primary Health Care

Primary Health Care
Shaheen Ghani
Lecturer INS
kmu
Levels of Care
• Primary health care

• Secondary health care
• Tertiary health care
Primary health care
• The “first” level of contact between the
individual and the health system.
• Essential health care (PHC) is provided.
• A majority of main health problems can be

satisfactorily managed.
• The closest to the people.
• Provided by the primary health centers.

Secondary health care
• More complex problems are distributed with.
• Comprises curative services
• Provided by the district hospitals
• The 1st referral level

Tertiary health care
• Offers super-specialist care
• Provided by regional/central level

institution.
• Provide training programs
• Primary health care (PHC) became a core policy
for the World Health Organization with the Alma-
Ata Declaration in 1978 and the ‘Health-for-All by
the Year 2000’ Program.
•The commitment to global improvements in health,

especially for the most disadvantaged populations,
was renewed in 1998 by the World Health
Assembly. This led to the ‘Health-for-All for the
twenty-first Century’ policy and program, within
which the commitment to PHC development is
restated.
What is Primary Health Care?
PHC is essential health care that is:

• a socially appropriate,
• universally accessible,
• scientifically sound first level care provided by a

suitably trained workforce
• supported by integrated referral systems
Cont..
• and in a way that gives priority to those

most in need, maximizes community and
individual self-reliance and participation
and involves collaboration with other
sectors.
Cont…
PHC includes the following:
•Health promotion
•Illness prevention
•Care of the sick
•Advocacy
•Community development
Primary Health Care (PHC)
• PHC is:
Essential health care based on practical,
scientifically sound and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation and at
a cost that community and the country can afford
… (Alma-Ata, 1978)
Principles for PHC
• PHC based on the following principles :
• Social equity
• Nation-wide coverage
• Self-reliance
• Inter-sectoral coordination
• People’s involvement in the planning and

implementation of health programs
Principles of PHC
A set of PRINCIPLES for primary health care. PHC
(1978 Declaration of Alma-Ata )
1. “Reflect and evolve from the economic conditions
and socio-cultural and political characteristics of

the country and its communities, and be based on
the application of the relevant results of social,
biomedical and health services research and public
health experience”
Cont…
• 2. “Address the main health problems in

the community, providing promotive,
preventive, curative and rehabilitative
services accordingly”
Cont..
3. “Involve, in addition to the health sector,
all related sectors and aspects of national

and community development, in particular
agriculture, animal husbandry, food,
industry, education, housing, public works,
Cont…..
• 4. “Promote maximum community and
individual self-reliance and participation in
the planning, organization, operation and
control of primary health care, making
fullest use of local, national and other
available resources; and to this end
develop through appropriate education the
ability of communities to participate”
5. “Be sustained by integrated, 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”
.”
Cont…
• 6. “Rely, at local and referral levels, on
health workers, including physicians,
nurses, midwives, auxiliaries and
community workers as applicable, as well
as traditional practitioners as needed,
suitably trained socially and technically to
work as a health team and to respond to
the expressed health needs of the
community
Core Activities for PHC
There is a set of CORE ACTIVITIES,

which were normally defined nationally or
locally. According to the 1978 Declaration
of Alma-Ata proposed that these activities
should include:
Cont.
1. Education concerning prevailing health

problems and the methods of preventing
and controlling them.
2. Promotion of food supply and proper

nutrition
Cont..
3. An adequate supply of safe water and
basic sanitation
4. Maternal and child health care, including
family planning
5. Immunization against the major infectious
diseases
6. Prevention and control of locally endemic
diseases.
Cont..
7. Appropriate treatment of common
diseases and injuries.
8. Basic laboratory services and provision of
essential drugs.
9. Training of health guides, health workers
and health assistants.
10. Referral services
• Mental health
• Physical handicaps
• Health and social care of the elderly
WHO Strategies of PHC
1. Reducing excess mortality of poor marginalized
populations:
PHC must ensure access to health services for the most
disadvantaged populations, and focus on interventions
which will directly impact on the major causes of
mortality, morbidity and disability for those populations.
Cont..
• 2. Reducing the leading risk factors to
human health:
• PHC, through its preventative and

health promotion roles, must address
those known risk factors, which are the
major determinants of health outcomes for
local populations.
3. Developing Sustainable Health Systems:
PHC as a component of health systems

must develop in ways, which are
financially sustainable, supported by
political leaders, and supported by the
populations served.
Cont…..
• 4, Developing an enabling policy and
institutional environment:
• PHC policy must be integrated with other

policy domains, and play its part in the
pursuit of wider social, economic,
environmental and development
• policy.
The Basic Requirements for Sound
PHC (the 8 A’s and the 3 C’s)
• Appropriateness • Assessability
• Availability • Accountability
• Adequacy • Completeness
• Accessibility • Comprehensiveness
• Acceptability • Continuity
• Affordability
Appropriateness
• Whether the service is needed at all in

relation to essential human needs,
priorities and policies.
• The service has to be properly selected
and carried out by trained personnel in
the proper way.
Adequacy
• The service proportionate to

requirement.
• Sufficient volume of care to meet the need
and demand of a community
Affordability
• The cost should be within the means

and resources of the individual and the
country.
Accessibility
• Reachable,
• convenient services
• Geographic, economic, cultural

accessibility
Acceptability
• Acceptability of care depends on a variety

of factors, including:
• satisfactory communication between
health care providers and the patients,
• whether the patients trust this care, and
whether the patients believe in the
confidentiality and privacy of information
shared with the providers.
Availability
• Availability of medical care means that

care can be obtained whenever people
need it.
Assessability
• Accessibility means that medical care can

be readily evaluated.
Accountability
• Accountability implies the feasibility of

regular review of financial records by
certified public accountants.
Completeness
• Completeness of care requires adequate

attention to all aspects of a medical
problem, including prevention, early
detection, diagnosis, treatment, follow up
measures, and rehabilitation.
Comprehensiveness
• Comprehensiveness of care means that

care is provided for all types of health
problems.
Continuity
• Continuity of care requires that the

management of a patient’s care over time
be coordinated among providers.
To Summarize
Primary care is an approach that:
• Focuses on the person not the disease,
considers all determinants of health
• Integrates care when there is more than
one problem
• Uses resources to narrow differences
Cont….
• Forms the basis for other levels of health
systems
• Addresses most important problems in the
community by providing preventive,
curative, and rehabilitative services
• Organizes deployment of resources
aiming at promoting and maintaining
health.
THANK YOU

Primary Health Care

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Primary Health Care

• Primary health care

• A majority of main health problems can be

• Provided by the primary health centers.

• More complex problems are distributed with.

• Comprises curative services

• Provided by the district hospitals

• The 1st referral level

• Offers super-specialist care

• Provided by regional/central level

•The commitment to global improvements in health,

PHC is essential health care that is:

• scientifically sound first level care provided by a

• and in a way that gives priority to those

•Care of the sick

• People’s involvement in the planning and

1. “Reflect and evolve from the economic conditions

and socio-cultural and political characteristics of

• 2. “Address the main health problems in

3. “Involve, in addition to the health sector,

all related sectors and aspects of national

There is a set of CORE ACTIVITIES,

1. Education concerning prevailing health

2. Promotion of food supply and proper

• PHC, through its preventative and

PHC as a component of health systems

• PHC policy must be integrated with other

• Whether the service is needed at all in

• The service proportionate to

• The cost should be within the means

• Geographic, economic, cultural

• Acceptability of care depends on a variety

• Availability of medical care means that

• Accessibility means that medical care can

• Accountability implies the feasibility of

• Completeness of care requires adequate

• Comprehensiveness of care means that

• Continuity of care requires that the

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