PHC

Dr. Shirmohammadi

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• The International Conference on Primary Health Care (PHC) was held in September 1978 in
Alma-Ata, resulting in a 10-point declaration defining primary health services.

• This declaration set the goal of "Health for All" by 2000, emphasizing physical, mental, and
social well-being, and identified primary health care as essential to achieving this goal.

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Key Emphases and Actions:

 2003: The World Health Report emphasized the importance of Primary Health Care (PHC) in
promoting health and reducing inequalities.

 2004: The World Health Organization established a Global Commission to examine social
determinants affecting health, aiming to guide policy-making.

 2005: A report highlighted disparities and challenges in accessing health services, focusing on
the prevention of avoidable deaths.

 2008: The report focused on the importance of PHC and emphasized the essential for
investment at various healthcare levels.

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• Margaret Chan, dean of WHO, stated that PHC can serve as a framework for organizing health
services from home to hospital, and with appropriate investment, it can reduce the burden of
diseases.

• The 2008 WHO report emphasizes that a significant portion of resources is allocated to curative
services, while prevention and health promotion capable of reducing 70% of the global disease
burden are often overlooked.

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 Key Principles of Primary Health Care (PHC):

 Universal Coverage: Everyone should have access to health services according to their needs, regardless
of their ability to pay.

 People-Centered Services: Health systems must answer to the needs of the people and create access points
within communities.

 Public Health Policies: Attention should be given to health determinants that lie outside the health sector.

 Leadership in Health Systems: Leadership must actively participate in managing systems and engage all
components of the community

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History of PHC in Iran:
Behvar Training Program: Launched in 1940 in Mashhad, followed by implementation in Isfahan and
Shiraz.

Health Sepah Initiative: Operated from 1964 to 1978.

Rezaiyeh Research Project: Started in 1972 in Urmia to train non-medical personnel for primary health care
delivery.

Health Networks: Established in cities since 1984.

Family Physicians: Introduced in 2005 to enhance public access to health services.

These initiatives reflect Iran's efforts to address healthcare delivery challenges and medical workforce
distribution.

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The Primary Health Care (PHC) system faces serious challenges, including:
Human Resource Shortage
Inadequate Financial and Educational Resources
Low Quality of Services

In developing countries, additional issues such as barriers in referral systems and a tendency to invest more in
higher levels of health services also exist.
To address these challenges, proposed strategies include:

 Infrastructure Development

 Reorganization of PHC

 Transformation in Human Resource Education

 Intersectoral Coordination

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The Role of Health in Today's Life: Public health advancements, such as access to safe drinking water and
vaccination programs, have helped reduce risks for health. Governments are obligated to design appropriate
interventions to control risk factors. Additionally, educating and raising community awareness to prevent
risky behaviors is essential.

Importance of Health: Health is defined as complete physical, mental, and social well-being, and maintaining
it requires significant efforts. Health equity must be established to answer the needs of the community
effectively. Health has a substantial impact on other sectors of society, and existing health inequalities must
be addressed.

Conclusion: The PHC system must be strong to enhance public health coverage, improve service quality, and
reduce costs.
Identifying strategies to reinforce this system has been conducted in six key areas:
governance, financing, human resources, technology, pharmaceuticals and equipment, information systems.

These actions can contribute to improving community health and require active participation from all sectors.

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Health Equity:
Health equity refers to the provision and maintenance of health for all individuals in society. This concept
emphasizes equity in access to healthcare services and the absence of economic and social status effects on
individuals’ health. Health inequity occurs when there are unfair differences in the distribution of resources
and access to healthcare services.

Key Points:
Definition of Health Equity: Equity is achieved when all individuals can use natural resources and healthcare
services without limitations on their access to these services.
Importance of Primary Health Care: The Primary Health Care (PHC) approach is recognized as a global
strategy for achieving equity in access to health services.
Government Responsibilities: Provision of public health requirements and designing of necessary
interventions to control risk factors are the main duties of governments.
Conclusion:
Health should be regarded as a public right, and efforts to achieve health equity require teamwork between
all sectors with attention to social, economic, and cultural factors.

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Primary Health Care (PHC) is defined as essential and fundamental health services that are accessible to
all individuals and families. These services form the core of the health system and economic and social
development, PHC is the first point of contact for individuals within national health systems.

Definition by the World Health Organization (WHO):

PHC refers to essential health care that is universally accessible to all members of the community, aiming to
maintain and improve individual health levels. These services should encompass a comprehensive range of
preventive, curative, and rehabilitative care.

Key Components of PHC:

Meeting Health Needs: This includes comprehensive, preventive, curative, rehabilitative, and palliative
care throughout a person's life.

Determinants of Health: Attention to social, economic, and environmental factors that impact health.

Empowerment: Encouraging individuals and communities to optimize their health and participate in social
policies and services.

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Key Facts:
• PHC can address a significant portion of an individual's health needs
throughout their life.
• At least half of the world's population still lacks full coverage of essential health services.

 History:
The Primary Health Care (PHC) conference was held in 1978 in Alma-Ata, aiming to introduce
methods for achieving health for all.
 PHC is a comprehensive approach that focuses on the needs and priorities of individuals, families,
and communities, emphasizing the physical, mental, and social aspects of health.
 Overall, PHC is recognized as a key element in global health systems, with the goal of promoting
equity in access to health services for all members of society.
 As essential and fundamental services, PHC meets individuals' health needs throughout their lives and
includes promotion, prevention, rehabilitation, and palliative care.
 The objective of these services is to maintain and enhance community health levels, emphasizing the
need to cover a full spectrum of preventive, curative, and rehabilitative services.

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Principles and Concepts of PHC:
Social Justice: PHC is recognizing every individual's right to reach the highest possible level of
health.
Diverse Definitions: ranging from the provision of personal care to health interventions for low-
income populations.
Community Participation: Service delivery should be carried out with the full participation of the
community and based on local needs.
Key Components of PHC:
Health education
Proper nutrition
Access to safe water and sanitation
Maternal and child health care
Immunization against infectious diseases
Disease prevention and control
Treatment of common diseases and injuries
Provision of essential medications

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Goals of PHC:
• To provide easy and continuous access to health services in individuals'
living areas.
• To ensure equitable distribution of health resources, particularly in low-
income regions.
• To promote health as a central focus of economic and social development.
• PHC is a comprehensive approach that centers on the needs and priorities of
individuals, families, and communities, emphasizing the physical, mental,
and social aspects of health

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Components of Primary Health Care (PHC):The components of PHC are defined as a comprehensive
framework for delivering health services in various communities. These components include:
Health Education: Increasing community awareness about health issues and prevention methods.
Nutrition Improvement: Ensuring adequate nutritional needs to promote overall health.
Maternal and Child Health Care and Family Planning: Providing specialized health services for mothers
and children, along with family planning programs.
Access to Safe Water and Environmental Sanitation: Ensuring access to safe drinking water and
improving environmental conditions.
Occupational Health: Promoting health in workplace environments.
Immunization or Vaccination: Preventing infectious diseases through vaccination.
Prevention and Control of Common and Endemic Infectious Diseases: Identifying and controlling
infectious diseases.
Provision of Appropriate Diagnostic and Treatment Facilities: Ensuring access to effective medical
services.
Predicting and Provision of Essential Medicines: Supplying necessary medications for disease treatment.
Mental Health: Addressing the mental well-being of community members.
Oral Health: Providing oral health services.
Accident and Injury Prevention: Reducing risks associated with accidents.
Control of Non-Communicable Diseases: Managing diseases such as diabetes and hypertension. 14
Levels of Service Delivery
Primary health care is provided at three levels:

Level One: This level includes essential primary care services delivered by trained personnel at rural
health centers. It focuses on addressing basic health needs.

Level Two: This level includes more complex medical services provided at county health centers and
hospitals. It serves as the first point of referral for particular services.

Level Three: This level consists of super-specialized services that require planning, management, and
training of specialized staff. It supports the implementation of actions at Level One.

This structure aims to ensure the equitable distribution of health resources and easy access to services for
all members of the community.

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Key indicators for evaluating and comparing countries according to the World Health Organization
(WHO) to achieve the goal of "Health for All" (HFA) have been established. These indicators
include (PART 1)
Adoption of Health Policy for All: It should be accepted as a general policy by first-level
authorities in the country.
Community Participation: Engaging the community, including non-governmental organizations
(NGOs), in health provision.
Financial Resource Allocation: At least 5% of Gross National Product (GNP) should be allocated
to health.
National Health Budget: A reasonable percentage of the national budget should be allocated to
primary health care in each region.
Equitable Distribution of Resources: Health resources should be distributed fairly between urban
and rural areas.
Comprehensive Strategy for HFA: Developing strategies to achieve the goal of health for all.
Access to Primary Care: Ensuring access to safe water and sanitary waste removal near living
areas.
Vaccinations: Immunization against six major diseases, including tetanus, diphtheria, whooping
cough, measles, polio, and tuberculosis. 16
Key indicators for evaluating and comparing countries according to the World Health Organization
(WHO) to achieve the goal of "Health for All" (HFA) have been established. These indicators
include (PART 2)
Access to Medicines: Access to at least 20 essential medicines within a one-hour walk or by vehicle.
Trained Personnel: Access to trained staff for the care of pregnant women and children up to at
least one year of age.
Adequate Child Nutrition: Ensuring that newborns weigh more than 2500 grams at birth and
maintaining appropriate weight for children.
Child Mortality Rate: Reducing infant mortality under one year to less than 50 per thousand.
Life Expectancy: Increasing life expectancy to over 60 years.
Literacy Rate: Achieving literacy rates of over 70% among adult men and women.
Per Capita GNP: The per capita GNP should exceed $500.
These indicators not only set quantitative targets but also emphasize the importance of ongoing
processes to improve community health, demonstrating that "Health for All" is not a limited goal but
an ongoing effort requiring continuous action to enhance individual health.

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  The foundation of the "Health for All" policy includes key principles and objectives as follows:
 Birthright of the People: Health and well-being are recognized as fundamental rights for all
individuals, and ensuring this is a global social goal.
 Equitable Distribution of Resources: Fair distribution of health services among countries and within
countries to ensure public access to primary health care.
 Community Participation: Encouraging active participation of the community in shaping the health
and economic future of society.
 Political Commitment from Governments: There must be a political commitment from governments
to ensure health for all.
 Foundation for Economic and Social Development: Health and well-being should be considered the
basis for economic and social development, requiring collaboration from other sectors such as
agriculture, industry, housing, education, and media.
 International Cooperation: The essential of technical and economic cooperation among countries for
the development and implementation of health strategies, emphasizing that self-sufficiency in health
is not required, but international collaboration is essential.

 These principles reflect the importance of a comprehensive and coordinated approach to ensuring
public health and enhancing the quality of life for individuals in various communities.
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