Health for all- primary health care- millennium development goals

Health For All , Primary Health Care and Millennium Development Goals
Dr. Ahmed-Refat AG Refat
www.SlideShare.net/AhmedRefat

HFA, PHC & MDG
Health For All,
Primary Health Care
and

Millennium Development
Goals
Dr. Ahmed-Refat AG Refat 07/12/20121

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Contents
 Alma Ata Declaration- Health for All
 Basic Principles of Primary Health care PHC
 Components of Primary Health care
 Comprehensive Vs. Selective PHC approaches
 Selective PHC "GOBI & GOBI-FFF"
 Millennium Development Goal -MDGs
 The 8 MDG – Facts – Targets
 Q &A

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Alma-Ata Declaration
&
Primary Health Care
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Declaration of Alma-Ata
International Conference on Primary Health Care,
Alma-Ata, USSR, 6–12 September 1978

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth
day of September in the year Nineteen hundred and seventy-eight, expressing 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 the people of the world, hereby makes
the following Declaration:

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I

The Conference strongly reaffirms that health, which is a state of
complete physical, mental and social wellbeing, and not merely the
absence of disease or infirmity, 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.
II
The existing gross inequality in the health status of the people
particularly between developed and developing countries as well as
within countries is politically, socially and economically unacceptable
and is, therefore, of common concern to all countries.

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III

Economic and social development, based on a New International
Economic Order, is of basic importance to the fullest attainment of health
for all and to the reduction of the gap between the health status of the
developing and developed countries. The promotion and protection of the
health of the people is essential to sustained economic and social
development and contributes to a better quality of life and to world peace.

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IV

The people have the right and duty to participate individually and
collectively in the planning and implementation of their health care.
V
Governments have a responsibility for the health of their people which
can be fulfilled only by the provision of adequate health and social
measures. A main social target of governments, international
organizations and the whole world community in the coming decades
should be the attainment by all peoples of the world by the year 2000 of a
level of health that will permit them to lead a socially and economically
productive life. Primary health care is the key to attaining this target as
part of development in the spirit of social justice.

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VI

Primary health care 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 the community and
country can afford to maintain at every stage of their development in the
spirit of self reliance and self-determination. It forms an integral part both
of the country’s health system, of which it is the central function and
main focus, and of the overall social and economic development of the
community. It is the first level of contact of individuals, the family and
community with the national health system bringing health care as close
as possible to where people live and work, and constitutes the first
element of a continuing health care process.

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VII

Primary health care:

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

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

3. includes at least: education concerning prevailing health problems and
the methods of preventing and controlling them; promotion of food

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supply and proper nutrition; an adequate supply of safe water and basic
sanitation; maternal and child health 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. involves, 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,
communications and other sectors; and demands the coordinated efforts
of all those sectors;

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5. requires and promotes 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 develops through appropriate
education the ability of communities to participate;

6. should 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;

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7. relies, 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.
VIII
All governments should formulate national policies, strategies and plans
of action to launch and sustain primary health care as part of a
comprehensive national health system and in coordination with other
sectors. To this end, it will be necessary to exercise political will, to
mobilize the country’s resources and to use available external resources
rationally.

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IX

All countries should cooperate in a spirit of partnership and service to
ensure primary health care for all people since the attainment of health by
people in any one country directly concerns and benefits every other
country. In this context the joint WHO/UNICEF report on primary health
care constitutes a solid basis for the further development and operation
of primary health care throughout the world.

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X

An acceptable level of health for all the people of the world by the year
2000 can be attained through a fuller and better use of the world’s
resources, a considerable part of which is now spent on armaments and
military conflicts. A genuine policy of independence, peace, détente and
disarmament could and should release additional resources that could
well be devoted to peaceful aims and in particular to the acceleration of
social and economic development of which primary health care, as an
essential part, should be allotted its proper share.

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The International Conference on Primary Health Care calls for urgent and
effective national and international action to develop and implement
primary health care throughout the world and particularly in developing
countries in a spirit of technical cooperation and in keeping with a New
International Economic Order. It urges governments, WHO and UNICEF,
and other international organizations, as well as multilateral and bilateral
agencies, nongovernmental organizations, funding agencies, all health
workers and the whole world community to support national and
international commitment to primary health care and to channel
increased technical and financial support to it, particularly in developing
countries.
The Conference calls on all the aforementioned to collaborate in
introducing, developing and maintaining primary health care in
accordance with the spirit and content of this Declaration.

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PRIMARY HEALTH CARE (PHC)

Definition:

PHC is the essential care based on practical, scientifically sound and
socially acceptable method and technology made universally accessible to
individuals and families in the community through their full participation
and at a cost they and the country can afford to maintain in the spirit of self
reliance and self determination.

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BASIC PRINCIPLES OF PRIMARY HEALTH CARE

THE BASIC PRINCIPLES OF PRIMARY HEALTH CARE include:

1. Community participation

2. Intersectoral collaboration

3. Integration of health care programmes

4. Equity

5. Self-reliance.

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1- COMMUNITY PARTICIPATION

Is the wholemark of primary health care, without which it will not succeed.
Community participation is a process by which individuals and family
assume responsibility for their own health and those of the community and
develop the capacity to contribute to their/and the community development.
Participation can be in the area of identification of needs or during
implementation.

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The community needs to participate at village, ward, district or local
government level. Participation is easier at the ward or village level
because the issue of heterogeneity is eliminated.

ADVANTAGES
-It addresses the felt health needs of the people
-It ensures social responsibility among the community
-It ensures sustainability
-It ensures cost sharing
-It ensures enhancement of knowledge
-It encourages intersectoral collaboration

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2- INTER SECTORAL COLLBORATION

This is the coordination of health activities with other sectors; such sectors
include Education, Finance, Agriculture, Information etc. There should be a
working relationship these bodies and the health ministry.

ADVANTAGES
-Overall human development
-It ensures economic development
-It ensures affordability

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3- INTEGRATON OF HEALTH SERVICES
This is defined as coordination of various primary health care components

into a whole programme and made available at all times including referrals.

ADVANTAGES

-It ensures efficient use of all resources and removes areas of wastage.

-It ensures sustainability of programme

-It ensures bye pass phenomenon

-It reduces opportunity cost

-It grantees clients confidentiality

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4- EQUITY
The health care resources available in a given community should not be in
the handle of a few. And resources should be accessible and affordable to
all. It is divided in 3 components:
1. Decentralization of health of services into federal state-local
government-ward levels.
2. The essential drug services and the national drug formulae. making
drugs available at all levels and at low cost.
3. National health insurance scheme-where people contribute to the health
services of those who don’t have or cannot afford.

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5- SELF RELIANCE

This involves the use of technological methods and scientifically sound
and maintain by the community .It can be in terms of human resources,
money or materials.
.
ADVANTAGES OF SELF RELIANCE
-Affordability
-Sustainability
-Acceptability
-Authenticity

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COMPONENTS OF PRIMRY HEALTH CARE
There are 8 components (elements)of primary health care.
1. Immunization: An increasing number of infectious diseases can be
prevented by vaccinations example-measles, Meningitis, Pertusis,
tuberculosis, yellow fever etc

2. Maternal and child care: Pregnant women and women of child bearing
age (15-49 years) are the target group for special care. Children under
5yrs of age are also vulnerable to childhood killer disease. Maternal and
child health clinics are established in Nigeria to take care of these
groups.

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COMPONENTS OF PRIMRY HEALTH CARE- cont's
3. Essential drugs: The most vital drugs should be available and
affordable at all levels.
4. Food and Nutrition: The family’s food should be adequate, affordable
and balanced in nutrients.
5. Education: The community should be informed of health problem and
methods of prevention and control.
6. Illness and injury: Adequate provision of curative services for common
ailments and injuries should be made by the community.
7. Water and sanitation: A safe water supply and the clean disposal of
wastes are vital for health.
8. Vector and reservoirs: Endemic infection diseases can be regulated
through the control or eradication of vectors and animal reservoir.

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The Basic Requirements for Sound PHC
(the 8 A’s and the 3 C’s)
 Assessability  Appropriateness
 Accountability  Availability
 Adequacy
 Completeness  Accessibility
 Comprehensiveness  Acceptability
 Continuity  Affordability

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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.

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Adequacy
The service proportionate to
requirement.
Sufficient volume of care to meet the
need and demand of a community

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Affordability
The cost should be within the means
and resources of the individual and the
country.

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Accessibility
Reachable, convenient services
Geographic, economic, cultural
accessibility

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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 .
•

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Availability
Availability of medical care means that
care can be obtained whenever people
need it.

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Assessability
Assessebility means that medical care
can be readily evaluated.
Accountability
• Accountability implies the feasibility of
regular review of financial records by
certified public accountants.
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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.

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Comprehensiveness
Comprehensiveness of care means that
care is provided for all types of health
problems.

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Continuity
Continuity of care requires that the
management of a patient’s care over
time be coordinated among providers.

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Comprehensive Vs Selective PHC
package
Comprehensive package of PHC included at least the
following:

1) Education on prevailing health problems and methods for
preventing and controlling them

2) Promotion of food supply and proper nutrition

3) An adequate supply of safe water and basic sanitation
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4) Maternal and child health care, including family planning

5) Immunization against major infectious diseases

6) Prevention and control of locally endemic diseases

7) Appropriate treatment of common diseases and injuries

8) Provision of essential drugs.

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Selective Primary Health Care (1978 to Present)
A “selective” approach attacks the most severe public
health problems facing a locality in order to have the

greatest chance to improve health and medical care in less

developed countries.

Selective PHC, or the more frequently used term “vertical

approach”, refers to the implementation of a single disease

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programme that may have a significant impact on reducing

high morbidity and mortality within a short time frame.

Some examples are polio eradication, making pregnancy

safer, immunization programme, control of HIV/AIDS,

tuberculosis and malaria.

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Selective Primary Health Care (1978 to Present)
GOBI & GOBI-FFF

The Alma-Ata Declaration was criticized for being too
broad and idealistic, with an unrealistic timetable. A common
criticism was that saying Health for All by 2000 was not feasible.

The term " Selective PHC meant a package of low-cost, technical
interventions to tackle the main disease problems of poor countries.

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This interventions were known as GOBI,
Meaning:
growth monitoring,
oral rehydration techniques,
breast feeding, and
immunizations.

These four interventions appeared easy to monitor and evaluate.
Moreover, they were measurable and had clear targets. Funding
appeared easier to obtain because indicators of success and
reporting could be produced more rapidly.

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GOBI-FFF

Later, some agencies added FFF to the
acronym GOBI, creating GOBI-FFF.
 Food supplementation,
 Female literacy,
 Family Planning

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The Millennium
Development Goals
( MDGs )
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The Millennium Development Goals
(MDGs)

The Millennium Development Goals (MDGs) are eight international
development goals that were officially established following the
Millennium Summit of the United Nations in 2000, following the
adoption of the United Nations Millennium Declaration. All 193
United Nations member states and at least 23 international
organizations have agreed to achieve these goals by the year 2015.
The goals are:

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The 8 MDG are:

1. Eradicating extreme poverty and hunger,
2. Achieving universal primary education,
3. Promoting gender equality and empowering women
4. Reducing child mortality rates,
5. Improving maternal health,
6. Combating HIV/AIDS, malaria, and other diseases,
7. Ensuring environmental sustainability, and
8. Developing a global partnership for development.
Each of the goals has specific stated targets and dates for achieving those
targets.

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Goal 1: Eradicate extreme poverty and hunger

Quick facts
 The proportion of people living on less than $1.25 a day fell from 47
per cent in 1990 to 24 per cent in 2008.
 Women are far more likely than men to be engaged in vulnerable
employment
 The numbers of malnourished have stabilized since 1990
 Progress in relieving food deprivation has slowed or stalled in many
regions
 Countries in sub-Saharan Africa were the hardest hit by the food and
financial crises

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Goal 1: Eradicate extreme poverty and hunger-cont's
 Nearly one in five children under age five in the developing world is
underweight
 Differences in undernutrition found between rural and urban children
are largest in Latin America and the Caribbean
 Poverty is a major determinant of undernutrution in children in all
regions
 The number of refugees and of the displaced remains high, even with
an upturn in repatriation in 2011

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Targets of this goal:
 Target 1A: Halve the proportion of people living on less than $1 a day
 Proportion of population below $1 per day (PPP values)

 Poverty gap ratio [incidence x depth of poverty]

 Share of poorest quintile in national consumption

 Target 1B: Achieve Decent Employment for Women, Men, and Young
People
 GDP Growth per Employed Person

 Employment Rate

 Proportion of employed population below $1 per day (PPP values)

 Proportion of family-based workers in employed population

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 Target 1C: Halve the proportion of people who suffer from hunger
 Prevalence of underweight children under five years of age

 Proportion of population below minimum level of dietary energy

consumption[12]

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Goal 2: Achieve universal primary education

Quick Facts
 Progress on primary school enrolment has slowed since 2004, even
as countries with the toughest challenges have made large strides.
 More than half of all out-of-school children are in sub-Saharan Africa
 Success at the primary level places increased demands on secondary
schools
 Illiteracy still holds back more than 120 million young people



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Goal 2: Achieve universal primary education
 Target 2A: By 2015, all children can complete a full course of primary
schooling, girls and boys
 Enrollment in primary education

 Completion of primary education

 everyone will get into school

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Goal 3: Promote gender equality and empower women

Quick Facts
 Parity is achieved in developing world primary schools, even though
some regions lag behind
 Gender disparities emerge at different points through the education
system
 Girls from the poorest households face the highest barriers to
education
 Equal access to job opportunities remains a distant target for women
in some regions
 Women, more often than men, turn to the informal economy

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 Targets of this goal:

 Target 3A: Eliminate gender disparity in primary and secondary
education preferably by 2005, and at all levels by 2015
 Ratios of girls to boys in primary, secondary and tertiary education
 Share of women in wage employment in the non-agricultural
sector
 Proportion of seats held by women in national parliament.


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 Targets of this goal:
 For girls in some regions, education remains elusive.
 Poverty is a major barrier to education, especially among older
girls.
 Women are largely relegated to more vulnerable forms of
employment.
 Women are over-represented in informal employment, with its lack
of benefits and security.
 Top-level jobs still go to men — to an overwhelming degree.
 Women are slowly rising to political power, but mainly when
boosted by quotas and other special measures.

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Goal 4: Reduce child mortality rates

Quick Facts
 Globally, deaths within the first month of life fell from 32 per 1,000 live
births in 1990 to 23 in 2010.
 Since 1990, in the developing regions, the mortality rate of under-five
years old has declined by 35 percent, from 97 deaths per 1,000 births
to 63.
 Sub- Saharan Africa has doubled its average rate of child mortality
reduction from 1.2 percent a year during 1990-2000, to 2.4 percent
during 2000-2010.

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 Sub-Saharan Africa suffers though a higher neonatal mortality rate (35
deaths per 1,000 live births in 2010) than any other region, and has
recorded the least improvement over the last two decades.
 Children in the developing regions as a whole, are twice as likely to
die before their fifth birthday as children in the richest 20 percent of
households.
 Sub-Saharan Africa had a 85 percent drop in measles deaths
between 2000 and 2010.

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Goal 4: Reduce child mortality rates

 Target 4A: Reduce by two-thirds, between 1990 and 2060, the under-
five mortality rate
 Under-five mortality rate

 Infant (under 1) mortality rate

 Proportion of 1-year-old children immunized against measles[16]

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Goal 5: Improve maternal health

Quick Facts
 An estimated 287,000 maternal deaths occurred in 2010 worldwide, a
decline of 47 percent from 1990.
 The regions with the highest maternal mortality, sub Saharan Africa
and Southern Asia, are also those with the lowest coverage of births
attended by skilled health personnel—less than half.
 The rural-urban gap in skilled care during childbirth has narrowed.
 The number of maternal deaths per 100,000 live births is down from
440 in 1990 to 240 in 2010, for the developing regions as a whole.

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 hile Southern Africa reported almost universal coverage in 2010, in
West Africa about one-third of women did not receive antenatal care
visits.
 The use of contraception is lowest among the poorest women and
those with no education.
 More than half of all women aged 15 to 49 who were married or in a
union were using some form of contraception in 2010 in all regions
except sub-Saharan Africa and Oceania.
 Fewer teens are having children in most regions, but progress has
slowed.
 Maternal health coverage has progressively increased in developing
regions from 63 percent in 1990 to 71 percent in 2000, and then to 80
percent in 2010.

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Goal 5: Improve maternal health

 Target 5A: Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio
 Maternal mortality ratio

 Proportion of births attended by skilled health personnel

 Target 5B: Achieve, by 2015, universal access to reproductive health
 Contraceptive prevalence rate

 Adolescent birth rate

 Antenatal care coverage

 Unmet need for family planning.

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Goal 6: Combat HIV/AIDS, malaria, and other diseases

Quick facts
 In sub-Saharan Africa, annual new infections in 2011 reached 1.7
million people, including 300,000 children. This is 21 percent lower
than the 1997 peak and 15 percent lower than in 2001.
 The number of people dying of AIDS- related causes fell to 1.7 million
in 2011, a decline of 24% since the peak in 2005.
 At the end of 2011, an estimated 8 million people people were
receiving antiretroviral therapy for HIV or AIDS in low- and middle-

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income countries, up from 6.6 million people in 2010 and up from just
400 000 in 2003.
 HIV incidence and prevalence is substantially lower in Asia than in
some other regions. But the absolute size of the Asia population
means it has the second largest number of people living with HIV.
 57% of HIV-positive pregnant women received treatment to prevent
HIV transmission to their child in 2011.
 The estimated incidence of malaria globally has decreased by 17
percent since 2000, and malaria-specific mortality rates by 25 percent.

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Goal 6: Combat HIV/AIDS, malaria, and other diseases

 Target 6A: Have halted by 2015 and begun to reverse the spread of
HIV/AIDS
 HIV prevalence among population aged 15–24 years

 Condom use at last high-risk sex

 Proportion of population aged 15–24 years with comprehensive

correct knowledge of HIV/AIDS
 Target 6B: Achieve, by 2010, universal access to treatment for
HIV/AIDS for all those who need it

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 Proportion of population with advanced HIV infection with access
to antiretroviral drugs
 Target 6C: Have halted by 2015 and begun to reverse the incidence
of malaria and other major diseases
 Prevalence and death rates associated with malaria

 Proportion of children under 5 sleeping under insecticide-treated

bednets
 Proportion of children under 5 with fever who are treated with

appropriate anti-malarial drugs
 Incidence, prevalence and death rates associated with

tuberculosis
 Proportion of tuberculosis cases detected and cured under DOTS

(Directly Observed Treatment Short Course).

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Goal 7: Ensure environmental sustainability

Quick Facts
 The net loss worldwide of forests decreased over the last 20 years,
from -8.3 million hectares per year in the 1990s to -5.2 million
hectares per year in the last decade.
 Overexploitation of global fisheries has stabilized, but steep
challenges remain to ensure their sustainability.
 The number of people who do not use any facility and resort to open
defecation has decreased by 271 million since 1990. But there remain
1.1 billion people, or 15 percent of the global people with no sanitation
facilities at all.

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 The number of people using improved drinking water sources reached
6.1 billion in 2010, up by over 2 billion since 1990.
 In 2010, 89 percent of the world’s population was using improved
water sources, up from 76 percent in 1990.
 The share of urban slum residents in the developing world declined
from 39 percent in 2000 to 33 percent in 2012.
 More than 200 million people gained access to improved water
sources , improved sanitation facilities, or durable or less crowded
housing.
 Slum prevalence remains high in sub-Saharan Africa and increase in
countries affected by conflict.

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Target 7A: Integrate the principles of sustainable
development into country policies and programs;
reverse loss of environmental resources


 Targets of this goal:


 Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant
reduction in the rate of loss
 Proportion of land area covered by forest

 CO2 emissions, total, per capita and per $1 GDP (PPP)

 Consumption of ozone-depleting substances

 Proportion of fish stocks within safe biological limits

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 Proportion of total water resources used
 Proportion of terrestrial and marine areas protected

 Proportion of species threatened with extinction

 Target 7C: Halve, by 2015, the proportion of the population without
sustainable access to safe drinking water and basic sanitation (for
more information see the entry on water supply)
 Proportion of population with sustainable access to an improved

water source, urban and rural
 Proportion of urban population with access to improved sanitation

 Target 7D: By 2020, to have achieved a significant improvement in
the lives of at least 100 million slum-dwellers
 Proportion of urban population living in slums.



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Goal 8: Develop a global partnership for development

Quick facts
 Official development assistance stands at 0.31 per cent of the
combined national income of developed countries, still far short of the
0.7 per cent UN target.
 Aid to the African continent increased by 0.9 percent to 31.4 billion in
2011, but remains below expectations.

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 Developing countries gain greater access to the markets of developed
countries.
 In 2011, 75 percent of the worldwide mobile cellular subscriptions
were in the developing regions, up from 59 percent in 2006.
 By the end of 2011, over 160 countries in the world had launched 3G
mobile broadband services and 45 percent of the population
worldwide was covered by a high-speed mobile broadband signal.
 The developing world share of the world’s Internet users rose to 63
percent in 2011, when 35 percent of the world was online.
 Only 1 in 6 people in the developing world has access to the Internet.

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Goal 8: Develop a global partnership for development
 Target 8A: Develop further an open, rule-based, predictable, non-
discriminatory trading and financial system
 Includes a commitment to good governance, development, and

poverty reduction – both nationally and internationally
 Target 8B: Address the Special Needs of the Least Developed

Countries (LDC) Includes: tariff and quota free access for LDC
exports; enhanced programme of debt relief for HIPC and
cancellation of official bilateral debt; and more generous ODA
(Official Development Assistance) for countries committed to
poverty reduction

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 Target 8C: developing countries through national and international
measures in order to make debt sustainable in the long term
 Target 8E: In co-operation with pharmaceutical companies, provide
access to affordable, essential drugs in developing countries
 Proportion of population with access to affordable essential drugs

on a sustainable basis
 Target 8F: In co-operation with the private sector, make available the
benefits of new technologies, especially information and
communications
 Telephone lines and cellular subscribers per 100 population
 Personal computers in use per 100 population
 Internet users per 100 Population.
http://www.un.org/millenniumgoals/
http://www.undp.org/content/undp/en/home/mdgoverview/

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Q &A
http://www.searo.who.int/LinkFiles/Primary_and_Community_Health_Care_SEA-HSD-338.pdf

76


What is primary health care?
How is it different from
primary care?

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Primary health care (PHC) is a broad and comprehensive
concept approach to health development.

It forms an integral part of both the country’s health
system

It is the first level of contact of individuals.

Primary care refers only to the first level of contact or
close-to-client health care.

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In rural areas, this contact is usually with the health
centre, health subcentre, health post or private practitioner
(doctor, nurse or midwife).

In urban areas, a majority of the middle- and upper-income
group visit a private practitioner, who may be a general
practitioner or a specialist, or go directly to a hospital.

In many countries, the so-called family doctor serves as the
first point of contact. Primary care is an integral component
of primary health care.

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Do developed countries also
adopt PHC for health
development?

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Yes, they do.

In fact, PHC is a universal concept for health development,
as articulated in its definition.

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The last part of the PHC
definition says that it is “a
continuing health-care
process”. What does this
mean?
82


A “continuing health-care process” implies that health care
does not stop at the primary level of care or at the first
point of contact. If more comprehensive or sophisticated
care is needed, the patient will be referred to a higher level
of care – either secondary or tertiary.

83


How do we define
equity in health?

84


WHO has operationally defined “equity in health” as
“minimizing avoidable disparities in health and its
determinants – including but not limited to health care –
between groups of people who have different levels of
underlying social attributes”.

WHO’s definition of “equity in health” encompasses two
different aspects.

85


means the attainment by
all citizens of the highest possible level of physical,
psychological and social well-being.

-care resources
are allocated according to need; health care is provided in
response to the legitimate expectations of the people;
health services are received according to need regardless of
the prevailing social attributes, and payment for health
services is made according to the ability to pay.

86


How does PHC aim to address
inequities in health?

87


PHC addresses inequity in health by advocating the following
approaches:

i) universal coverage,

ii) intersectoral collaboration,

iii) community participation, and

iv) appropriate technology.

88


How can we define
“health system”?

89


A health system consists of all organizations, people and
actions whose primary intent is to promote, restore or
maintain health. This includes efforts to influence the
determinants of health as well as more direct health-
improving activities.

91


What is the difference between
health system and health care
service?

91


Health systems are much broader than health services.
Health services refer to medical and public health services
provided by both the government (the health sector) and the
private sector. They cover modern and traditional medicine
as well as services provided by the community.

92


How can we define
“Health for All”?

93


Health for All (HFA) is a social goal. HFA aims at providing
the highest possible level of health to all people so that
they are able to live a socially and economically productive
life.

HFA can be defined as: a stage of health development
whereby everyone has access to quality health care or will
practise self-care protected by financial security so that no
individual or family experiences catastrophic expenditure
that may bring about impoverishment.1 HFA is a process

94


leading to progressive improvement in the health of the
people. It translates into the following:

a. People will be enabled to use better approaches to
prevent disease and alleviate unavoidable disease and
disability through the life course.

b. Available resources for health will be evenly distributed
among the population.

95


c. Essential health care will be accessible to all individuals
and families in an acceptable and affordable way, and with
their full involvement.

d. People will realize that they themselves have the power
to shape their lives and the lives of their families. They will
be free from the avoidable burden of disease, and aware
that ill-health is not inevitable.

96


There are so many technical terms in the
definition of health system using the
PHC approach. Compare
comprehensive and selective
care?

97


In 1978, the comprehensive package included at least the
following:

1) Education on prevailing health problems and methods for
preventing and controlling them

2) Promotion of food supply and proper nutrition

3) An adequate supply of safe water and basic sanitation

4) Maternal and child health care, including family planning

5) Immunization against major infectious diseases

98


6) Prevention and control of locally endemic diseases

7) Appropriate treatment of common diseases and injuries

8) Provision of essential drugs.

A “selective” approach attacks the most severe public
health problems facing a locality in order to have the
greatest chance to improve health and medical care in less
developed countries.

99


Selective PHC, or the more frequently used term “vertical
approach”, refers to the implementation of a single disease
programme that may have a significant impact on reducing
high morbidity and mortality within a short time frame.

Some examples are polio eradication, making pregnancy
safer, immunization programme, control of HIV/AIDS,
tuberculosis and malaria.

What is Equity ? is an ethical concept that eludes a
precise definition.

111


Synonyms are social justice and fairness, which again, could
be taken to mean different things by people at different
times. Equity usually deals with a predetermined standard or
norm, which is considered “just” or “fair”.

There are three dimensions of equity:

Focus: Equity in health mainly focuses on the health of the
vulnerable population in absolute rather than relative terms.
A policy or programme aimed at improving the health of the
most vulnerable would be seen as being equitable.

111


Inclusion: No one in the community should be left out. In
this view, a health policy that does not provide health care
to certain population groups, e.g. people living in thinly
settled, remote, mountainous, island or desert areas would
be inequitable.

Narrowing gaps: Equity measurement identifies the relative
and absolute gaps in health status. Thus, a policy that
improves the health of the best off more than anyone else
would not be considered equitable.

112


Equality: Equality does not take into account whether the
existing disparity/gap/difference is “fair or just”. In
practice, the terms equity and equality are used
interchangeably.

113


What is the difference between
allocative inefficiency and
technical inefficiency?

114


Allocative inefficiency occurs when more health funds are
allocated towards less cost-effective interventions. For
example, allocating an unnecessary amount of funds to
medical care as opposed to public health interventions would
qualify as allocative inefficiency. Overall, public health
interventions (disease prevention and health promotion) are
more cost-effective than medical care (treatment of cases
and rehabilitation of disabilities).

115


Technical inefficiency is said to occur when we choose
sophisticated technologies that may be unnecessary instead
of available and appropriate technology.

116


What is it the relationship
between PHC and the
Millennium Development
Goals?

117


The Millennium Development Goals are a commitment made by the world's
nations to improve the health and well-being of people throughout the world,
including reducing poverty, infant and maternal mortality and the spread of
HIV by 2015. Within the framework of PHC as a strategy aimed at improving
the living conditions of communities, reducing the burden of disease, and
favoring equity in health, the principles the PHC need to be aligned,
harmonized, and adjusted along these goals. Due to its capacity for
strengthening health services, PHC can become a basic strategy for the
achievement of these internationally agreed-upon objectives.

118


Cited References
1. World Health Organization Regional Office for South-East Asia. Strengthening health systems based on
primary health care approach. New Delhi,
WHO SEARO, 2007. Pyongyang, Democratic People Republic of Korea, 18–20 April 2007. (SEA-HSD-298).
Available at: http://203.90.70.117/PDS_DOCS/B0583.pdf
2. World Health Organization Regional Office for South-East Asia. The Regional six-point strategy for health
systems strengthening based on primary health care approach. New Delhi, World Health Organization
Regional Office for South-East Asia, 2007 (SEA-HSD-305). Available at:
http://203.90.70.117/PDS_DOCS/B0684.pdf
3. World Health Organization Regional Office for South-East Asia. Revisiting community-based health
workers and community health volunteers. New Delhi, WHO SEARO, 2008 (SEA-HSD-309). Chiang Mai,
Thailand, 3–5 October 2007. Available at: http://www.searo.who.int/LinkFiles/Publications_HSD -

119

309.pdf
4. World Health Organization Regional Office for South-East Asia. Strategic directions for strengthening
community-based health workers and community health volunteers in the South-East Asia Region. New
Delhi, World Health Organization Regional Office for South-East Asia, 2008 (SEA-HSD-311). Available at:
http://www.searo.who.int/LinkFiles/Publications_HSD-311-Regional_Strategy_CBHWs_CHVs.pdf
5. World Health Organization Regional Office for South-East Asia. Accelerating progress towards achieving
maternal and child health Millennium Development Goals (MDGs) 4 and 5 in South-East Asia. New Delhi,
WHO SEARO, 2009 (SEA-CHD-7). Ahmedabad, India, 14–17 October 2008. Available at:
http://www.searo.who.int/LinkFiles/FCH_SEA-CHD-7.pdf
6. World Health Organization Regional Office for South-East Asia. Revitalizing primary health care. N ew Delhi,
SEARO, 2008 (SEA-HSD316). Jakarta, Indonesia, 6–8 August 2008. Available at:
http://www.searo.who.int/LinkFiles/Health_System_Strengthening_SEA-HSD-316.pdf
7. World Health Organization Regional Office for South-East Asia. Self-care in the context of primary health
care. New Delhi, SEARO, 2009 (SEA-HSD-320). Bangkok, Thailand, 7–9 January 2009. Available at:
http://www.searo.who.int/LinkFiles/Health_System_Strengthening_SEA-HSD-320.pdf

111

8. World Health Organization Regional Offices for South-East Asia and the Western Pacific. The application of
sociocultural approaches to accelerate the achievement of MDGs 4 and 5. New Delhi/Manila, WHO
SEARO/WPRO, 2009 (SEA-MCH-256). Bali, Indonesia, 11–13 August 2009.
9. World Health Organization Regional Office for South-East Asia. Health care reform for the twenty-first
century in the South-East Asia Region. New Delhi, WHO SEARO, 2009 (SEA-HSD-329). Bangkok, Thailand, 20–
22 October 2009. Available at: http://www.searo.who.int/LinkFiles/Reports_SEA-HSD-329.pdf
10. World Health Organization Regional Office for South-East Asia. The use of herbal medicines in primary
health care. New Delhi, WHO SEARO, 2009 (SEA-HSD-322). Yangon, Myanmar, 10–12 March 2009. Available
at: http://203.90.70.117/PDS_DOCS/B4260.pdf
11. World Health Organization Regional Office for South-East Asia. Teaching of public health in medical
schools. New Delhi, WHO SEARO, 2010 (SEA-NUR-465). Bangkok, Thailand, 8–10 December 2009. Available
at: http://203.90.70.117/PDS_DOCS/B4507.pdf
12. World Health Organization Regional Office for South-East Asia. Decentralization of health care services.
New Delhi, WHO SEARO, (in preparation). Bandung, Indonesia, 6–8 July 2010. –
http://www.undp.or.id/mdg/documents/MDG%20Indicators-UNDG.pdf

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